Medical history (history of illness) represents an important component in the diagnosis of angina pectoris. Family history Is there a history of frequent cardiovascular disease in your family? Social history What is your profession? Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological … Angina Pectoris: Medical History
Respiratory System (J00-J99) Bronchitis* – inflammation of the mucous membrane of the bronchi. Mediastinitis – serious disease, with inflammation of the mediastinum. Pleurisy* (pleurisy). Pneumonia* (pneumonia) Pneumothorax* – accumulation of air in the physiologically airless space between the lung and pleura. Cardiovascular system (I00-I99) Aortic aneurysm* , symptomatic – outpouching (aneurysm) of the aorta. Aortic … Angina Pectoris: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by angina pectoris or coronary artery disease (CAD): Cardiovascular System (I00-I99) Acute coronary syndrome – spectrum of cardiovascular disease ranging from unstable angina (UA) to the two major forms of myocardial infarction (heart attack), non-ST elevation myocardial infarction (NSTEMI) and ST … Angina Pectoris: Complications
Canadian Cardiovascular Society (CCS): staging of stable angina pectoris. CCS stage Definition 0 Silent ischemia (reduced blood flow) without any symptoms (= no restriction of physical activity)Angina pectoris only during severe, rapid or sustained exertion I Symptomatology only with severe physical exertion (= mild limitation of physical activity)Angina pectoris when walking or climbing stairs at … Angina Pectoris: Classification
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood glucose) (annual control) [oGTT is more appropriate as a screening parameter – see below. oGTT] HbA1c [linear association with coronary artery disease (CAD) in nondiabetics; moreover, independent association of HbA1c level with … Angina Pectoris: Test and Diagnosis
Therapeutic targets Prevention of angina pectoris symptoms. Preservation of exercise capacity* Reduction of cardiovascular morbidity (e.g. heart failure (heart failure), myocardial infarction (heart attack))* . Reduction of CHD associated mental illness (anxiety disorders, depression)* . Reduction in mortality (death rate)* Therapy recommendations * See “Coronary artery disease/drug therapy” below for therapy recommendations. Symptomatic therapy and … Angina Pectoris: Drug Therapy
Medical device diagnostics are based on the patient’s history, any symptoms, and the results of laboratory diagnostics Obligatory diagnostics Resting electrocardiogram (resting ECG with 12 leads) – Indications: Arterial hypertension (high blood pressure) or diabetes mellitus (class II a, C). Resting ECG may be considered (class IIb, C). [Myocardial infarction/heart attack: new pathologic Q-spikes? ST-segment … Angina Pectoris: Diagnostic Tests
For prevention of angina pectoris, refer to Prevention of Coronary Artery Disease (CAD): see “Coronary Artery Disease/Prevention” below.
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 neck–lower jaw region as well as to the upper abdomen, back; pain may be dull, pressing, cramping, or drillingCaution! In … Angina Pectoris: Symptoms, Complaints, Signs
Pathogenesis (disease development) The most common cause of angina is atherosclerosis (arteriosclerosis, hardening of the arteries) of the large coronary vessels (coronary arteries). In second place is microangiopathy – narrowing of the small coronary artery branches (small vessel disease). Other causes of narrowing are vasospasm (vasoconstriction) of the coronary arteries (Prinzmetal’s angina) or allergic reactions … Angina Pectoris: What Causes It?
General measures If pectanginal complaints (“chest tightness”, chest pain) persist for more than 20 minutes or the complaints suddenly become more intense and occur at shorter intervals, then the patient must be immediately admitted to hospital accompanied by an emergency physician (because of suspected acute coronary syndrome = unstable angina pectoris or acute myocardial infarction/heart … Angina Pectoris: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [in left heart failure (left ventricular failure): Neck vein congestion? [Caveat (Warning): May be absent in acute heart failure.] Cyanosis? (purplish-bluish discoloration of oral mucosa, … Angina Pectoris: Examination
