Anginal symptoms

The evaluation of a patient with suspected IHD begins with a detailed history of anginal symptoms. The five components commonly used to characterize chest pain are quality, location, duration of pain, factors that provoke pain, and factors... 

Although P-blockers should be avoided in patients with decompensated heart failure from left ventricular systolic dysfunction complicating an MI, clinical trial data suggest that it is safe to initiate P-blockers prior to hospital discharge in these patients once heart failure symptoms have resolved.64 These patients may actually benefit more than those without left ventricular dysfunction.65 In patients who cannot tolerate or have a contraindication to a P-blocker, a calcium channel blocker can be used to prevent anginal symptoms, but should not be used routinely in the absence of such symptoms.2,3,62... 

A calcium channel blocker can be used to prevent anginal symptoms in patients who cannot tolerate or have a contraindication to a /1-blocker but should not be used routinely in the absence of such symptoms. 

The short-term goals of therapy for IHD are to reduce or prevent anginal symptoms that limit exercise capability and impair quality of life. Longterm goals are to prevent CHD events such as MI, arrhythmias, and heart failure and to extend the patient s life. 

Short-acting nitrates, such as nitroglycerin, are predominantly used for the suppression of acute anginal symptoms. The well-known sublingual (oro-mucosal) route of administration is characterised by... 

Because of these interindividual variations in the kinetics of propranolol, the therapeutic dose of this drug is best determined by titration. End points of titration include relief of anginal symptoms, increases in exercise tolerance, and plasma concentration of propranolol between 15 and 100 ng/mL. For additional details on the pharmacokinetics of propranolol and other (3-receptor antagonists approved for clinical use in the treatment of angina pectoris, see Table 17.3 and Chapter 11. 

The development of useful vasodilators for management of angina has been marked by frustrating episodes when pharmacologists found that new drugs that were extremely effective vasodilators in normal animals were ineffective or even caused increased anginal symptoms in patients. It is now... 

Nitrates, (3-blockers, and calcium channel blockers are equally effective for relief of anginal symptoms. However, for prompt relief of an ongoing attack of angina precipitated by exercise or emotional stress, sublingual (or spray form) nitroglycerin is the drug of choice. 

Stone PH, Gibson RS, Glasser SP, DeWood MA, Parker JD, Kawanishi DT, Crawford MH, Messineo FC, Shook TL, Raby K, et al. Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group. Circulation 1990 82(6) 1962-72. 

As shown in Table 4, sophisticated adhesive patches for transdermal delivery of scopolamine (motion sickness), nitroglycerine (anginal symptoms), clonidine (regulation... 

Lanza GA, Colonna G, Pasceri V, Maseri A. Atenolol versus amlodipine versus isosorbide-5-mononitrate on anginal symptoms in syndrome X. Am J Cardiol 1999 84 854-856, A8. 

Symptoms of pulmonary hypertension include dyspnea on exertion, chest pain, palpitations, syncope, ascites and lower extremity edema. Anginal symptoms may occur and are thought to be due to increased RV oxygen demand, decreased right coronary artery perfusion due to decreased pressure difference between aorta and RV end diastolic pressure, and rare instances of compression of the left main coronary artery by the dilated pulmonary trunk. Right ventricular hypertrophy (RVH) correlates with EKG findings including RV... 

Tachycardia, hypotension, nausea, headache, palpitations, anginal symptoms, dyspnea, ventricular arrhythmias. 

The latter patients as well as patients with typical anginal symptoms, where a low CACS may not confer the same low risk as generally seen in heterogeneous groups, are best evaluated initially by SPECT rather than CT. 

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