Arteriosclerosis is the commonest cause and it is a chronic process initiated by lipid deposition and vascular wall injury that causes increased endothelial permeability and inflammatory reaction. To ward off this inflammation, lipid laden deposits with additional vascular smooth muscle cell recruitment fascilates the formation of fibrous cap or plaque. Luminal obstruction develops with gradual enlargement of plaque.

What is the etiology of angina pictoris?

Commonest is the Coronary Artery Disease. It may be presenting features for profound Anaemia, Thyrotoxicosis, Aortic Stenosis , Hypertensive heart disease etc.

Most important causes of premature death in developed world. The overall prevalence of Coronary Artery Disease is rising. Eastern Europe in particular, experienced escalating rates of rise in Coronary Artery Disease mortality. Among the ethnic group Indo- Asian have higher rate than Caucasians.

Risk Factors

• Smoking

• Strong Family History

• Hypertension

• Diabetes Mellitus

• Obesity

Coronary artery disease has a male preponderance. After menopause females are equally affected.

Diet plays an important role. High consumption of saturated animal fat (red meat & dairy products) is associated with increased risk. In contrast, a  polyunsaturated fatty acid of fish oils confers a protective role due to presence of omega –3 fatty acid. Many studies has now shown that physical activity particular during leisure, is associated with reduction in coronary artery disease. However the optimal intensity of exercise is still debatable. Physical activity does not have to be arduously long to be beneficial. Even short session (15 min) appear to confer benefits. The benefits of exercise on coronary artery disease risk may also be mediated indirectly in reducing other risk factors such as hypertension and hyper cholesterolaemia .In addition, exercise improves insulin sensitivity and delays or prevents the onset of type II diabetes. Finally exercise has shown to decrease arterial stiffness, which has emerged as a independent risk for coronary artery disease. However patient with known coronary artery disease needs to be medically evaluated before starting active exercise programme.

Revascularization is the treatment of choice for Coronary Artery Disease. Usually single system disease with discreet block are treated with percutaneous coronary angioplasty (balloon angioplasty). By this method the area of narrowing is dilated and stent is placed to prevent further blocking of the vessel. More severe disease (two system or three system and left main disease) with particularly depressed heart function  (due to previous heart attack) are treated by Coronary Artery Bypass Grafting (CABG).