-IBIS-1.5.0-
tx
cardiovascular system
angina pectoris
diagnoses
definition and etiology
definition:
An episodic clinical syndrome due to myocardial ischemia and recognized by precordial discomfort or pain similar to a myocardial infarction but generally less severe and ameliorated by rest.
etiology:
Most patients are males, especially those younger than 50. The average age of patient with angina pectoris is between 50-60 years old. Angina pectoris occurs when the cardiac work and myocardial oxygen demand is greater than the ability of the coronary arteries to supply oxygen to the heart tissues. The pain seems to be created by the accumulation of hypoxic metabolites that develop in the heart muscle and trigger sensory nerves. Risk factors include smoking, diabetes mellitus, hyperlipidemia, "type A" personality, sedentary lifestyle, poor diet, and family history of coronary artery disease.
signs and symptoms
degree of discomfort varies from patient to patient: vague ache; heaviness; pressure; squeezing; smothering; choking; pain
typically substernal or precordial
may radiate to the left
shoulder, down the left arm; or through the back; up to the jaw; down the right arm.
worse with exertion (which often brings it on): especially when the exertion follows a large meal: and better with rest (usually within five minutes of rest the attack subsides); worse in cold weather and strong emotions; better with nitroglycerine
signs during an attack: increased BP, diffuse apical impulse, 4th heart sound may be present
patient may present with mild to severe anxiety
variations:
» nocturnal angina: occurs at night when the patient is sleeping
» angina decubitus: occurs when the patient is at rest and without any clear stimulation (similar to nocturnal angina)
» unstable angina: also known as preinfarction angina, intermediate syndrome, acute coronary insufficiency: these terms indicate a patient with angina symptoms whose condition is worsening and whose attacks are increasing in severity (i.e. decreased stimulus needed to cause attack, attacks last longer or are harsher)
» variant angina (Prinzmetal's angina): pain while resting; EKG shows S-T elevation (normal angina typically shows S-T depression)
lab findings:
(+) EKG: needs to be taken during an angina attack, or as a stress EKG under supervision
(+) exercise tolerance test
(+) coronary arteriography
course and prognosis
The prognosis is based upon age of patient, extent of coronary artery occlusion, and ventricular function. Sudden death or multiple MI are probable consequences of untreated angina pectoris. Conventional treatment consists of smoking cessation, weight loss, control of atherosclerosis and hypertension, and specific drug therapy (nitrates, beta-adrenergic blocking drugs etc.) and coronary bypass surgery. Unstable angina is a medical emergency.
differential diagnosis
myocardial infarction
musculoskeletal conditions: (costochondral separation, costochondritis, problem with the cervicothoracic spine)
gastrointestinal disease (peptic ulcer, esophageal spasm, hiatal hernia, gall bladder disease)
pericarditis, pleuritis
anxiety states
footnotes