The sprint to the bus, climbing several stories by stairs or an unusually strenuous physical activity - and suddenly the upper body becomes tight, the breathing difficult and behind the sternum it hurts. This is called angina pectoris - a clear warning signal that must be taken seriously, because in many cases, there is a circulatory disorder of the heart muscle behind it.
Development of angina pectoris
The arterial blood supply to the heart muscle takes place via the coronary arteries, which originate in the main artery and fanned out like a canopy on the outside of the heart.
If there is a mismatch between the oxygen demand of the heart muscle and the supply of oxygen via the coronary heart system, circulatory disorders may occur in the heart muscle. This causes pain and tightness - the angina (AP).
Causes of angina
By far the most common cause of circulatory disorders is a progressive hardening of the arteries (atherosclerosis). The resulting constrictions lead to the fact that the coronary arteries initially, especially with increased oxygen demand of the heart muscle, as for example during exercise, and later in peace can not ensure sufficient blood flow.
This is also known as coronary heart disease (CHD) - the angina pectoris is thus its main symptom.
More rare causes of angina pectoris can be vasospasms, so the spasmodic constriction of the coronary vessels (Prinzmetal's angina), as well as myocardial or heart valve diseases, all of which can also lead to increased oxygen demand of the heart muscle.
Features, diagnostics, history
Depending on whether angina pectoris occurs during exercise or at rest, one speaks of stress angina or resting angina:
- Stress angina: In addition, it is characteristic that the coronary arteries can still ensure adequate blood circulation despite existing constrictions under rest conditions. However, with increased oxygen demand, for example, during physical activity, the circulation deficiency becomes clear. The symptoms return in peace (or after the administration of nitroglycerin) back.
- Rest angina: In high-grade constrictions of the coronary arteries circulatory disorders of the heart muscle may already occur under rest conditions. If exercise-related angina pectoris returns to restless angina over time, it is often indicative of an increase in coronary blood vessel narrowing and an important alarm symptom.
Stable and unstable angina pectoris
Experts also distinguish between stable angina pectoris and unstable angina pectoris - where the stress angina is almost always a stable form unless it is very severe for the first time or increasingly worsening during a seizure. The resting angina, on the other hand, is always assigned to the unstable form, since it can be an immediate precursor or already the first symptom of a heart attack.
In order to be sure to distinguish between a resting angina and an acute myocardial infarction, it is even necessary for a doctor to write an electrocardiogram (ECG) and to determine laboratory values.
In case of angina pectoris complaints, a doctor should be consulted as soon as possible.
Heart attack as a complication
Angina pectoris is in most cases the warning symptom of coronary heart disease. The most serious complication may be a heart attack that can lead to immediate death or significantly reduce life expectancy due to sequelae such as cardiac arrhythmia or myocardial insufficiency.
But even without an acute myocardial infarction, there is a risk for the person affected, due to the chronic circulatory disorders, that cardiac arrhythmias may occur or that the cardiac muscle strength is declining.