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Chronic%20coronary%20syndromes Signs and Symptoms
Introduction
- Also known as stable coronary artery disease (CAD), stable ischemic heart disease (SIHD), chronic stable angina or stable angina pectoris
- Clinical syndrome characterized by constricting discomfort in the chest, neck, jaw, shoulder, back or arms which is precipitated by exertion and/or emotional stress and relieved by rest and/or Nitroglycerin
- Can be attributed to myocardial ischemia of which atherosclerotic coronary artery disease is the most common cause
- Angina is stable when it is not a new symptom and when there is no deterioration in frequency, duration or severity of episodes
Signs and Symptoms
- Quality of chest pain
- Described as squeezing, grip-like, suffocating and heavy pain but rarely sharp or stabbing and typically does not vary with position or respiration
- Occasionally, the patient may demonstrate a Levine’s sign in which a clenched fist is placed over the precordium to describe the pain
- Many patients do not describe angina as frank pain but as tightness, pressure or discomfort
- Other patients, particularly women and elderly, can manifest with atypical symptoms such as nausea, vomiting, midepigastric discomfort or sharp (atypical) chest pain
- Location of pain or discomfort
- Usually substernal and pain can radiate to the neck, jaw, epigastrium, shoulders, back or arms
- Pain above the mandible, localized to a small area over the left lateral chest wall or below the epigastrium is rarely anginal
- Duration of pain
- Lasts for minutes, usually not >20 minutes
- Precipitating factors
- Often precipitated by exertion, emotional stress, heavy meal or cold weather
- Alleviating factors
- Typically relieved by rest
- Sublingual Nitroglycerin also relieves angina within 30 seconds to several minutes
Risk Factors
Conditions that Exacerbate or Provoke Ischemia
Noncardiac Diseases
Noncardiac Diseases
- Hyperthyroidism
- Hyperthermia
- Anxiety
- Anemia
- Hyperviscosity
- Leukemia
- Hypertension
- Sympathomimetic toxicity (eg cocaine toxicity)
- Arteriovenous fistulae
- Sickle cell disease
- Polycythemia
- Thrombocytosis
- Hypergammaglobulinemia
- Hypoxemia secondary to pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary hypertension, obstructive sleep apnea, interstitial pulmonary fibrosis
- Aortic stenosis
- Dilated cardiomyopathy
- Arrhythmias (eg supraventricular tachycardia, ventricular tachycardia)
- Hypertrophic cardiomyopathy
- Significant coronary obstruction
- Microvascular disease
- Unstable angina is defined as angina of new onset, increases in frequency, intensity or duration, or occurs at rest
- Presence of unstable angina predicts a higher short-term risk of acute coronary event
- Moderate- to high-risk patients should be promptly evaluated and treated in the emergency department because of higher risk of coronary artery plaque rupture and death
- Low-risk patients are comparable to those patients with stable angina and their evaluation can be performed safely and expeditiously in an outpatient setting
- Please see Acute Coronary Syndromes w/out Persistent ST-Segment Elevation disease management chart for further information
