Angina Pectoris: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate angina pectoris (AP):

  • Sudden onset of retrosternal (“behind the sternum localized”) pain (of short duration; see below), left > right; usually radiating to the left shoulder-arm region or necklower jaw region as well as to the upper abdomen, back; pain may be dull, pressing, cramping, or drillingCaution! In some cases, the pain is localized in other regions and radiates to the thorax (chest); sometimes the thorax is not affected at all.Furthermore, the following characteristics are met:
    • Triggered by physical or psychological stress (trigger mechanisms: see below).
    • Decline at rest and/or within a few minutes after nitrate application.
  • Feeling of tightness or annihilation
  • Dyspnea (shortness of breath), suffocation.
  • Sweating
  • Anxiety up to fear of death

The duration of an AP is minutes in the context of the trigger mechanism and usually lasts no longer than 20 minutes.Trigger mechanisms can be: physical and emotional stress, opulent meal, cold, etc..

Typical angina is present when all three of the following characteristics are met:

  • Retrosternal symptomatology/pain of short duration.
  • Triggered by physical or psychological stress
  • Decrease at rest and/or within a few minutes after nitrate application

If only two of these three characteristics are met, it is called “atypical angina“. If only one or none of these three points apply, one speaks of non-anginal thoracic symptoms. Stable angina pectoris is classified into different degrees of severity using the CCS classification (classification of the Canadian Cardiovascular Society) (see classification below).

Definition: Thoracic pain (chest pain) reproducible by physical or mental exertion that resolves at rest or after administration of nitroglycerin.

Unstable angina (UA) is defined as follows:

Classification of unstable angina.

Severity Clinical situation
Class A Class B Class C
Class I: new-onset severe or worsening angina pectoris (AP), no resting AP. IA IB IC
Class II: resting AP in the past month but not in the past 48 h (subacute AP). IIA IIB IIC
Class III: resting AP within the past 48 h (acute resting AP). IIIA IIIC

Legend

  • Class A: patients with an extracardiac cause (cause located outside the heart/secondary angina, AP).
  • Class B: patients without an extracardiac cause (primary unstable AP).
  • Class C: patients 2 weeks after myocardial infarction/heart attack (postinfarction AP).

Warning signs (red flags)