Conditions that exacerbate or provoke angina
One study found that smokers with coronary artery disease had a significantly increased level of 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 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 smoking men 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. Other medical problems
Esophageal disorders
Gastroesophageal reflux disease (GERD)
Hyperthyroidism
Hypoxemia
Profound anemia
Uncontrolled hypertension

Other cardiac problems
Bradyarrhythmia
Hypertrophic cardiomyopathy
Tachyarrhythmia
Valvular heart diseaseMyocardial ischemia can result from:

a reduction of blood flow to the heart that can be caused by stenosis, spasm, or acute occlusion (by an embolus) of the hearts arteries. resistance of the blood vessels. This can be caused by narrowing of the blood vessels; a decrease in radius. Blood flow is proportional to the radius of the artery to the fourth power. reduced oxygen-carrying capacity of the blood, due to several factors such as a decrease in oxygen tension and hemoglobin concentration.
This decreases the ability of hemoglobin to carry oxygen to myocardial tissue.Atherosclerosis is the most common cause of stenosis (narrowing of the blood vessels) of the hearts 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 Prinzmetals angina and 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 smoking. Pathophysiology
Angina results when there is an imbalance between the hearts oxygen demand and supply. This imbalance can result from an increase in demand (e.g., during exercise) without a proportional increase in supply (e.g., due to obstruction or atherosclerosis of the coronary arteries). However, the pathophysiology of angina in females varies significantly as compared to males. Non-obstructive coronary disease is more common in females. Diagnosis
Angina should be suspected in people presenting tight, dull, or heavy chest discomfort that is:
Retrosternal or left-sided, radiating to the left arm, neck, jaw, or back. Associated with exertion or emotional stress and relieved within several minutes by rest. Precipitated by cold weather or a meal.Some people present with atypical symptoms, including breathlessness, nausea, or epigastric discomfort, or burning. These atypical symptoms are particularly likely in older people, women, and those with diabetes.Anginal pain is not usually sharp or stabbing or influenced by respiration.