Angina pectoris is a chest pain that originates from the heart muscle. Angina is a signal that the heart muscle is not getting sufficient blood flow, specifically sufficient oxygen and nutrients. Lack of oxygen with inadeguate removal of metabolites, is called ischemia. Impairment of blood flow is often due to coronary artery disease (CAD), which causes a narrowing of the arteries that carry blood to the heart muscle.


Narrowing in the coronary arteries occurs as a result of calcium and fatty deposits, called plaques. In more severe cases, heart attack (myocardial infarction), heart failure, or rhythm abnormalities can cause sudden cardiac death.
Angina may be provoked by an activity or exercise or any other physical or mental stress, which increases the heart's demand for blood. Angina can be "stable" or "unstable". Angina is unstable when there is a change in the usual pattern, such as a change in frequency, occurrence with less exertion, or occurrence at rest. Unstable angina, which may or may not be associated with damage to the heart muscle, is called acute coronary syndrome and requires immediate evaluation in a hospital.
The treatment of CAD has changed significantly over the past several years due to improvements in surgical and medical methods of improving blood flow to the heart muscle. The optimal treatment plan is tailored to a person's age, other medical conditions, lifestyle, personal preferences, medication side effects, and the risks of procedures.
DRUG THERAPY VERSUS INTERVENTIONAL THERAPY — All therapies for people with CAD have the same goals: to decrease the effects of the disease on the quality of life and alleviate symptoms. The choice between use of medication and a surgical procedure to open narrowed or blocked blood vessels depends upon a number of individual factors.
OTHER MEASURES TO SLOW OR REVERSE CAD — Regardless of whether medical or interventional therapy is chosen, it is very important that people with CAD follow guidelines to reduce the risk that their heart disease will worsen. These guidelines, which should be discussed with a healthcare provider, include the following: Treat high blood pressure.Treat high cholesterol. Quit smoking. Lose excess weight .Reduce stress Exercise regularl. Avoid or minimize activities that provoke angina, such as exercising during cold weather or exercising vigorously, particularly after a meal Learn to use nitroglycerin preventively.
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.



REFERENCES

1. Gibbons, RJ, Abrams, J, Chatterjee, K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003; 107:149.
2. Heidenreich, PA, McDonald, KM, Hastie, T, et al. Meta-analysis of trials comparing ß-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999; 281:1927.
3. Eagle, KA, Guyton, RA, Davidoff, R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004; 110:e340.
4. Smith, SC Jr, Feldman, TE, Hirshfeld, JW Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1. Available at: www.acc.org/qualityandscience/clinical/statements.htm (accessed September 18, 2007).
5. Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial. Lancet 1993; 341:573.