Angina

Question 1

What is Angina?

Answer 1

Chest pain from reduced blood flow to the heart resulting in transient myocardial ischemia without
infarction.

Question 2

Describe stable angina

Answer 2

Stable Angina:

• Most common
• Triggered by physical exertion, strong emotional stress, cold temperature
• pain usually lasts 3-5 minutes
• typically relieved by rest

Question 3

Describe unstable angina.

Answer 3

Unstable Angina:

• Is more serious and unpredictable
• Can occur at rest
• Signals a heart attack

Question 4

Describe the epidemiology of Angina

Answer 4

More common in men than women, incidence increases with age.

Question 5

How does Angina occur?

Answer 5

Occurs when the coronary arteries are narrowed and decreases the amount of oxygenated blood supplying the heart therefore causing pain.

Question 6

What commonly causes the narrowing of coronary arteries?

Answer 6

Atherosclerosis

Question 7

What causes the narrowing of the coronary arteries other than atherosclerosis?

Answer 7

Hypertension
Aortic stenosis or regurgitation
Hypertrophic cardiomyopathy

(In these cases, angina can occur whether atherosclerosis is present or not because these pathologies increase cardiac workload without exertion)

Question 8

What are some signs and symptoms of Angina?

Answer 8

• Chest discomfort
• Crushing, tight, heavy sensation
• Radiation to arm, back, jaw and neck and can also radiate to right arm and upper abdomen
  Note* the discomfort of angina is never above the ears or below the umbilicus
• Some Pts. display atypical angina, which may feel like indigestion and bloating, gas, abdominal distress
• Dyspnoea
• increased HR and BP
• diaphoresis (excessive sweating)

Question 9

Why would more people have angina in the morning?

Answer 9

Because the arterial tone is high (increases the already narrowed vessels)

Question 10

What are some differentials for angina?

Answer 10

• Acute myocardial infarction - pain lasts longer than 5 minutes and is not relieved by rest.
• Acute pericarditis: more constant pain, which is aggravated by inspiration, lying flat, swallowing and movement.
• Musculoskeletal pain: worse on movement.
  Injury to the chest wall or pain from the thoracic spine. Deep inspiration and rotation are likely to aggravate the pain and there may be local tenderness.
• GERD: burning pain, most common on lying down and after meals. Exercise may aggravate the pain, which is relieved by acid/alginate mixtures and much reduced by a course of a proton pump inhibitor.
• Pleuritic chest pain: the pain is sharp on deep inspiration. It may occur with infection, especially pneumonia, or with infarction following a pulmonary embolism. There may well be purulent sputum or hemoptysis.