Types of Angina

Stable (SA) – chronic stable angina is angina which follows a precipitating event (exercise like stair climbing or walking up a hill, after a heavy meal, after sexual intercourse, after emotional stress, after being out in the cold weather). This form of angina is characterized by repeated similar attacks and is relieved by the same number of nitroglycerin pills. It is usually caused by a fixed obstruction of the coronary artery secondary to atherosclerosis.

Unstable (USA)(Rest or Crescendo Angina) – which is defined as Class I or II angina that started or progressed within the last 2 months or with chest pain at rest for greater then 20 minutes. (This form of angina is of recent origin and is of increasing severity, frequency, duration, and more nitroglycerin pills are needed to control it.)

Prinzmetal’s Variant Angina – is angina that occurs at rest, with electrocardiogram showing episodes of ST elevations, with ventricular arrhythmias often occurring in these patients, and caused by coronary artery spasm with or without superimposed coronary artery disease.

Clinical Characteristics of Angina

Evaluate all three types of angina with the following guidelines:

  • History:
    • Pressure, heaviness, squeezing, or a suffocating discomfort or ache (not described by patient as a pain) in the substernal or retrosternal area that may radiate into the neck, jaw, epigastric region, arms or shoulder
    • Usually lasting for minutes (not seconds and usually not hours)
    • Provoked by physical or emotional stress
    • Relieved by rest or nitroglycerin
    • Associated symptoms include dyspnea, diaphoresis and nausea
    • Symptoms that are not suggestive of Angina:
      • Pain lasting for a few days or for a few seconds
      • Pain localized with one finger.
      • Pain mainly in the umbilical region or in the lower abdomen
      • Pain radiating to the lower extremities
      • Pain that is exactly caused by or reproduced with movement of the chest or arms

  • Physical examination:
    • Frequently unremarkable
    • On auscultation with ongoing chest pain physician may hear:
      • A new gallop (S3 and/or S4)
      • A new mitral regurgitation murmur
      • Pulmonary crackles

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