Study note

Causes of angina and coronary artery spasm

THE CONTEXT

Angina most commonly arises from coronary atherosclerosis, but structural cardiac disease, inflammation and coronary vasospasm can also cause it.

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Coronary atherosclerosis is by far the most common cause of angina pectoris.

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Other causes include aortic valve disease, hypertrophic cardiomyopathy and coronary involvement by vasculitis or aortitis.

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Approximately 10%–20% of patients reporting stable angina on effort have normal coronary arteries on angiography.

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Coronary artery vasospasm can cause angina and may coexist with atherosclerosis, especially in unstable angina.

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Rarely, vasospasm occurs in isolation in patients with normal coronary arteries on angiography; this is sometimes called variant angina.

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Variant angina accompanied by transient ST elevation on the electrocardiogram is termed Prinzmetal angina.

NEETx

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