Table of Contents
1. Introduction – What is Angina
- Angina pectoris, often simply called angina, is a type of chest pain or discomfort that occurs when the heart muscle doesn’t get enough oxygen-rich blood.
- It is usually a symptom of coronary artery disease (CAD) and acts as a warning sign for possible heart attack or serious heart complications.
- The pain is often described as tightness, heaviness, squeezing, or burning, and may radiate to the shoulders, arms, neck, jaw, or back.
2. Types
| Type | Cause | Key Features | Relief |
| Stable | Fixed narrowing of coronary arteries | Predictable, triggered by exertion or stress | Rest or nitroglycerin |
| Unstable | Rupture of a plaque with clot formation | Occurs at rest, more severe and frequent | Urgent medical attention |
| Variant (Prinzmetal’s) | Coronary artery spasm | Occurs at rest, often at night or early morning | Calcium channel blockers, nitrates |
| Microvascular | Dysfunction of small coronary vessels | Chest pain despite normal coronary arteries | Lifestyle changes + medications |
3. WHO-Recommended Drugs for Treatment
References: KD Tripathi – Essentials of Medical Pharmacology & Katzung – Basic & Clinical Pharmacology
| Drug Class | Examples | Mechanism of Action | Use |
| Nitrates | Glyceryl trinitrate (GTN), Isosorbide dinitrate, Isosorbide mononitrate | Dilates veins & coronary arteries, reduces heart’s oxygen demand | Rapid relief in acute angina |
| β-Blockers | Metoprolol, Atenolol, Propranolol | Decrease heart rate & contractility | Prevention of effort-induced angina |
| Calcium Channel Blockers | Verapamil, Diltiazem, Amlodipine, Nifedipine | Reduce coronary spasm & oxygen demand | Variant and stable angina |
| Potassium Channel Openers | Nicorandil | Vasodilation via K⁺ channel activation | Alternative/add-on therapy |
| Metabolic Modulators | Trimetazidine, Ranolazine | Improve cardiac metabolism | Used when other drugs are insufficient |
| Antiplatelets | Aspirin, Clopidogrel | Prevent platelet aggregation | Unstable angina & post-MI prevention |
4. Combination Drugs
Sometimes, no single drug is enough to control symptoms. Combination therapy aims to target different mechanisms at once.
Examples:
- β-Blocker + Nitrate → Reduces heart workload + dilates vessels
- Calcium Channel Blocker + Nitrate → Good for variant angina
- Trimetazidine + β-Blocker → Improved exercise tolerance (TRIMPOL II study)
- Aspirin + Clopidogrel → Standard in unstable angina to prevent clot formation
These combinations are supported by WHO cardiovascular guidelines and clinical pharmacology references.
5. Mortality & Statistics
- Global Impact:
- Cardiovascular diseases cause 19.8 million deaths annually (WHO, 2022).
- Ischemic heart disease is the leading cause of death worldwide.
- Cardiovascular diseases cause 19.8 million deaths annually (WHO, 2022).
- Prevalence:
- Around 112 million people worldwide live with angina.
- About 1.6% of the global population is affected.
- Around 112 million people worldwide live with angina.
- Prognosis:
- Long-term studies show 59% mortality in men and 47% in women over 13 years.
- Risk of death is significantly higher without early diagnosis and proper drug therapy.
- Long-term studies show 59% mortality in men and 47% in women over 13 years.
6. Conclusion
It is not a disease in itself but a red flag for underlying heart problems.
Ignoring it can lead to heart attacks, heart failure, or sudden cardiac death—making awareness and timely treatment critical.
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