Risk Factors and Causes of Angina
Risk factors for ischemic heart disease (IHD) and angina include the following:
- Carotid artery intima-media thickness
- Chlamydial pneumonia, and other signs of infection
- Coronary calcification (detected by electron beam and helical-computed tomography)
- Elevated C-reactive protein (CRP)
- Elevated LDL ("bad") cholesterol
- Elevated levels of fats in the blood (hyperlipidemia)
- Elevated lipoprotein
- Tobacco use (including cigars)
- Diabetes mellitus
- Emotional stress (e.g., frustration, anger)
- Family history of ischemic heart disease
- Reduced HDL ("good") cholesterol
- Sedentary lifestyle
Some risk factors can be reduced by making lifestyle modifications.
Cardiac ischemiainsufficient blood flow to heart tissueand angina can be caused by the following:
- Blocked artery
- Aortic valve disease (e.g., aortic stenosis, aortic regurgitation)
- Hypertrophic cardiomyopathy
- Microvascular constriction
- Pulmonary hypertension
- Coronary artery spasm (in variant angina)
Atherosclerosis is the build-up of cholesterol deposits (plaques) in the wall of an artery. If the surface of a plaque ruptures, a blood clot (thrombus) may form on top of it and create a larger blockage. If the clot grows large enough, it can completely obstruct the artery. A 70% or greater blockage can deprive the heart of the volume of blood needed to meet an increased demand and cause angina.
Aortic valve disease causes the aortic valve to malfunction. This impairs the heart's ability to pump oxygen-rich blood out of the left ventricle and to the rest of the body.
In hypertrophic cardiomyopathy, an area of abnormally thick heart muscle impairs the heart's pumping action. This commonly causes angina during or shortly after exercise.
The pulmonary artery carries oxygen-depleted blood from the lower chamber in the right side of the heart (right ventricle) to the lungs, where it is oxygenated. Pulmonary hypertension is a rare disorder in which the pulmonary arteries are constricted, increasing pressure in the lung's blood vessels. Pulmonary hypertension makes it harder for the heart to pump blood out of the right ventricle.