What causes angina pectoris?
Angina pectoris is the most intense pain behind the breastbone (retrosternal pain). This pain can radiate into various parts of the body. The cause of angina pectoris is a hardening of the arteries or so-called arteriosclerosis. The causes of arteriosclerosis include increased blood lipids, high blood pressure or diabetes mellitus. Risk factors for arteriosclerosis include smoking, overweight, lack of exercise and age.
Causes of angina pectoris
Angina pectoris can be caused by various factors. These include, among others:
- Coronary heart disease (CHD)
- Psychosomatic causes (depression, stress, pessimistic mood, etc.) – High blood pressure (arterial hypertension)
- Diabetes mellitus
- Cold
- Overweight
- Lack of exercise
- Poor nutrition
- Smoking as a cause
- Heart valve diseases
- Anaemia (lack of blood)
Coronary heart disease is by far the most common cause of angina pectoris (AP).
It causes atherosclerotic changes in the area of the coronary vessels. These include calcification and hardening of the vessel walls as well as the deposition of so-called atherosclerotic plaques within the vessel. As a result, the blood supply to the heart muscles is reduced due to the reduced diameter of the vessels.
Particularly during exercise, the heart muscle cells receive less oxygen from the blood, which causes chest pain or a feeling of tightness in the chest (angina pectoris). There are numerous risk factors for the development of coronary heart disease. These include diabetes mellitus, smoking, high blood pressure, overweight, increased fat levels (hyperlipoproteinemia) and old age.
Chronic stress is a cause of the development of angina pectoris that has been little studied to date. This is mainly a so-called negative stress, which occurs in combination with frustration. In the case of a strong sensation of stress, the body releases more of the stress hormone cortisol from the adrenal cortex.
This hormone has numerous functions in the body. In addition to increasing blood pressure, it also leads to the release of vascular-damaging molecules. An already existing coronary heart disease can be aggravated by an increase in blood pressure and vascular damage in the area of the coronary vessels.
As a result, the symptoms of angina pectoris can occur. Other psychological factors that have been investigated in numerous studies in recent years show a similar effect to stress. Above all depression, a pessimistic basic mood and sleep disorders have shown effects on various organ functions.
Among other things, the blood circulation of the heart was also affected. Depression, for example, was shown to increase the risk of a heart attack by a factor of 2.5. The reduced release of the happiness hormone (serotonin) leads to an increased formation of blood platelets (thrombocytes) in the body.
As a result, there is an increased risk of blood clots (thrombi) forming, which can be deposited within the small coronary vessels. If coronary heart disease is already present, this additional displacement of the vessel can then lead to the acute occurrence of angina pectoris. For this reason, the psychological component should always be taken into account in the therapy of angina pectoris and, if necessary, treated with psychotherapy or drug therapy with psychotropic drugs.
As studies have shown, angina pectoris symptoms occur more frequently, especially during the winter months. Particularly at temperatures below zero, the cold causes the vessels to contract. While this phenomenon was already known on the hands, this mechanism was also observed on the vessels of the heart located near the surface.
Because of the narrowed vessels, the heart in turn has to pump against greater resistance and therefore requires more oxygen. As a consequence, an overload of the heart occurs, especially in the case of pre-existing coronary heart disease. The heart muscle cells can therefore no longer be supplied with sufficient oxygen.
For this reason, the patient experiences chest pain (angina pectoris). Diabetes mellitus is a frequent risk factor for the development of coronary heart disease. Chronically elevated blood sugar levels cause damage to the inner vessel walls (endothelium) due to the attachment of sugar molecules to various proteins and lipids of the vessel walls.
In addition, the sugar molecules react with cholesterol molecules, allowing them to be deposited within the vascular walls and promote the development of arteriosclerosis. As a result, multiple vascular damage occurs in the body. The coronary arteries are also affected, which can restrict the blood flow to the heart muscle cells.
As a result, the risk of developing angina pectoris is increased. Smoking is another risk factor for the development of coronary heart disease. The substances present in cigarette smoke (especially carbon monoxide and nicotine) have numerous effects on the arterial vessels.
The nicotine in cigarettes leads to an increase in blood pressure by hardening the walls of the blood vessels and constricting them. The small vessels (including the coronary vessels) are particularly affected. In addition, nicotine can lead to changes in blood coagulation in the long term, making the blood more viscous and encouraging the formation of blood clots.
In the human body, carbon monoxide accumulates mainly in the red blood cells (erythrocytes). There it causes less oxygen to be transported and released to the cells of the body. As a result, the heart muscle cells, among others, suffer from oxygen deficiency, which manifests itself as angina pectoris symptoms.
In addition, smoking promotes lipid metabolism disorders, which are responsible for the development of atherosclerosis. Pathological overweight (obesity) is also a risk factor for the development of coronary heart disease. Obesity in the abdominal cavity is particularly affected by this.
The fatty tissue releases numerous messenger substances that promote the development of diabetes mellitus, arterial hypertension and atherosclerosis. As a consequence, vascular changes occur in the area of the coronary vessels, among other things, which promote the development of angina pectoris. Regular physical activity is known to be a protective factor in the development of cardiovascular disease.
Thus, the four major risk factors of coronary heart disease (diabetes mellitus, high blood pressure, lipid metabolism disorders, obesity) are mainly caused by lack of exercise. Light endurance activities (such as cycling, jogging, swimming) can already reduce the risk of coronary heart disease. Physical activity for at least 20-30 minutes, 4-5 times a week, is recommended.
This improves the blood supply to the heart muscle and reduces the above-mentioned risk factors for coronary heart disease. A poor diet over a long period of time also increases the risk of developing coronary heart disease with angina pectoris symptoms. A low-fat diet and regular and plentiful consumption of fish products, wholemeal products, fruit and vegetables should be taken into account.
Above all, saturated animal fats (e.g. meat, sausage and dairy products) lead to an accumulation of fats (including cholesterol) in the blood, thus increasing the risk of developing atherosclerosis. Another risk factor for the development of coronary heart disease is age. However, this should always be assessed in the light of the other risk factors. According to this study, male patients over 45 years of age and female patients over 55 years of age show a significant increase in the risk of atherosclerotic changes that can lead to coronary heart disease. Women show a lower risk of developing coronary heart disease due to a protective effect of the female sex hormones (especially estrogen).
