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Aetiology

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Angina is pain caused by regional myocardial ischaemia (1). Ischaemia develops when there is inadequate coronary artery blood supply (oxygen demand exceeds supply) (1).

Ischaemia develops when oxygen demand exceeds supply.

The commonest cause of myocardial ischaemia is reduced oxygen supply due to atherosclerotic coronary artery stenosis.

Other causes of reduced oxygen supply include:

  • thrombus formation on fissured atheromatous plaque
  • coronary artery spasm
  • tachycardia, which reduces the time during diastole when blood flows most rapidly through the coronary arteries
  • anaemia and carbon monoxide poisoning

Causes of increased oxygen demand include:

  • exertion
  • hypertension
  • tachycardia
  • aortic stenosis
  • hypertrophic cardiomyopathy

Reference:

1. NICE CKS, November 2020. Angina.

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