Anginal syndrome

Diuretics are very effective in the treatment of cardiac oedema, specifically the one related with congestive heartfailure. They are employed extensively in various types of disorders, for example, nephrotic syndrome, diabetes insipidus, nutritional oedema, cirrhosis of the liver, hypertension, oedema of pregnancy and also to lower intraocular and cerebrospinal fluid pressure. In some instances where oedema is not present, the diuresis may be specifically indicated and effected by certain highly specialized dimetics as in hypertension, epilepsy, migraine, glaucoma, anginal syndrome and bromide intoxication. 

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 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... 

This syndrome is defined as a chest pain frequently of anginal characteristics that is related to small-vessel disease, in the absence of atherosclerotic lesions. It is more frequently seen in the female population, and probably but not always ischaemia is the origin of the chest pain (Kaski, 2004). 

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. 

Angina pectoris is the principal syndrome of ischemic heart disease, anginal pain occurring when axy- en delivery to the heart is inadequate for myocardial requirement. 

Because Cora Nari s lipid profile indicated an elevation in both serum j triacylglycerols and LDL cholesterol, she was classified as having a com-bined hyperlipidemia. The dissimilarities in the lipid profiles of Cora and her two siblings, both of whom were experiencing anginal chest pain, is characteristic of the multigenic syndrome referred to as familial combined hyperlipidemia (FCH). 

When it was used experimentally by 20 patients, an increase in heart rate was seen in all, frank tachycardia in 4. Anginal pains were reported by 6 patients. Symptoms of shock were observed in 2 cases, while in 6 patients redness of the skin, flushing and sweating occurred. In one case there was a paradoxical reaction in the form of a marked increase in blood pressure with tachycardia, anginal pains, flushing and sweating. This whole syndrome lasted for some 4 hours (124 ). 

---