Chronic stable angina overview
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Overview
Angina pectoris, commonly known as angina, is chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. The term derives from the Greek ankhon ("strangling") and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". In angina pectoris the sensation of chest discomfort can be a feeling of tightness, heaviness, or pain.
Angina pectoris is a sign of coronary heart disease. If it occurs chronically this is called stable angina. If it occurs at rest or in an accelerating pattern this is called an acute coronary syndrome and can be a symptom of either:
- Unstable angina: An open artery with insufficient blood flow to the heart but without irreversible damage
- Non ST elevation MI: An open artery with insufficient blood flow to the heart with irreversible damage
- ST elevation MI: A closed artery with insufficient blood flow to the heart and irreversible damage
In patients with chronic stable angina, the factors influencing the choice of coronary revascularization therapy (percutaneous coronary intervention or coronary artery bypass surgery) are varied and complex.
The severity of symptoms, lifestyle, extent of objective ischemia, and underlying risks must be weighed against the benefits of revascularization and the patient’s preference, as well as local availability and expertise. Evidence from randomized trials and large revascularization registers can guide these decisions, but the past decade has seen rapid change in medical treatment, bypass surgery and percutaneous coronary intervention.