Angina pectoris: The most important facts at a glance

1. What is angina pectoris?
2. What are the consequences of angina pectoris?
3. What increases the risk of developing angina pectoris?
4. How can angina pectoris be prevented?
5. How are angina pectoris, diabetes and obesity related?
6. What are the symptoms of angina pectoris?
7. How is angina pectoris diagnosed?
8. How is angina pectoris treated?

Angina pectoris is divided into 4 levels of severity:

• Severity level 1: No complaints during everyday activities such as walking or climbing stairs, but pain occurs during sudden or prolonged physical exertion.
• Severity level 2: Complaints during strenuous exertion such as fast running, walking uphill, climbing stairs after eating, in cold weather, wind or mental stress.
• Severity level 3: Discomfort even with light physical exertion such as normal walking or getting dressed in the morning.
• Severity level 4: Complaints at rest or with minimal physical exertion.

The CHD underlying angina pectoris is one of the most common widespread diseases. More than 9 in 100 people aged between 40 and 79 develop CHD in the course of their lives. Men fall ill more often than women. With increasing age, the risk of developing CHD increases. In the over 65 age group, around 18 in 100 women and 28 in 100 men are affected by coronary heart disease.

Angina pectoris is associated with a reduced quality of life. In addition, angina pectoris or the underlying coronary heart disease (CHD) can lead to other heart diseases:

• Heart attack: The coronary arteries supply the heart with oxygen. These are narrowed in the event of CHD. If one of the coronary arteries becomes completely blocked, part of the heart muscle is no longer supplied with sufficient oxygen. This leads to a heart attack.
• Heart failure (cardiac insufficiency): CHD can weaken the heart muscle, which reduces the heart’s pumping power and makes the person affected less fit.
• Cardiac arrhythmia: If the heart is no longer supplied with sufficient oxygen due to CHD, the heart muscle cells responsible for the heart rhythm may be damaged. The heartbeat gets out of sync and becomes faster, slower and/or irregular.

There are various factors that may increase the risk of developing coronary heart disease (CHD) and therefore angina pectoris. Many of these factors are influenced by lifestyle and can be changed. Other causes of CHD and therefore angina pectoris are invariable.

The most important controllable risk factors for angina pectoris include:

• Smoking
• Severe overweight (obesity)
• Elevated cholesterol levels
• High blood pressure
• Elevated blood sugar levels (blood glucose levels)

Risk factors for angina pectoris that cannot be controlled are:

• Age: Angina pectoris occurs more frequently with increasing age.
• Gender: Men fall ill more often than women.
• Hereditary (familial) factors: If close relatives (grandparents, parents) have or had CHD, there is a greater likelihood of also developing CHD and the associated angina pectoris.

Since the cause of angina pectoris is always coronary heart disease (CHD), chest tightness can only be prevented by preventing CHD. The most important measure to protect against cardiovascular diseases such as CHD is a healthy lifestyle. This includes:

• Abstaining from smoking: Quitting smoking is one of the most important measures to prevent cardiovascular disease. You can find tips and contact points for quitting smoking here.
• Balanced diet: You should include plenty of fruit, vegetables, pulses, whole-grain products and low-fat milk and dairy products in your diet. Fish and nuts are also recommended, as well as a small amount of lean meat as a supplement if desired. Try to avoid sugar or use it as sparingly as possible.
• Little or no alcohol: It is best to avoid alcohol completely. Even small amounts can increase the risk of a variety of diseases and have a negative impact on life expectancy.
• Regular exercise: Ideally, you should do 150 to 300 minutes of moderate physical activity per week. This includes, for example, cycling or brisk walking. In principle, the following applies: Every extra minute of exercise is good and will do you good!
• Reduce existing excess weight: If necessary, try to reduce your body weight. A body mass index (BMI) between 18.5 kg/m² and 25 kg/m² is considered normal weight.

People who already have risk factors for cardiovascular disease should be treated by a doctor. These risk factors are in particular:

• High blood pressure
• Elevated blood lipids
• Diabetes

Coronary heart disease (CHD) is the most common cause of angina pectoris. However, chest pain does not always have to be indicative of angina pectoris caused by CHD. There are a number of other diseases of the heart, lungs, respiratory tract and esophagus that can cause similar symptoms and must be ruled out by a doctor. Psychological stress may also cause symptoms similar to those of angina pectoris.

The following factors are initially relevant for the doctor:

• Age
• Other diseases
• How exactly the symptoms manifest themselves and in which situations they occur
• Cardiovascular diseases in close relatives (grandparents, parents)
• Risk factors such as smoking

The doctor will also palpate the chest. All of this helps to assess whether the chest pain is angina pectoris caused by CHD.

If, after the initial assessment, CHD and associated angina pectoris are suspected, further examinations will provide clarity:

• Electrocardiogram (ECG): The ECG measures the electrical activity of the heart. Changes in the ECG can indicate constrictions in the coronary arteries and therefore CHD.
• Ultrasound examination of the heart (echocardiography): Echocardiography can provide indications of circulatory disorders in the coronary arteries.
• Imaging techniques: Procedures such as magnetic resonance imaging (MRI) or computer tomography (CT) can show whether there are constrictions in the coronary arteries.

Which examinations are necessary to clarify chest pain also depends on age, previous illnesses and the nature of the symptoms.

If these examinations confirm CHD, the doctor will often carry out a series of further tests. These tests help with treatment planning and contribute to a more accurate assessment of the risk of complications following CHD, such as a heart attack. This includes, for example, blood pressure measurement and a blood count.

The symptoms characteristic of angina pectoris and the associated restrictions in everyday life can be alleviated by various medications. Healthcare professionals can prescribe beta blockers, calcium channel blockers or nitrates, for example.

It is also important to treat the underlying disease of angina pectoris, i.e., the coronary heart disease (CHD). This can also be achieved with various active substances, which primarily include medication that thins the blood so that it can flow better through the narrowed coronary arteries. This can reduce the risk of blood clots.

It is also important to keep an eye on other risk factors that can promote both CHD itself and the development of complications, and to treat them if necessary. These include high blood pressure, elevated blood lipids and diabetes.

Surgical procedures

If lifestyle changes and treatment with medication fail to be sufficient, various surgical procedures are available to treat CHD and therefore angina pectoris. All these procedures aim at improving or restoring blood flow to the heart. There are various procedures:

• Angioplasty: This procedure is used to reopen or widen narrowed or blocked blood vessels. A thin wire (cardiac catheter) is inserted into the blocked coronary artery via a blood vessel in the groin and advanced to the narrowed area. The tip of the catheter can be inflated into a balloon to widen the vessel so that sufficient blood can flow through the vessel again. This is known as balloon dilatation. To prevent the vessel from closing again, a small tube made of wire mesh (stent) is inserted into the vessel.
• Bypass operation: If several blood vessels are narrowed at the same time or if the balloon catheter fails to widen the narrowed blood vessel, the surgeon will apply one or more coronary bypasses. This is a kind of “detour” for the supply of blood. A blood vessel is removed from another part of the body and used to create a detour around the blocked coronary vessel.

Prognosis of angina pectoris

Both CHD, i.e., the underlying disease of angina pectoris, and myocardial infarction – one of the most common complications of CHD – are among the most frequent causes of death in Germany. Both diseases can significantly shorten life expectancy. It is therefore important to treat or prevent CHD and the existing risk factors for cardiovascular diseases (e.g., smoking, high blood pressure, diabetes).

People affected should make consistent changes to their lifestyle and regularly take the medication prescribed by their doctor. This usually stops the progression of the plaques and results in fewer complications and cases of death.