Angina: Types and Symptoms

Angina is a basic discomfort in the chest and the adjacent area due to myocardial ischemia. It is due to a discrepancy between myocardial oxygen demand and supply, i.e, symptom complex brought about by myocardial ischemia.

All coronary artery diseases have genetic implications. People in middle age and older men and post menopausal women are more likely to suffer from the disease.

Types

Classic Angina – A heaviness or pressure felt over the precordium, triggered by physical exertion, anxiety, anger or excitement and relieved by rest. During the attack, there is transient ST segment depression.

Angina Equivalent – Dyspnoea, fatigue, nausea or pain localized to an atypical location (such as jaw), brought about by myocardial ischemia and unaccompanied by typical precordial chest pressure.

Variant Angina (Prinzmetal’s Angina) – Angina occurring at rest or in typical patterns such as after exercise or at night. It is caused by coronary artery spasm with ECG changes (ST elevation) during symptoms. It is more common in women. Pain is usually more severe and prolonged than that of classical angina.

Unstable Angina – Pain which is new or which has changed its character to become more frequent, more severe or both. Unstable angina leads to myocardial infarction in certain patients. Angina which is rapidly worsening in intensity, frequency or duration e.g. on minimal or no exertion.

Decubitus Angina – Angina when patient lies flat.

Nocturnal Angina – Angina due to violent dreams.

Grades

Grade I – Angina on severe exertion
Grade II – Angina on walking uphill or climbing more than one flight of ordinary stairs.
Grade III – Angina on walking on level ground or climbing one flight of ordinary stairs.
Grade IV – Angina at rest.

Clinical Presentation

Chest pain precordial with pressure and heaviness as if a weight in the centre lasting for 5–15 minutes following physical exertion. Pain is usually of crushing type, band type, pressing, squeezing, strangling or constricting radiating to back, neck, jaw or one or both arms.

Other symptoms include dyspnoea, palpitation, nausea and epigastric pain.