Editing Angina (section)

==Cause==
===Major risk factors===
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{{citation needed|reason=previous source was not relevant|date=March 2016}}
* Age (≥ 45 years for men, ≥ 55 for women)
* [[Smoking]]
* [[Diabetes mellitus]]
* [[Dyslipidemia]]
* Family history of premature [[cardiovascular disease]] (males <55 years, females <65 years old)
* [[Hypertension]]
* [[Kidney disease]] ([[microalbuminuria]] or [[Glomerular filtration rate|GFR]]<60 mL/min)
* [[Obesity]] ([[Body mass index|BMI]] ≥ 30&nbsp;kg/m2)
* [[Physical inactivity]]
* Prolonged [[psychosocial]] [[stress (psychological)|stress]]<ref name="pmid8615707">{{cite journal | vauthors = Linden W, Stossel C, Maurice J | title = Psychosocial interventions for patients with coronary artery disease: a meta-analysis | journal = Archives of Internal Medicine | volume = 156 | issue = 7 | pages = 745–52 | date = April 1996 | pmid = 8615707 | doi = 10.1001/archinte.1996.00440070065008 }}</ref>
}}
Routine counseling of adults by physicians to advise them to improve their diet and increase their physical activity has, in general, been found to induce only small changes in actual behavior. Therefore, as of 2012, [[The U.S. Preventive Services Task Force]] does not recommend routine lifestyle counseling of all patients without known cardiovascular disease, hypertension, hyperlipidemia, or diabetes, and instead recommends selectively counseling only those patients who seem most ready to make lifestyle changes and using available time with other patients to explore other types of intervention that would be more likely to have a preventative impact.<ref>{{cite journal | vauthors = Moyer VA | title = Behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 157 | issue = 5 | pages = 367–71 | date = September 2012 | pmid = 22733153 | doi = 10.7326/0003-4819-157-5-201209040-00486 | doi-access = free }}</ref>

; Conditions that exacerbate or provoke angina<ref>{{cite book | vauthors = Wells B, DiPiro J, Schwinghammer T, DiPiro C |year=2008 |title=Pharmacotherapy Handbook |url=https://archive.org/details/pharmacotherapyh00well_572 |url-access=limited |edition=7th |location=New York |publisher=McGraw-Hill |page=[https://archive.org/details/pharmacotherapyh00well_572/page/n152 140] |isbn=978-0-07-148501-2}}</ref>
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* [[Medications]]
** [[Vasodilation|Vasodilators]]
** Excessive [[thyroid hormone replacement]]
* [[Vasoconstrictor]]s
* [[Polycythemia]], which thickens the blood, slowing its flow through the heart muscle
* [[Hypothermia]]
* [[Hypervolemia]]
* [[Hypovolemia]]
}}
One study found that [[Tobacco smoking|smokers]] with coronary artery disease had a significantly increased level of [[sympathetic nervous system|sympathetic nerve]] activity when compared to those without. This is in addition to increases in blood pressure, heart rate, and peripheral vascular resistance associated with nicotine, which may lead to recurrent angina attacks. In addition, the [[Centers for Disease Control and Prevention]] (CDC) reports that the risk of CHD (Coronary heart disease), stroke, and [[Peripheral vascular disease|PVD (Peripheral vascular disease)]] is reduced within 1–2 years of smoking cessation. In another study, it was found that, after one year, the prevalence of angina in smokingmales under 60 after an initial attack was 40% less in those having quit smoking compared to those that continued.  Studies have found that there are short-term and long-term benefits to smoking cessation.<ref>{{cite web |publisher= U.S. Centers for Disease Control and Prevention |title=Health Benefits of Cessation |url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm |date=January 3, 2013}}</ref><ref>{{cite journal | vauthors = Daly LE, Graham IM, Hickey N, Mulcahy R | title = Does stopping smoking delay onset of angina after infarction? | journal = British Medical Journal | volume = 291 | issue = 6500 | pages = 935–7 | date = October 1985 | pmid = 3929970 | pmc = 1417185 | doi = 10.1136/bmj.291.6500.935 }}</ref><ref>{{cite journal | vauthors = Daly LE, Mulcahy R, Graham IM, Hickey N | title = Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction | journal = British Medical Journal | volume = 287 | issue = 6388 | pages = 324–6 | date = July 1983 | pmid = 6409291 | pmc = 1548591 | doi = 10.1136/bmj.287.6388.324 }}</ref><ref>{{cite journal | vauthors = Shinozaki N, Yuasa T, Takata S | title = Cigarette smoking augments sympathetic nerve activity in patients with coronary heart disease | journal = International Heart Journal | volume = 49 | issue = 3 | pages = 261–72 | date = May 2008 | pmid = 18612184 | doi = 10.1536/ihj.49.261 | doi-access = free }}</ref>

