ANGINA PECTORIS

MR. khaemba
Angina pectoris is a clinical syndrome usually
characterized by episodes or paroxysms of pain or
pressure in the anterior chest.
The cause is usually insufficient coronary blood flow.
The insufficient flow results in a decreased oxygen
supply to meet an increased myocardial demand for
oxygen in response to physical exertion or emotional
stress.
In other words, the need for oxygen exceeds the supply.
The severity of angina is based on the precipitating
activity and its effect on the activities of daily living.
Precipitating factors for Anginal pain
Physical exertion- increases myocardial oxygen demand
Exposure to cold- causes vasoconstriction and an
elevated blood pressure, with increased oxygen demand
Eating a heavy meal, which increases the blood flow to
the mesenteric area for digestion, thereby reducing the
blood supply available to the heart muscle
Stress or any emotion-provoking situation- causes of
release of adrenaline leading to ↑BP, ↑HR and increase
the myocardial workload
Types of Angina
1. Stable angina: predictable and consistent pain that occurs
on exertion and is relieved by rest
2. Unstable angina (also called preinfarction angina or
crescendo angina): symptoms occur more frequently and
last longer than stable angina. The threshold for pain is
lower, and pain may occur at rest.
3. Intractable or refractory angina: severe incapacitating
chest pain
4. Variant angina (also called Prinzmetal’s angina): pain
at rest with reversible ST-segment elevation; thought to be
caused by coronary artery vasospasm
5. Silent ischemia: objective evidence of ischemia (such as
ECG changes with a stress test), but patient reports no
symptoms
Signs and symptoms
Same as in MI;
Chest pain- retrosternal, may radiate to the jaw, neck,
shoulder, inner aspect of left arm
Weakness or numbness in the arms, wrists, and hands
Shortness of breath
Pallor
Diaphoresis
Dizziness or lightheadedness
Nausea and vomiting.
An important characteristic of angina is that it abates
or subsides with rest or nitroglycerin
Management
Same as MI