Nocturnal angina pectoris pathophysiology

• Among patients who develop nocturnal angina within one to two hours of falling asleep, the mechanism of angina in this group is likely to be an increase in venous return and hence an increased intracardiac volume, with a resulting increase in myocardial oxygen requirements.
• Among patients who develop nocturnal angina in the early morning hours, increased coronary vascular tone causing a primary reduction in coronary blood flow has been postulated as the potential underlying mechanism. This is due to the diurnal increase in sympathetic activity which occurs in the early morning hours causing increased heart rate, blood pressure, and vascular tone.

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