Angina pectoris

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Angina pectoris

• Ana Gašparovic
• Mentor A. Žmegac Horvat

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Definition

• Generally described as retrosternal heavy or
  gripping sensation with radiation to left arm or
  neck, provoked by exertion and eased with rest or
  nitrates

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Angina can be

• Stable
• Unstable? caused by unstable plaque, occurs at
  rest, unpredictable, pain can increase for no
  obvious reason
• Prinzmetals? occurs without provocation, usually
  at rest, as a result of coronary artery spasm

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Stable angina pectoris

• Provoked by physical exertion, especially in cold
  weather, after meals and commonly aggravated by
  anger or excitement
• The pain fades quickly with rest
• In some patients pain occurs predictably at a
  certain level of exertion

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Etiology and pathogenesis

• Symptoms are results of myocardial ischemia due
  to insufficient blood flow through
  atherosclerotically changed coronary vessels

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Clinical symptoms

• Patient history is a?golden standard?
• Retrosternal pain
• Dyspnea
• Nausea
• Arrhythmia
• Restlessness
• Levine sign
• Pain eased after taking nitrates

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Physical examination

• Hypertension
• Obesity
• Hyperglycemia
• Hyperlipidemia
• Auscultation

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Investigations

• Laboratory tests (leukocytes, hemoglobin, thyroid
  hormones, troponin I and T, MB-CPK)
• Resting ECG
• Excercise ECG
• Cardiac scintigraphy
• Echocardiography
• Coronary angiography

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Treatment

• Prognostic therapy Aspirin, lipid-lowering
  therapy
• Symptomatic treatment GTN, beta-blockers,
• long-acting nitrates, calcium-channel
  blockers, ACEI
• Percutaneous coronary intervention, coronary
  artery bypass grafting

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• Literature
• P.Kumar and M.Clark Kumar Clarks Clinical
  Medicine
• Božidar Vrhovac and associates Interna
  Medicina
• Damjanov, Jukic, Nola Patologija