Angina pectoris refers to the typical symptoms of acute coronary insufficiency.

Symptoms

Chest Pain or Discomfort

• Described as pressing, squeezing, crushing, or burning pain
• Usually felt behind the breastbone (retrosternal)
• Can radiate to arms, shoulders, neck, jaw, or back

Associated Symptoms

• Shortness of breath (dyspnea)
• Fatigue or weakness
• Nausea
• Dizziness or lightheadedness
• Sweating

Characteristics

• Often triggered by physical exertion, emotional stress, or cold temperatures
• Usually lasts for a few minutes
• Typically relieved by rest or nitroglycerin

Forms of Angina Pectoris

Walking-through-Angina

• Occurs at the beginning of physical activity
• Disappears with continued exertion due to the release of endogenous vasodilators
• Especially common in athletes

Stable Angina

• Occurs predictably with physical exertion or emotional stress
• Typically lasts a few minutes
• Relieved by rest or nitroglycerin

Unstable Angina

• Occurs unexpectedly, often at rest
• May last longer than stable angina
• Not reliably relieved by rest or medication
• Considered a medical emergency

Prinzmetal’s Angina (Variant Angina)

• Caused by coronary artery spasms
• Usually occurs at rest, often between midnight and early morning
• Can be very painful
• More common in women

Microvascular Angina

• Previously called Syndrome X
• Causes chest pain without coronary artery blockage
• Due to dysfunction of small blood vessels
• More common in women

Nocturnal Angina

• Occurs during sleep
• May be triggered by dreams causing changes in respiration and heart rate
• Can be a sign of recurrent left ventricular failure

Diagnosis

Medical History

• Inquire about triggers for symptoms
• Response to nitrates
• Family history (cardiovascular events in first-degree relatives)

Physical Examination

• Vascular sounds (carotids, femorals) as a sign of generalized atherosclerosis
• Blood pressure: Arterial hypertension can also cause anginal symptoms without coronary heart disease
• Signs of heart failure (jugular vein distension, rales over the lungs, positive hepatojugular reflex)

Laboratory Tests

• Blood fats and glucose to assess risk factors
• Complete blood count to rule out anemia

Further Diagnostic Procedures

• Electrocardiogram (ECG)
• Coronary angiography

Differential Diagnosis

Cardiovascular

• Acute myocardial infarction
• Pericarditis
• Aortic stenosis or regurgitation
• Aortic dissection
• Cardiomyopathy
• Myocarditis
• Mitral valve prolapse
• Pulmonary hypertension
• Hypertrophic cardiomyopathy

Pulmonary

• Pneumothorax
• Pneumonia
• Pulmonary embolism
• Tracheobronchitis

Gastrointestinal

• Gastroesophageal reflux
• Esophageal spasm
• Peptic ulcer disease
• Biliary colic
• Acute cholecystitis
• Pancreatitis

Musculoskeletal

• Costochondritis
• Rib injury
• Muscle spasm
• Chest wall injury

Psychiatric

• Anxiety disorders
• Panic attacks
• Depression

Other

• Anemia
• Hyperthyroidism
• Herpes zoster (shingles)