Pathogenesis (disease development)
The most common cause of angina is atherosclerosis (arteriosclerosis, hardening of the arteries) of the large coronary vessels (coronary arteries). In second place is microangiopathy – narrowing of the small coronary artery branches (small vessel disease).
Other causes of narrowing are vasospasm (vasoconstriction) of the coronary arteries (Prinzmetal’s angina) or allergic reactions (Kounis syndrome).
Prinzmetal’s angina is a special form of angina pectoris. It is triggered by vasospasm of the coronary arteries (coronary artery spasm) and is therefore also called spastic angina. The ST elevations in the ECG are reversible and there is also no troponin and CK rise.
Kounis syndrome (synonyms: allergic angina, allergic myocardial infarction/heart attack, allergic acute coronary syndrome) is vasospasm of the coronary arteries or a typical myocardial infarction (e.g., because of plaque rupture) on the basis of an allergic reaction.
Etiology (Causes)
Because angina typically occurs in the setting of coronary artery disease, reference is made here to the topic “Coronary Artery Disease/Causes.”