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Ns. M. Nurman, M.Kep
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

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Angina pectoris

  • 2. 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
  • 3. 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
  • 4. 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
  • 5. Etiology and pathogenesis  Symptoms are results of myocardial ischemia due to insufficient blood flow through atherosclerotically changed coronary vessels
  • 6. Clinical symptoms  Patient history is a˝golden standard˝  Retrosternal pain  Dyspnea  Nausea  Arrhythmia  Restlessness  Levine sign  Pain eased after taking nitrates
  • 7. Physical examination  Hypertension  Obesity  Hyperglycemia  Hyperlipidemia  Auscultation
  • 8. Investigations  Laboratory tests (leukocytes, hemoglobin, thyroid hormones, troponin I and T, MB-CPK)  Resting ECG  Excercise ECG  Cardiac scintigraphy  Echocardiography  Coronary angiography
  • 9. 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
  • 10.  Literature : P.Kumar and M.Clark: Kumar & Clark’s Clinical Medicine Božidar Vrhovac and associates: Interna Medicina Damjanov, Jukić, Nola : Patologija