Angina pectoris (AP) – colloquially called heart constriction – (Latin angina “constriction”, pectus “chest“; synonyms: Chest tightness; stenocardia; obsolete: ICD-10-GM I20.- Angina pectoris, I20.0 Unstable angina pectoris I20.1, Angina pectoris with proven coronary spasm, I20.8 Other forms of angina pectoris I20.9 Angina pectoris, unspecified) refers to an attack-like thoracic or The term angina pectoris is used to describe an attack of thoracic or retrosternal pain (chest pain or pain localized behind the breastbone (sternum)) caused by ischemia (insufficient blood supply) to the myocardium (heart muscle). The symptom angina typically occurs in the setting of coronary artery disease (CAD). Angina pectoris (AP) can be divided according to its course as follows:
- Stable angina pectoris: at rest there is absence of symptoms; symptoms occur stress-induced (stress AP), for example, after heavy meals, after emotional or physical stress, in cold weather)Definition: thoracic pain (chest pain) reproducible by physical or mental stress, which disappears at rest or after administration of nitroglycerin.
- Unstable angina pectoris (iAP; unstable angina, UA): inconstant symptomatology.
- Angina decubitus (synonym: angina nocturnal): AP that occurs especially at night while lying down with chest pain (chest pain); the cause is the overload of the pre-damaged myocardium (heart muscles) with increased venous blood return while lying down.
- De novo angina: AP that occurs for the first time (de novo) and severe.
- Resting angina: AP occurs at rest.
- Crescendo angina: crescendo symptomatology, i.e., more severe symptoms: e.g., in terms of seizure frequency, pain intensity or seizure duration.
- Postinfarction angina (synonym: postinfarction AP): AP occurring within 2 weeks after myocardial infarction.
It is called refractory angina when it does not respond to any therapeutic measures. “Staging of stable angina” and “Classification of unstable angina” see below the sub-topic “Angina pectoris/Classification”. The following epidemiological data are based on coronary heart disease (CHD), as the symptom angina pectoris typically occurs in the context of this disease. Sex ratio: men have an increased coronary risk compared with women before menopause (menopause). However, after menopause, coronary risk also increases in women. After age 75, the sex ratio is balanced. Peak incidence: the disease occurs predominantly in middle to older age (men ≥ 55 yr and women ≥ 65 yr). The lifetime prevalence of chronic CHD in Germany is 9.3% (95% CI 8.4-10.3%) in 40-79 year olds (n = 5 901). Chronic ischemic heart disease represents the most common cause of death in industrialized countries. 20% of deaths in Germany are caused by coronary heart disease. Course and prognosis: Angina pectoris attacks occur in particular when the body’s oxygen demand is increased due to physical or mental stress, but the myocardium (heart muscle) is no longer supplied with sufficient oxygen due to the disease. Chronic ischemic heart disease is a progressive disease that can lead to cardiac arrhythmias, heart failure, myocardial infarction, and sudden cardiac death (PHT).The prognosis depends on how many coronary stenoses (narrowing of the coronary arteries) the affected person has. There is no cure for the disease, but pharmacotherapy (drug treatment) and, if necessary, surgery (percutaneous coronary intervention (PCI); aortocoronary vein bypass (ACVB)) can improve the prognosis. The lethality (mortality relative to the total number of people with the disease) is 3-4% for single-vessel disease, 6-8% for two-vessel disease, and 10-13% for three-vessel disease. Comorbidities: Coronary artery disease (CAD) is often associated with depression. Furthermore, peripheral atherosclerosis (arteriosclerosis, hardening of the arteries) is present in 10-15% of cases.Note: The likelihood of the presence of any other prognostically relevant mental disorder (anxiety disorders, posttraumatic stress disorder, schizophrenia, bipolar disorder) or psychosocial risk constellation (low socioeconomic status, social isolation, lack of social support, occupational or family stress) should be assessed by appropriate history questions or questionnaires.
