Angina pectoris Ana Gašparović Mentor A Žmegač Horvat

Angina pectoris Ana Gašparović Mentor: A. Žmegač Horvat

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

Angina can be: Stable Unstable caused by unstable plaque, occurs at rest, unpredictable, pain can increase for no obvious reason Prinzmetal’s occurs without provocation, usually at rest, as a result of coronary artery spasm

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

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

Clinical symptoms Patient history is a˝golden standard˝ Retrosternal pain Dyspnea Nausea Arrhythmia Restlessness Levine sign Pain eased after taking nitrates

Physical examination Hypertension Obesity Hyperglycemia Hyperlipidemia Auscultation

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

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

Literature : P. Kumar and M. Clark: Kumar & Clark’s Clinical Medicine Božidar Vrhovac and associates: Interna Medicina Damjanov, Jukić, Nola : Patologija