Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain and tightness located behind the breastbone. Pain commonly radiates to the shoulders, neck, jaw, back, and upper arms, most frequently affecting the left arm. This radiation pattern helps distinguish angina from other causes of chest discomfort.

Beyond chest pain, patients may experience dyspnea, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting. These symptoms often occur alongside the chest discomfort and can help clinicians recognize angina presentations. Symptom patterns vary among patients and may indicate disease severity.

Assessment involves gathering detailed patient history documenting onset, duration, intensity, and triggers of chest pain. Clinicians also evaluate risk factors including hypertension, diabetes, smoking, family history of heart disease, and lifestyle habits. This comprehensive history guides diagnosis and treatment planning.

During physical examination, vital signs including blood pressure, heart rate, and respiratory rate are measured. The heart is auscultated for abnormal sounds or murmurs. Signs of heart failure such as edema or jugular venous distention are inspected. These findings help assess cardiac status and disease progression.

A 12-lead electrocardiogram may reveal T-wave inversion, ST-segment elevation, or abnormal Q waves indicative of ischemia. An exercise stress test evaluates the heart's response to physical activity and detects exercise-induced ischemia. Together, these tests confirm angina and assess cardiac function under stress conditions.

Blood tests for cardiac biomarkers including troponin and CK-MB help rule out myocardial infarction. Lipid profiles assess cardiovascular risk, while imaging studies like echocardiograms and chest X-rays evaluate the heart's size, structure, and function. Advanced tests such as coronary angiography provide detailed images of coronary arteries and detect blockages.

Stable angina follows a predictable pattern triggered by physical exertion, emotional stress, heavy meals, or cold exposure, typically lasting a few minutes. Unstable angina is marked by attacks that increase in frequency and severity, do not relieve with rest or nitroglycerin, and require immediate medical intervention. This distinction is critical for treatment urgency.