Ns. M. Nurman, M.

Kep
Definition
Generally described as
retrosternal heavy or gripping
sensation with radiation to left
arm or neck, provoked by exertion
and eased with rest or nitrates
Angina can be:
Stable

Unstable caused by
unstable plaque, occurs at
rest, unpredictable, pain
can increase for no obvious
reason

Prinzmetal’s occurs
without provocation,
usually at rest, as a result of
coronary artery spasm
Stable angina pectoris
Provoked by physical exertion,
especially in cold weather,
after meals and commonly
aggravated by anger or
excitement
 The pain fades quickly with
rest
 In some patients pain occurs
predictably at a certain level of
exertion
Etiology and pathogenesis
Symptoms are results of
myocardial ischemia due to
insufficient blood flow through
atherosclerotically changed
coronary vessels
Clinical symptoms
Patient history is a˝golden standard˝
Retrosternal pain
Dyspnea
Nausea
Arrhythmia
Restlessness
Levine sign
Pain eased after taking nitrates
Physical examination
Hypertension
Obesity
Hyperglycemia
Hyperlipidemia
Auscultation
Investigations
Laboratory tests (leukocytes, hemoglobin,
thyroid hormones, troponin I and T, MB-CPK)
Resting ECG
Excercise ECG
Cardiac scintigraphy
Echocardiography
Coronary angiography
Treatment
Prognostic therapy: Aspirin, lipid-lowering therapy
Symptomatic treatment: GTN, beta-blockers,
long-acting nitrates, calcium-channel blockers, ACEI
Percutaneous coronary intervention, coronary artery
bypass grafting
 Literature :
P.Kumar and M.Clark: Kumar & Clark’s Clinical Medicine
Božidar Vrhovac and associates: Interna Medicina
Damjanov, Jukić, Nola : Patologija