| History: Angina is typically described as discomfort beneath the breastbone with pressure, heaviness, or a weight-like sensation that may travel (radiate) across the chest into one or both arms and extend into the fingers. The discomfort may radiate to the back, between the shoulder blades, upper abdomen, neck, left maxilla, mandible (jaw), or earlobes. Individuals with angina sometimes complain of a pressure sensation, tightness, or squeezing in the chest. Angina is a generalized sensation and rarely can individuals point to the exact location of their discomfort.
Angina can be associated with shortness of breath, heavy sweating (diaphoresis), nausea, and vomiting. It can be brought on by exercise, stress, eating a heavy meal, or exposure to cold and wind. It usually occurs in the morning rather than at the end of the day. Angina pain usually lasts at least 30 seconds but not longer than 15 minutes, and is often relieved with rest or nitroglycerin medication, or both. Physical exam: The exam is usually normal in individuals with angina but it may reveal findings associated with risk factors for angina such as high blood pressure, irregular heartbeat, or abnormalities seen with an overactive thyroid. Listening to the heart (auscultation) may reveal extra sounds associated with valve dysfunction or heart failure. Auscultation of the carotid arteries in the neck may identify abnormal sounds (bruits) suggesting atherosclerosis. Tests: Tests include the resting electrocardiogram (ECG) that examines the electrical activity of the heart and detects a new heart attack (myocardial infarction), a heart attack that occurred sometime in the past, or acute changes indicating the heart muscle is not getting enough blood flow (myocardial ischemia). The graded exercise stress test examines the ECG and the individual's symptoms during exercise, and is therefore more sensitive to detecting low blood flow to the heart than the routine ECG. Ambulatory Holter monitoring uses a cassette tape recorder to observe the ECG for a 24-hour period while the individual goes about usual activities. This test is therefore more sensitive to low blood flow conditions during stress or exercise, and to irregularities of heart rhythm that may occur only occasionally.
More sophisticated tests to look at the structure and function of the heart, its arteries, and valves include perfusion scintigraphy, radionuclide angiography, and 2-dimensional echocardiography. Selective coronary angiography is the most definitive diagnostic test for examining the coronary arteries, but it is also invasive. In order to demonstrate vasospasm as the cause of the angina, a drug called ergonovine may be injected directly into the coronary arteries during angiography. |