Learn about different types of Angina Pectoris Pain i.e Stable, Unstable, Prinzmetal, Microvascular, Atypical; their symptoms and causes. The term angina is applied to varying forms of transient chest discomfort that are associated with insufficient supply of oxygen to myocardial tissues.
Angina is a clinical syndrome characterized by discomfort in the chest shoulder, back, jaw and arms. Symptoms of angina may aggravated by exertion or stress and relieved by administration of nitroglycerin.
Angina is a type of chest pain caused by reduced blood flow to the heart muscle. People having uncontrolled hypertension, valvular heart disease, ischemic heart disease or any defect in cardiovascular system are at higher risk to acquire angina.
Another major cause of angina is Atherosclerosis that causes stenosis of the coronary arteries which leads to imbalance of oxygen demand and supply. Some other diseases that may cause imbalance of oxygen demand and supply are tachycardia, anemia, hyperthyroidism, hypotension, and arterial hypoxemia.
An angina attack is not the same as a heart attack, although many of the symptoms are the same. An angina attack may be provoked by extremes in emotion (being very angry or upset), eating a large meal or eating it very quickly, doing more exercise than usual (overexerting yourself), being exposed to extremes in temperature (too hot or too cold), or smoking.
If the angina is a result of physical activity, stopping the activity generally stops the pain. But no matter what the cause of the chest pain or discomfort, it is important that you get medical attention as soon as possible.
Different Types of Angina
Five different kinds of angina have been identified, with the two most common being stable angina and unstable angina. Let’s look at them in details:
It is most common form of angina that has a more predictable pattern which is brought on by exertion, emotional stress, or a heavy meal. Stable (classic) angina is usually relieved by rest, nitroglycerin or both. The diagnostic criteria of Stable (classic) angina includes 5 components which are quality, location, duration of pain, factors provoking pain and factors that relieve pain. Pain associated with Stable (classic) angina feels like squeezing or grip-like. The anginal episode typically lasts for minutes and is usually substernal but has a tendency to radiate to the neck, jaw, epigastrium, or arms. Most common cause of Stable (classic) angina is obstruction in a coronary artery.
In many patients who experience unstable angina, symptoms will be caused by significant coronary artery disease. Unstable angina may occur during rest time and less responsive to nitroglycerine and rest. Duration of pain associated with unstable angina is more as compared to Stable (classic) angina. The most common causes associated with Unstable angina are disruption of an atherosclerotic plaque with partial thrombosis and possibly embolization or vasospasm. However, incidence of unstable angina is
less as compared to stable angina.
Angina Decubitus (Nocturnal Angina)
The is angina occurs in the recumbent position and is not specifically related to either rest or exertion. Gravitational forces shift fluids within the body with a resultant increase in ventricular volume, which increases oxygen needs and produces angina decubitus, and which may indicate cardiac decompensation.
Diuretics alone or in combination effectively reduce left ventricular volume and may aid the patient. Nitrates such as nitroglycerin may relieve the paroxysmal nocturnal dyspnea (PND) associated with angina decubitus by reducing preload, owing to venous pooling, and improving left ventricular dysfunction.
Variant Angina (Prinzmetal/Vasospastic)
Coronary artery spasm that reduces blood flow precipitates this angina. The spasm may be superimposed on a coronary artery that already has a fixed obstruction owing to thrombi or plaque formation. It usually occurs at rest (i.e., pain may disrupt sleep) rather than with exertion or emotional stress, and usually resolves without progression to an acute MI. However, if the attack is prolonged then it may lead to the development of myocardial infarction(MI), life-threatening ventricular arrhythmias or sudden cardiac death can occur.
Microvascular angina is sometimes referred to as Syndrome X—occurs when tiny vessels in the heart become narrow and stop functioning properly, even if the bigger arteries are not blocked by plaque. Usually it is treated with common angina medications.
Atypical angina often does not cause pain, but you may feel a vague discomfort in your chest, experience shortness of breath, feel tired or nauseous, have indigestion, or pain in your back or neck. Women are more likely than men to have feelings of vague chest discomfort.