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Angina – Causes, Symptoms and Treatment

Angina refers to chest pain caused by reduced blood flow to the heart, or to a throat infection involving the tonsils. Learn about causes, symptoms, and treatment.

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Things worth knowing about "Angina"

Angina refers to chest pain caused by reduced blood flow to the heart, or to a throat infection involving the tonsils. Learn about causes, symptoms, and treatment.

What is Angina?

Angina is a medical term that can refer to two distinct conditions: angina pectoris (chest pain caused by reduced blood supply to the heart) and angina tonsillaris (tonsillitis, an inflammation of the tonsils). The correct interpretation depends on the clinical context in which the term is used.

Angina Pectoris

Angina pectoris is a symptom of coronary artery disease (CAD). It occurs when the heart muscle does not receive enough oxygen-rich blood, typically due to narrowing of the coronary arteries (coronary stenosis), most often caused by atherosclerosis.

Causes of Angina Pectoris

Atherosclerosis (plaque buildup in arterial walls)
Coronary artery disease (CAD)
High blood pressure (hypertension)
Diabetes mellitus
Smoking and elevated blood lipid levels

Symptoms of Angina Pectoris

Pressure, tightness, or burning sensation in the chest
Pain radiating to the arm, shoulder, jaw, or back
Shortness of breath and sweating
Nausea or dizziness
Symptoms typically triggered by physical exertion or stress (stable angina) or occurring at rest (unstable angina)

Diagnosis of Angina Pectoris

Diagnosis involves a thorough medical history, a resting ECG, and a stress ECG. Additional investigations include blood tests, echocardiography (cardiac ultrasound), and coronary angiography (cardiac catheterization) to visualize narrowings in the coronary arteries directly.

Treatment of Angina Pectoris

Medications: Nitrates (for acute vessel dilation), beta-blockers, calcium channel blockers, antiplatelet agents (e.g., aspirin)
Interventional procedures: Balloon angioplasty (PTCA) with or without stent placement
Surgical treatment: Coronary artery bypass grafting (CABG) for severe narrowings
Lifestyle changes: Smoking cessation, healthy diet, regular physical activity, weight management

Angina Tonsillaris (Tonsillitis)

Angina tonsillaris is an acute inflammation of the palatine tonsils, most commonly caused by bacteria -- particularly Group A Streptococcus -- or by viruses.

Causes of Angina Tonsillaris

Bacterial infection, especially Streptococcus pyogenes
Viral infections (e.g., Epstein-Barr virus, adenoviruses)
Weakened immune system

Symptoms of Angina Tonsillaris

Severe sore throat, often with difficulty swallowing
Red, swollen tonsils, sometimes with white or yellowish patches
Fever and general feeling of illness
Swollen lymph nodes in the neck
Bad breath (halitosis)

Diagnosis of Angina Tonsillaris

Diagnosis is based on a clinical examination of the throat and a throat swab to detect streptococcal infection. A rapid antigen test (strep test) may be used for quick confirmation at the point of care.

Treatment of Angina Tonsillaris

Bacterial cause: Antibiotics, typically penicillin or amoxicillin
Symptomatic relief: Pain-relieving and fever-reducing medications (e.g., ibuprofen, paracetamol), adequate fluid intake, and rest
Surgical option: Tonsillectomy (surgical removal of the tonsils) may be considered in cases of recurrent tonsillitis

When to Seek Medical Attention

New or sudden chest pain requires immediate emergency medical assistance (call 911 or your local emergency number) to rule out a heart attack. Severe sore throat with high fever, difficulty swallowing, or prolonged illness also warrants prompt medical evaluation.

References

World Health Organization (WHO): Cardiovascular Diseases -- Key Facts. www.who.int (2023)
European Society of Cardiology (ESC): Guidelines on the Management of Stable Coronary Artery Disease. European Heart Journal (2019)
Shulman, S.T. et al.: Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Infectious Diseases Society of America (IDSA), Clinical Infectious Diseases (2012)

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