Angina pectoris

Introduction Angina pectoris is a clinical syndrome characterized by episodes of chest pain or chest discomfort caused by acute coronary insufficiency, acute myocardial ischemia, and hypoxia. It is characterized by paroxysmal chest compression pain, which can be accompanied by other symptoms. The pain is mainly located in the posterior part of the sternum and can be radiated to the anterior and left upper limbs. It often occurs during labor or emotional excitement. ~5min, can be used once a day, or several times a day, rest or disappear after using nitrate ester preparation. The disease is more common in men, most patients are over 40 years old, tired, emotional, full of food, cold, rainy weather, acute circulatory failure are common causes.

Cause

The main pathological changes in angina are varying degrees of coronary atherosclerosis. The risk factors for coronary atherosclerosis are currently considered to be dyslipidemia, hypertension, diabetes, smoking, obesity, hyperuricemia, hyperfibrinogenemia, genetic factors, and the like. In addition, men, old age, and people who do not love sports often.

an examination

Related inspection

Cardiovascular angiography Doppler echocardiography dynamic electrocardiogram (Holter monitoring) selective cardiovascular angiography cardiovascular MRI

According to the typical characteristics and signs of seizures, the relief with nitroglycerin, combined with age and the predisposition to coronary heart disease, except for angina caused by other causes, can generally establish a diagnosis.

At the time of onset, ECG examination showed that in the lead-based lead, the ST segment was depressed, the T wave was flat or inverted (variant angina was associated with ST-segment elevation), and gradually recovered within a few minutes after the onset. Patients with no changes in ECG may be considered for stress testing. If the episode is atypical, the diagnosis depends on the observation of the efficacy of nitroglycerin and the changes in the electrocardiogram at the time of onset; if it is still undiagnosed, the electrocardiogram, ECG load test or continuous monitoring of 24-hour Holter can be performed multiple times, such as positive changes in ECG or load test. Can also be diagnosed when induced angina pectoris. Those who have difficulty in diagnosis can be used for radionuclide examination or for selective coronary angiography. Selective coronary angiography is required for patients undergoing surgical treatment. Intracoronary ultrasonography can show lesions in the wall and may be more helpful for diagnosis. Coronary angioscopy can also be considered.

In China, the performance of patients with angina pectoris is often atypical, so it is necessary to be cautious when judging chest discomfort or pain or angina. In recent years, foreign scholars have also emphasized that angina is not a complete expression of pain. The patient's feeling of myocardial ischemia and hypoxia may be other feelings other than pain, and thus may deny feeling pain. The following aspects help to discriminate angina pectoris clinically.

(1) Nature

Angina should be crushed, compressed, suffocated, heavy and swelled, not sharp or painful, sharp acupuncture or electric shock, or a feeling of chest tightness around the clock. In fact, it is not "colic." In a small number of patients, there may be a burning sensation, a feeling of tension or shortness of breath accompanied by a tight sense of pressure above the throat or trachea. Pain or discomfort begins with a lighter, progressive increase, and then gradually disappears, rarely affected by postural changes or deep breathing.

(2) Parts

Pain or discomfort is often located in the sternum or adjacent to it, or at any level between the upper abdomen and the pharynx, but rarely above the pharynx. Sometimes it can be located in the left shoulder or left arm, and occasionally in the right arm, lower jaw, lower cervical vertebra, upper thoracic vertebra, left shoulder tibia or upper scapula, but few in the left or lower left chest. For the extent of pain or discomfort distribution, patients often need to use the entire palm or fist to indicate that only one finger is used to indicate that there is very little.

(3) Time limit

1 to 15 minutes, most of the 3 to 5 minutes, occasionally up to 30 minutes (except for the intermediate syndrome), the pain lasts only a few seconds or discomfort (mostly sullen) for a whole day or a few days are not like angina.

(four) predisposing factors

Physical exertion is the main factor, followed by emotional excitement. Going to the building, walking on the ground, walking after a meal, walking against the wind, even taking a light stool or lifting the arm over the head, exposed to cold, cold drinks, pain in other parts of the body, and horror, nervousness, anger, trouble, etc. Emotional changes can be induced. The morning pain threshold is low, and mild labor such as brushing, shaving, walking can cause seizures; in the morning and afternoon, the pain threshold is increased, and the heavier labor may not be induced. The discomfort that occurs after physical activity, not at the time of physical activity, does not resemble angina. Physical activity and emotional activity are more likely to be induced. Spontaneous angina can occur without any obvious cause.

(5) Effect of nitroglycerin

Sublingual nitroglycerin tablets should be effective, and angina should be relieved within 1 to 2 minutes (it also takes 5 minutes, taking into account that the patient may not be accurate enough). For supine angina, nitroglycerin may not be effective. When assessing the effects of nitroglycerin, it is also important to note whether the drug used by the patient has failed or is near failure.

Differential diagnosis

(a) cardiac neurosis

Patients with this disease often complain of chest pain, but for a short (several seconds) sting or a longer lasting (hours) of pain, patients often like to take a deep breath or sigh breath from time to time. The area of chest pain is mostly near the apex of the left breast, or changes frequently. Symptoms often appear after fatigue, while at the time of fatigue, mild activity is reflexive comfort, sometimes it can tolerate heavier physical activity without chest pain or chest tightness. Containing nitroglycerin is ineffective or "effective" after more than 10 minutes, often accompanied by symptoms of palpitations, fatigue and other nervous failure.

(two) acute myocardial infarction

The pain site of this disease is similar to angina pectoris, but the nature is more intense, the duration can be several hours, often accompanied by shock, arrhythmia and heart failure, and fever, containing nitroglycerin can not alleviate it. In the electrocardiogram, the ST segment of the lead to the infarction site is elevated and has an abnormal Q wave. Laboratory tests showed that white blood cell counts and serological tests showed an increase in creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase, myoglobin, myosin light chain, and increased erythrocyte sedimentation rate.

(C) X syndrome (syndrome X)

The disease is caused by small coronary artery systolic dysfunction, with recurrent angina pectoris as the main manifestation, pain can also occur at rest. At the time of onset or after the load, the electrocardiogram can show myocardial ischemia, the myocardial perfusion can show defects, and the echocardiogram can show segmental wall motion abnormalities. However, this disease is more common in women, the risk factors of coronary heart disease are not obvious, the pain symptoms are not typical, the coronary angiography is negative, the left ventricle is not hypertrophic, the ergometrine test is negative, the treatment response is unstable and the prognosis is good, then the crown Heart disease is different from angina.

(4) Angina caused by other diseases

Including severe aortic stenosis or regurgitation, coronary arteritis caused by rheumatic fever or other causes, coronary stenosis or occlusion caused by syphilitic aortitis, hypertrophic cardiomyopathy, congenital coronary artery malformation, etc., causing angina pectoris, Identification should be based on other clinical manifestations.

(5) intercostal neuralgia

The pain of this disease often involves 1 or 2 intercostal spaces, but it is not necessarily limited to the front chest. It is tingling or burning pain. It is mostly persistent rather than seizure. Cough, forced breathing and body rotation can aggravate the pain. There is tenderness at the nerve path, and there is local pain during the lifting of the arm, so it is different from angina. In addition, atypical angina needs to be differentiated from chest and abdomen pain caused by esophageal lesions, sputum, ulcer disease, intestinal disease, and cervical spondylosis.

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