Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold exposure.

Angina symptoms often follow a stable and predictable pattern in many patients. However, unstable angina is marked by attacks that increase in frequency and severity, do not relieve with rest or nitroglycerin, and require medical intervention.

Assessment and Diagnosis

Assessing angina involves a thorough, detailed patient history documenting the onset, duration, intensity, and triggers of chest pain and any associated symptoms. Risk factors include hypertension, diabetes, smoking, family history of heart disease, and lifestyle factors are also assessed. During the physical examination, vital signs like blood pressure, heart rate, and respiratory rate are measured. The heart is auscultated for abnormal sounds or murmurs, and signs of heart failure, such as edema or jugular venous distention, are inspected.

Diagnostic Tests and Imaging Studies

Diagnostic tests include a 12-lead electrocardiogram (ECG), which may reveal changes indicative of ischemia, such as T-wave inversion, ST-segment elevation, or the development of an abnormal Q wave. An exercise stress test evaluates the heart's response to physical activity and detects exercise-induced ischemia. Blood tests for cardiac biomarkers, including troponin and CK-MB, help rule out myocardial infarction, while lipid profiles assess cardiovascular risk, and glucose levels screen for diabetes. Imaging studies, such as echocardiograms and chest X-rays, consider the heart's size, structure, and function. Advanced diagnostic tests, like coronary angiography and CT angiography, provide detailed images of coronary arteries and detect blockages. Nuclear stress tests and MRIs assess myocardial perfusion and identify areas of reduced blood flow.