Angina clinical presentation

Nesto RW, Waxman S, Mittleman MA, et al. Angioscopy of culprit coronary lesions in unstable angina pectoris and correlation of clinical presentation with plaque morphology. Am J Cardiol 1998 81 225-228. 

Generally, the clinical presentation of myocardial ischaemia is the characteristic pain known as angina pectoris or some equivalents (e.g. dyspnoea), although sometimes ischaemia may be silent (see Silent ischaemia , p. 302). If the anginal pain is new or if it has increased with respect to previous discomfort (crescendo angina), this constitutes the clinical condition called acute coronary syndrome (ACS), which may evolve into myocardial infarction (MI) (see Section Acute coronary syndrome , p. 209). If the angina pain appears with exercise... 

The clinical presentation varies widely, ranging from no symptoms to severe symptoms of angina, HF, and/or sudden cardiac... 

Peripheral arterial occlusion can be the initial manifestation of cardiac or systemic disease. At times, patients with chronic stable claudication may experience abrupt shortening of the distance at which claudication occurs, and this may be the only symptomatic evidence of an acute arterial occlusion either by embolization of by thrombus formation on a pre-existing arterial stenosis. The situation is not chronic and stable any more, but acute and unstable. As ischemia becomes more severe, the patient with chronic peripheral arterial disease develops ischemic pain at rest. The pathophysiologic mechanisms and the clinical presentation parallel the evolution of chronic stable angina pectoris to unstable angina and acute coronary syndromes. 

Patients with acute coronary syndromes such as acute myocardial infarction and unstable angina remain at risk for recurrent myocardial ischemia despite therapy with antiplatelet agents and heparin. Although first clinical trials indicate a possible use of oral direct TIs for the prevention of cardiovascular events in patients after acute myocardial infarction, the presently available data are still limited and it has not... 

Table 3 presents the baseline demographic, clinical, and angiographic characteristics of the patients. Mean age was 63 years, More than 60% of patients presented with unstable angina 20% were diabetic, 23% had a previous AMI, and more than 80% had class B or C lesions according to the American College of Cardiology/American Heart Association classification. 

The interpretation of these sporadic cases is controversial, although some have argued that the reported cardiovascular adverse effects occur more often with sildenafil than with other pharmacological treatments of erectile dysfunction. It is at present unclear whether there is an increased risk with sildenafil. For example, in placebo-controlled trials there have been no differences in the incidences of myocardial infarction, angina, or coronary artery disorders between sildenafil and placebo (9). Exclusion criteria in clinical trials may have prevented the inclusion of patients who are at increased risk of adverse events. On the other hand, sexual activity itself increases cardiac workload and the risk of myocardial infarction. Patients with cardiovascular disease should be cautious in their use of sildenafil. 

HPI A 60-year-old woman presents to the clinic for a 6-month follow-up examination for newly diagnosed HTN, which has not been adequately controlled by dietary and lifestyle changes. PMH Angina and asthma. 

The clinical history remains of substantial value in estab-hshiug a diagnosis. A prodromal history of angina can be elicited in 40% to 50% of patients with AML Of the patients with AMI presenting with prodromal symptoms, approximately one third have had symptoms from 1 to 4 weeks before hospitahzation in the remaining two thirds, symptoms predate admission by a week or less, with one third of these patients having had symptoms for 24 hours or less. 

The philosophy of evidence-based practice is widely accepted, although operational and implementation issues represent major barriers. One of the significant barriers is a shortage of evidence reports on topics of critical interest, and the lack of a national infrastructure to prepare such reports. In response to this need, AHRQ has funded 12 Evidence-based Practice Centers to conduct systematic, comprehensive analyses and syntheses of the scientific literature to develop evidence reports and technology assessments on clinical topics that are common, expensive, and present challenges to decision makers. Since December 1998, 11 evidence reports have been released on topics that include sleep apnea, traumatic brain injury, alcohol dependence, cervical cytology, urinary tract infection, depression, dysphasia, sinusitis, stable angina, testosterone suppression, and attention deficit hyperactivity disorder. 

The term acute coronary syndrome (ACS) encompasses all the clinical situations with acute myocardial ischaemia expressed by chest pain, discomfort or equivalent, which appears suddenly at rest (de novo) or has increased with regard to prior anginal (in crescendo angina). All this leads the patient to seek urgent medical care. However, occasionally the patient may underestimate the symptoms or the physician may not interpret them properly. In addition, the ACS may occur with no anginal pain, or the pain may be atypical or may present other... 

S3 (ventricular gallop) Increased left ventricular diastolic pressure, with or without clinical CHE Not usually present unless patient sustained extensive Ml may occasionally be present during angina... 

A 52-year-old man presented at the Accident and Emergency department with severe chest pain which had been present for the past hour. He had previously attended the chest pain clinic and had a 2-year history of angina of effort. 

United States have diverse chemical structures. Five classes of compounds have been examined phenylalkylamines, dihy-dropyridines, benzothiazepines, diphenylpiperazines, and a diarylaminopropylamine. At present, verapamil (a phenyl-alkylamine) diltiazem (abenzothiazepine) nifedipine, amlo-dipine, felodipine, isradipine, nicardipine, nisoldipine, and nimodipine (dihydropyridines) and bepridil (a diarylaminopropylamine ether used only for refractory angina) are approved for clinical use in the United States. 

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