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Chest Pain / Angina Pectoris: Difference between revisions
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== History == | == History == | ||
Patients often describe angina pectoris as pressure, tightness, or heaviness located centrally in the chest, and sometimes as strangling, constricting, or burning. The pain often radiates elsewhere in the upper body, mainly arms, jaw and/or back. <Cite>REFNAME3</Cite> Some patients only complain about abdominal pain so the presentation can be a specific. <Cite>REFNAME4</Cite>, <Cite>REFNAME5</Cite> | Patients often describe angina pectoris as pressure, tightness, or heaviness located centrally in the chest, and sometimes as strangling, constricting, or burning. The pain often radiates elsewhere in the upper body, mainly arms, jaw and/or back. <Cite>REFNAME3</Cite> Some patients only complain about abdominal pain so the presentation can be a specific. <Cite>REFNAME4</Cite>, <Cite>REFNAME5</Cite> | ||
Angina pectoris however has some characteristics that can help to differentiate between other causes of (chest) pain. Angina pectoris is usually is brief and gradual in onset and offset, with the intensity increasing and decreasing over several minutes. The pain does not change with respiration or position. If patients had angina pectoris previously they are often able to recognize the pain immediately. <Cite>REFNAME6</Cite> | Angina pectoris however has some characteristics that can help to differentiate between other causes of (chest) pain. Angina pectoris is usually is brief and gradual in onset and offset, with the intensity increasing and decreasing over several minutes. The pain does not change with respiration or position. If patients had angina pectoris previously they are often able to recognize the pain immediately. <Cite>REFNAME6</Cite> | ||
Angina pectoris usually occurs with increasing oxygen demand such as during exercise. As soon as the demand is decreased (by stopping the exercise for example) the angina pectoris usually disappears within a few minutes. | Angina pectoris usually occurs with increasing oxygen demand such as during exercise. As soon as the demand is decreased (by stopping the exercise for example) the angina pectoris usually disappears within a few minutes. | ||
Another way to relieve pain is by administration of nitro-glycerine spray. Nitro-glycerine spray is a vasodilator which reduces venous return to the heart and therefore decreases the workload and therefore oxygen demand. It also vasodilates the coronary arteries and increases coronary blood flow. <Cite>REFNAME7</Cite> The response to nitro-glycerine is however not specific for angina pectoris, a similar response may be seen with oesophageal spasm or other gastrointestinal problems because nitro-glycerine also relaxes smooth muscle. <Cite>REFNAME8</Cite> | Another way to relieve pain is by administration of nitro-glycerine spray. Nitro-glycerine spray is a vasodilator which reduces venous return to the heart and therefore decreases the workload and therefore oxygen demand. It also vasodilates the coronary arteries and increases coronary blood flow. <Cite>REFNAME7</Cite> The response to nitro-glycerine is however not specific for angina pectoris, a similar response may be seen with oesophageal spasm or other gastrointestinal problems because nitro-glycerine also relaxes smooth muscle. <Cite>REFNAME8</Cite> | ||
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| caption3 = Table 3. Classification of Angina Severity According to the Canadian Cardiovascular Society | | caption3 = Table 3. Classification of Angina Severity According to the Canadian Cardiovascular Society | ||
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The classification of chest pain in combination with age and sex is helpful in estimating the pretest likelihood of angiographically significant coronary artery disease (Table 1). | The classification of chest pain in combination with age and sex is helpful in estimating the pretest likelihood of angiographically significant coronary artery disease (Table 1). | ||
Depending on the characteristics, chest pain can be identified as typical angina, atypical angina or non-cardiac chest pain (Table 2). | Depending on the characteristics, chest pain can be identified as typical angina, atypical angina or non-cardiac chest pain (Table 2). | ||
Furthermore, the intensity of the pain can be classified according to the Canadian Cardiovascular Society as shown in Table 3. | Furthermore, the intensity of the pain can be classified according to the Canadian Cardiovascular Society as shown in Table 3. | ||
During angina pectoris so called vegetative symptoms can occur, including sweating, nausea, paleface, anxiety and agitation. This is probably caused by the autonomic nerve system being more active in a reaction to stress. <Cite>REFNAME9</Cite> | During angina pectoris so called vegetative symptoms can occur, including sweating, nausea, paleface, anxiety and agitation. This is probably caused by the autonomic nerve system being more active in a reaction to stress. <Cite>REFNAME9</Cite> | ||
Finally, it is important to differentiate unstable angina (indicating an acute coronary syndrome or even myocardial infarction requiring urgent treatment) from stable angina. Unstable angina typically is severe, occurs and does not disappear with rest, and has a longer duration than stable angina. It is important to initiate the right treatment in these patients, as described in the acute coronary syndromes chapter. | |||
Finally, it is important to differentiate unstable angina (indicating an acute coronary syndrome or even myocardial infarction requiring urgent treatment) from stable angina. Unstable angina typically is severe, occurs and does not disappear with rest, and has a longer duration than stable angina. It is important to initiate the right treatment in these patients, as described in the acute coronary syndromes chapter. | |||
== Physical Examination == | == Physical Examination == | ||