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Pain from the heart because of poor blood flow to the heart muscle. The usual causeis atherosclerosis whereby the heart's own blood supply becomes inefficient and therefore cannot keep up with the demands ofthe heart muscle. The heart gets its blood supply from two main arteries (the right and left coronary arteries) either or both of which may become affected by atherosclerosis. This may not be a problem at rest when even a poor blood flow is enough to keep up with the heart's requirements. However,on exertion the heart starts to demand more blood flow than the coronary arteries can supply. This allows waste products to build up within the heart muscle causing pain. People who are especially prone to this sort of problem are smokers, diabetics, the overweight, those with high blood pressure and those who have high cholesterol.
Although atherosclerosis is overwhelmingly the likeliest cause nowadays, just occasionally pain arises because of damaged heart valves or because of severe anaemia which is starving the heart of oxygen.

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