Angina pectoris

Angina pectoris is a clinical syndrome of discomfort due to transient myocardial ischemia. It is worsened by factors which increase myocardial oxygen requirement or reduce supply. Transient myocardial ischemia is due to one or both of obstruction of coronary flow by atheroma. Clinical features are follows 1.Pian is usually in location and brought on by exertion. It is relieved by rest and sublingual nitrates, Pain seldom lasts more than 20 minutes, 2.Angina decubitus is pain while lying flat, 3.Nocturnal angina is an unusual form of angina occurring on aortic regurgitation, 3.Prinzmetal’s angina or variant angina is pain which comes capriciously due to coronary arterial spasm and is accompanied by transient ST segment elevation on ECG. Physical examinations are usually negative, but may find tendon xanthomas, thickening of Achilles tendons, aortic valve disease, diabetes, peripheral vascular disease and obesity. Some physical examinations are rise in blood pressure and heart rate, fourth heart sound and relief of pain by carotid sinus massage. Investigations are 1.Electrocardiography –ECG is normal in most patients at rest and in between attacks. Patients may require exercise testing, 2.Myocardial perfusion scanning using small radioactive thallium; 3.Echocardigraphy and radionuclide blood pool scanning provide information about ventricular function