Angina Pectoris Characters – Chest Pain

angina pectoris charactersAngina pectoris is defined as pain (discomfort), located most often retrosternal that has relatively specific characters, precipitated of physical effort and relieved by rest or sublingual nitroglycerin.

Characteristics of angina

  1. Location: typical retrosternal, rarely precordial, epigastric, interscapular – spinal or just in the irradiation zone;

  2. Irradiation: the most common are at the level of the left shoulder, the inner edge of the left arm and the neck. Other areas of irradiation are shoulders, arms, jaw, teeth, anterior chest, elbows, punches, and epigastrium. There are cases in which pain is perceived only in the areas of radiation.

  3. angina pectoris pain irradiationPain characters: constriction, chest pressure or precordial, dull, oppressive, burning, crushing, chest discomfort or nondescript. Stinging, pain with sharp character, twinge chest, breathing dependent, position crises are unlikely to be angina.

  4. Duration, intensity: are variables for stable angina typical length is 3-5 minutes, and the intensity is average. The access begins gradually, reaches a maximum point and then gradually removes after the end of exercise or the administration of sublingual nitroglycerin. A very strong pain lasting longer than 10-15 minutes is a counter argument for angina of effort and requires a differential diagnosis with acute coronary syndromes, aortic dissection, and pulmonary pleural disease.

  5. Pain triggers: physical effort, more frequently the isometric (high) one than isotonic (walking), psycho-emotional factors, lunches rich (by redistributing blood flow in the mesenteric territory), sexual effort, and tachyarrhythmia. The most common trigger of stable angina remains the physical effort. Angina pain may occur at rest with the significance of impairment of coronary vascular bed.

  6. Frequency of angina attacks: is addicted to the appearance of the provocative factors, some patients have rare bouts (weekly), to others it is higher (daily). Increased frequency of angina episodes may signify the existence of severe ischemia (unstable angina). It meets a circadian variation of occurrence of maximum pain in the morning and between the hours of 9-10.

  7. Symptoms associated with pain: dyspnea (difficulty breathing), sweating, anxiety, fatigue, faintness, nausea.

  8. nitroglycerin sublingual angina pectorisThe action of nitroglycerin: the administration of nitroglycerin sublingual which occupies the angina access between 1-3 minutes. If the pain recedes to a more prolonged period of time (20-30 minutes), then either its cause is ischemic origin, or it is a severe episode of ischemia.

Nocturnal angina

  • Decubitus angina that occurs during sleep and is accompanied by dyspnea and disappears when rising, the effective response to nitroglycerin and diuretics;

  • Angina in the last phase of sleep with favorable response to beta-blockers.


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