A Patient and Physician Perspective of Chronic Coronary Syndrome and Persistent Stable Angina in Brazil

Obstructions in the coronary arteries, arterial vasospasm, and microcirculation dysfunction may cause chronic coronary syndrome (CCS). Angina is a cardinal symptom of CCS and the journey of patients with angina is often filled with challenges and uncertainties. Diagnosis and treatment differences seem to vary between men and women with angina. This article is co-authored by a male and a female patient diagnosed with persistent stable angina and their treating cardiologist at the Heart Institute in São Paulo, Brazil. The patients share their personal experiences of more than 20 years of coping with pain and the related impact on their physical capacity, thus illustrating the challenging journey often faced by individuals with angina and how it differs between men and women. They describe the long pathway from the onset of symptoms to the correct diagnosis and list the various interventional procedures they underwent, focusing on the impact of angina on their daily lives. They also mention their participation in a clinical study. The cardiologist discusses the critical elements in the diagnostic process of angina, and reflects on how the misconception that heart disease primarily affects men can lead to delayed diagnosis and treatment for women suffering from this condition. Moreover, he emphasizes that many patients experience angina due to myocardial ischemia without obstructive coronary artery disease, highlighting the need to raise disease awareness among healthcare professionals, as well as in society. Finally, the physician underscores the importance of better patient assessment and medical treatment optimization to managing angina and meeting patients’ needs and expectations, while prioritizing patient quality of life. Chronic coronary syndrome is a long-lasting condition where the heart muscle receives insufficient blood supply. Patients with chronic coronary syndrome experience chest pain (angina) as the most common symptom, often described as a squeezing feeling or pressure in the chest. If not optimally controlled (persistent angina), this pain can negatively impact quality of life. In this article, two patients who have lived with angina for over 20 years share their stories, describing the first symptoms, the diagnostic process, and their active search for treatments that would give them some relief, including their participation in a clinical study. The patients recall their reaction to the angina diagnosis, describe the difficulties in managing the condition, and detail how angina has affected their daily lives. Their treating cardiologist, who is based at the Heart Institute in São Paulo, Brazil, also shares his perspectives by noting that these two patients are typical examples of the patients with angina he sees in the clinic. The physician explains why the journey of patients with angina is long, and why it differs between men and women. Finally, he encourages his colleagues to understand what the patients’ expectations are and to adjust treatment to control pain accordingly.