Crescendo angina

The principal forms relevant to choice of drug therapy are angina of exercise (commonest) and its worsening form, unstable (preinfarction or crescendo) angina (see below), which occurs at rest. Variant (Prinzmetal) angina (very uncommon) results from spasm of a large coronary artery. 

M. J. Davies and A. C. Thomas, Plaque Assuring - the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina, Br Heart J Si, 363-373 (1985). 

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... 

Figure 4.62 Above (Left) A 65-year-old man with typical in-crescendo angina, and practically normal ECG at rest. Only in some leads there is an ST-segment depression but not higher than 0.5 mm. (Right) During exercise test appears anginal pain and an evident, but not huge.

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... 

Vasospastic angina (Prinzmetal s variant), unstable (crescendo or preinfarction) angina, chronic stable (effort-associated) angina PO Initially, 80-120 mg 3 times a day For elderly patients and those with hepatic dysfunction, 40 mg 3 times a day. Titrate to optimal dose. Maintenance 240-480 mg/day in 3-4 divided doses. 

Classic angina (angina of effort or exercise) is due to coronary atherosclerotic occlusion vasospastic or variant angina (Prinzmetal) is due to a reversible decrease in coronary blood low unstable angina (crescendo) presents as an acute coronary syndrome with platelet aggregation. 

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