Clinical features

Angina is often a clinical diagnosis:

• atypical presentation is frequently seen in women than in men, in older patients than in younger patients and in patients with diabetes (1)
  
  
• angina is typically a tight, dull or heavy discomfort often seen retrosternally or left side of the chest (2)
• the pain is usually not sharp or stabbing in character and is not influenced by respiration or relieved by antacids and simple analgesia (2)
• there is usually some association with exertion or emotional stress; rest brings relief within a few minutes:
  • discomfort may radiate to arms, neck, jaw or back (2)
• additional precipitants include:
  • cold weather
  • heavy meals
  • emotion (3)
• nitrates typically offer rapid relief (3)
• pain may be associated with atypical symptoms such as fatigue or faintness, nausea, burping, restlessness or a sense of impending doom (3). These atypical symptoma are more likely to be seen in women, older patients and in diabetic patients (1)

The clinical examination is often normal in a patient complaining of angina. There may be signs of conditions which accelerate atherosclerosis:

• there may be signs of conditions which precipitate angina
  • anaemia - pallor
  • thyrotoxicosis - resting tachycardia, tremor, and goitre (1)
• hypertension:
  • the blood pressure should be documented
  • displaced apex beat and fourth heart sound if there is left ventricular hypertrophy
• hypercholesterolaemia:
  • xanthelasma and xanthoma
• smoking:
  • nicotine stains
• diabetes:
  • retinopathy
  • neuropathy

Reference:

• 1. Abrams J. Chronic Stable Angina. NEJM 2005;352:2524-2533
• 2. Scottish Intercollegiate Guidelines Network (SIGN) 2007. Management of stable angina
• 3. Fox K et al. Guidelines on the management of stable angina pectoris: executive summary. European Heart Journal 2006;27(11):1341-1381