===Other medical problems===
* [[Esophageal motility disorder|Esophageal disorders]]
* [[Gastroesophageal Reflux Disease|Gastroesophageal reflux disease]] (GERD)
* [[Hyperthyroidism]]
* [[Hypoxemia]]
* Profound [[anemia]]
* Uncontrolled [[hypertension]]

===Other cardiac problems===
* [[Bradyarrhythmia]]
* [[Hypertrophic cardiomyopathy]]
* [[Tachyarrhythmia]]
* [[Valvular heart disease]]<ref>{{cite journal | vauthors = Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB, Fihn SD, Fraker TD, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV | title = ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina) | journal = Journal of the American College of Cardiology | volume = 41 | issue = 1 | pages = 159–68 | date = January 2003 | pmid = 12570960 | doi = 10.1016/S0735-1097(02)02848-6 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW | title = 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina | journal = Journal of the American College of Cardiology | volume = 50 | issue = 23 | pages = 2264–74 | date = December 2007 | pmid = 18061078 | doi = 10.1016/j.jacc.2007.08.002 | author3 = 2002 Chronic Stable Angina Writing Committee | first22 = SM | first21 = MA | first20 = CE | first27 = BW | first26 = FG | first25 = HM | first29 = RL | first28 = R | first19 = JL | first30 = B | first18 = CD | first24 = SA | first16 = SC | first17 = AK | first14 = RA | first15 = SV | doi-access = free }}</ref>

[[Myocardial ischemia]] can result from:
# a reduction of blood flow to the heart that can be caused by [[stenosis]], [[spasm]], or acute [[Vascular occlusion|occlusion]] (by an [[Embolism|embolus]]) of the heart's arteries.
# resistance of the blood vessels. This can be caused by narrowing of the blood vessels; a decrease in radius.<ref>{{cite book |vauthors=Kusumoto FM |chapter=Chapter 10: Cardiovascular Disorders: Heart Disease |veditors=McPhee SJ, Hammer GD |title=Pathophysiology of Disease: An Introduction to Clinical Medicine |edition=6th |chapter-url=http://www.accesspharmacy.com/content.aspx?aID=5367630 |isbn=978-0-07-162167-0 |page=276 |date=2009-10-20 |publisher=McGraw-Hill Education |access-date=2010-04-28 |archive-date=2011-07-27 |archive-url=https://web.archive.org/web/20110727134638/http://www.accesspharmacy.com/content.aspx?aID=5367630 |url-status=dead }}</ref> Blood flow is proportional to the radius of the artery to the fourth power.<ref>{{cite book | vauthors = Michel T |chapter=Treatment of Myocardial Ischemia | veditors = Brunton LL, Lazo JS, Parker KL |title=Goodman & Gilman's The Pharmacological Basis of Therapeutic |edition=11th |page=823 |isbn=978-0-07-142280-2|date=2005-09-13 |publisher=McGraw-Hill Companies,Incorporated }}</ref>
# reduced oxygen-carrying capacity of the blood, due to several factors such as a decrease in oxygen tension and hemoglobin concentration.<ref name="podrid2012">{{cite web | vauthors = Podrid PJ |title=Pathophysiology and clinical presentation of ischemic chest pain |work=[[UpToDate]] |date=November 28, 2012 |publisher=[[Wolters Kluwer]] |url=http://www.uptodate.com/contents/pathophysiology-and-clinical-presentation-of-ischemic-chest-pain }}{{registration required}}</ref> This decreases the ability of hemoglobin to carry oxygen to myocardial tissue.<ref>{{cite web | vauthors = Traverso M | date = 8 August 2004 | url = http://www.chemistry.wustl.edu/~courses/genchem/Tutorials/Ferritin/IronBody.htm | archive-url = https://web.archive.org/web/20100607124022/http://www.chemistry.wustl.edu/~courses/genchem/Tutorials/Ferritin/IronBody.htm | archive-date = 7 June 2010 | title = The Crucial Role of Iron in the Body | work = Washington University in St Louis }}</ref>

[[Atherosclerosis]] is the most common cause of [[stenosis]] (narrowing of the blood vessels) of the heart's arteries and, hence, angina pectoris. Some people with chest pain have normal or minimal narrowing of heart arteries; in these patients, [[vasospasm]] is a more likely cause for the pain, sometimes in the context of [[Prinzmetal's angina]] and [[Cardiac syndrome X|syndrome X]].

Myocardial ischemia also can be the result of factors affecting blood composition, such as the reduced oxygen-carrying capacity of [[blood]], as seen with severe [[anemia]] (low number of red blood cells), or long-term [[tobacco smoking|smoking]].