Description of angina by patients
Pressing pain
Constricting pain
Pressing discomfort
Retrosternal heaviness
Burning pain
Dull pain
Like teeth pain
Squeezing
Suffocant
Localization and radiation of typical coronary pain
Sometimes patient describes NB only radiation of pain, including
atypical localizations
Duration of pain
Angina
Retrosternal pain lasts more than 15 minutes:
1.Acute MI ?
2.non-coronarogenic ?
Pain relief
Increasing supply
Decreasing demand (rest)
Summary on coronary chest pain
Localization: |
retrosternal |
Radiation: |
Left scapula, left arm, |
Character: |
mandibula, neck…. |
pressing, squeezing, burning |
|
Appears: |
During physical or emotional stress |
Stops: |
At rest |
Reliever: |
Nitroglycerin (after 2-3 min) |
Accompanying symptoms Fear, sweating, nausea
SYNDROME OF ANGINA
Angina is unlikely
Pricking like a needle |
|
Itching |
|
|
Shooting |
|
Tingling |
|
Knife-like |
|
Cutting |
Classification of chest pain
Typical (definite) angina
1.Retrosternal chest pain with typical character and duration
2.Is provoked by physical exertion and stress
3.Stops at rest and/or several minutes after nitrates intake
Atypical (probable) angina: 2 criteria of above mentioned
Not angina: ≤1 criteria
Рекомендации ЕОК по стабильной ИБС 2013
Distinguishing between angina and cardialgia
|
Angina |
Cardialgia |
Character |
Pressing, squeezing |
Pricking, nagging |
Localization |
retrosternal |
At the apex, in the |
|
|
shoulder, along the |
|
|
ribs |
Radiation |
Left shoulder, scapula |
- |
Is provoked by |
Physical exercise |
Other reasons: no |
|
|
association with |
|
|
exercise. Ma be |
|
|
provoked by meals, |
|
|
movements |
Nytroglycerin |
Stops the pain |
No effect |
effect |
|
|
Dyspnea
Subjective experience of breathing discomfort that consists of qualitatively distinct sensations – effort/work, chest tightness and air hunger and is accompanied by change in rhythm and deepness of breathing
Appears during exercise and at rest
Usually mixed
Goes with orthopnea
Principle causes:
1.Elevated pressure in pulmonary circulation:
-Decreased contractility of LV
-Diastolic dysfunction of LV
-Valvular disease
2.Pulmonary embolism
3.Arrythmias
Suffocation
Severe sudden dyspnea accompanied by fear of death, anxiety and signs of respiratory failure
Causes:
Lung diseases – severe bronchospasm, leads inability to exhale (asthma, COPD)
Heart diseases – congestion of blood in pulmonary circulation and development of pulmonary edema (AH, MI, mitral stenosis…)