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Angina pectoris
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Angina pectoris

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Contributors: Abdullah S. Abdullah MBBS, MRCP, MSc, Ryan Hoefen MD, PhD
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Synopsis

Angina pectoris, stable angina, and stable coronary artery disease are synonymous terms used to describe chest pain due to myocardial ischemia (usually caused by atheromatous obstruction of one or more coronary arteries) in the absence of acute myocardial necrosis or plaque rupture. Other subsets of ischemic heart disease (IHD) include myocardial infarction (non-ST segment elevation and ST segment elevation), unstable angina, and sudden cardiac death.

The hallmark of stable angina is chest discomfort. In a typical presentation, this manifests as a sensation of tightness or pressure triggered by exertion, cold, or emotional stress. It often comes after a certain amount of exertion in a predictable fashion. Often, patients with this condition rest to ease the discomfort. The pain also generally improves with use of nitroglycerin. Radiation to the shoulders, neck, or jaw may occur. The pain is short lived and starts gradually, rising to a maximum intensity within minutes, often described as "crescendo angina." Chest pain that reaches a peak within seconds should raise the possibility of an alternative diagnosis, notably aortic dissection. Angina equivalent is a term used to describe atypical symptoms due to ischemia, such as dyspnea or syncope. These atypical symptoms are seen more often in women and in elderly and diabetic patients.

Risk factors include hypertension, diabetes mellitus, hyperlipidemia, obesity, and a sedentary lifestyle. Males have a higher risk of developing ischemic heart disease.

Codes

ICD10CM:
I20.9 – Angina pectoris, unspecified

SNOMEDCT:
194828000 – Angina pectoris

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute coronary syndrome (myocardial infarction or unstable angina) – Features include new onset chest pain, pain of a new character, or pain of prolonged duration not relieved by rest. ECG is usually abnormal.
  • Aortic dissection – Acute pain (maximum within seconds) radiating to the back.
  • Pericarditis – Usually presents with pain that is pleuritic and/or positional, abnormal ECG, and abnormal inflammatory markers.
  • Esophageal disorder (ie, esophageal spasm, esophagitis, or reflux) – Pain could be related to food and is occasionally relieved by nitrates.
  • Musculoskeletal pain – Associated with localized pain and tender chest wall.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 09/22/2017
Last Updated: 09/22/2017
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Angina pectoris
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Angina pectoris : Recurring episodes, Chest discomfort
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