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Chest Pain / Angina Pectoris: Difference between revisions
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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> | ||
{| class="wikitable" border="1" style='float: left; width: 400px; font-size: 11px;' | |||
|- | |||
! align="left" colspan="2" | Table 2. Clinical classification of chest pain | |||
|- | |||
| valign="top" align="left" | Typical angina (definite) | |||
| align="left" | Meets three of the following characteristics | |||
* Substernal chest discomfort of characteristic quality and duration | |||
* Provoked by exertion or emotional stress | |||
* Relieved by rest and/or GTN | |||
|- | |||
| valign="top" align="left" | Atypical angina (probable) | |||
| align="left" | Meets two of these characteristics | |||
|- | |||
| valign="top" align="left" | Non-cardiac chest pain | |||
| align="left" | Meets one or none of the characteristics | |||
|} | |||
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. | ||
{| class="wikitable" border="1" style='float: right; width: 400px; font-size: 11px;' | |||
|- | |||
! colspan="2" | Table 3. Classification of angina severity according to the Canadian Cardiovascular Society | |||
|- | |||
| width="100" align="left" | ''Class'' | |||
| align="left" | ''Level of Symptoms'' | |||
|- | |||
| valign="top" align="left" | Class I | |||
| align="left" | 'Ordinary activity does not cause angina' | |||
Angina with strenuous or rapid or prolonged exertion only | |||
|- | |||
| valign="top" align="left" | Class II | |||
| align="left" | 'Slight limitation of ordinary activity' | |||
Angina on walking or climbing stairs rapidly, walking uphill or exertion after meals, in cold weather, when under emotional stress, or only during the first few hours after awakening | |||
|- | |||
| valign="top" align="left" | Class III | |||
| align="left" | 'Marked limitation of ordinary physical activity' | |||
Angina on walking one or two blocks on the level or one flight of stairs at a normal pace under normal conditions | |||
|- | |||
| valign="top" align="left" | Class IV | |||
| align="left" | 'Inability to carry out physical activity without discomfort' or 'angina at rest' | |||
|} | |||
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> | ||