Angina Pectoris (Chest Tightness)

Sprinting to the bus, climbing several floors by staircase or an unusually strenuous physical activity – and suddenly the upper body becomes tight, breathing becomes labored and there is pain behind the breastbone. This is called angina pectoris – a clear warning signal that must be taken seriously, because in many cases a circulatory disorder of the heart muscle is behind it.

Origin of angina pectoris

The arterial blood supply to the heart muscle is provided by the coronary arteries, which originate in the aorta and fan out like a tree crown on the outside of the heart.

If there is a mismatch between the oxygen demand of the heart muscle and the oxygen supply via the coronary artery system, circulatory disorders can occur in the heart muscle. This causes pain and a feeling of tightness – angina pectoris (AP).

Causes of angina pectoris

By far the most common cause of circulatory problems is hardening of the arteries (atherosclerosis) that progresses over years. The resulting narrowing causes the coronary arteries to be unable to provide adequate blood flow, initially especially when the heart muscle requires more oxygen, such as during physical exertion, and later even at rest.

This is also known as coronary heart disease (CHD) – angina pectoris is thus its main symptom.

Rarer causes of angina pectoris may include vasospasm, which is the cramp-like constriction of the coronary vessels (Prinzmetal’s angina), and myocardial or valvular heart disease, all of which can also lead to increased oxygen demand by the heart muscle.

Characteristics, diagnosis, course

Depending on whether angina occurs during physical exertion or at rest, it is referred to as exertional angina or resting angina:

  • Exertional angina: Characteristically, this occurs when the coronary arteries can still provide adequate blood flow under resting conditions despite existing constrictions. However, with increased oxygen demand, for example during athletic activity, the lack of blood flow becomes apparent. The complaints go back at rest (or after the administration of nitroglycerin).
  • Resting angina: In cases of high-grade narrowing of the coronary arteries, circulatory disturbances of the heart muscle can already occur under resting conditions. If an exercise-induced angina transitions over time into resting angina, this is often a sign of an increase in coronary artery stenosis and an important alarm symptom.

Stable and unstable angina pectoris.

Experts also distinguish between stable angina and unstable angina – with exercise angina is almost always a stable form, unless it is very severe for the first time or progressively worsens during an attack. Resting angina, on the other hand, is always assigned to the unstable form because it can be a direct precursor or already the first symptom of a heart attack.

In order to be able to distinguish with certainty between angina at rest and an acute heart attack, it is necessary, even for a physician, to additionally write an electrocardiogram (ECG) and determine laboratory values.

In any case, a physician should be consulted as early as possible when angina pectoris symptoms occur.

Heart attack as a complication

Angina pectoris is in most cases the warning symptom of coronary artery disease. The most serious complication can be a heart attack, which can lead directly to death or significantly reduce life expectancy due to sequelae such as cardiac arrhythmias or myocardial weakness.

However, even without an acute myocardial infarction, the affected person is at risk of cardiac arrhythmias or loss of cardiac muscle strength due to chronic circulatory disorders alone.