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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Angina is often a clinical diagnosis: (1)

  • atypical presentation is frequently seen in women than in men, in older patients than in younger patients and in patients with diabetes
  • angina is typically a tight, dull or heavy discomfort often seen retrosternally or left side of the chest
  • the pain is usually not sharp or stabbing in character and is not influenced by respiration or relieved by antacids and simple analgesia
  • 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
  • additional precipitants include:
    • cold weather
    • heavy meals
    • emotion
  • nitrates typically offer rapid relief
  • pain may be associated with atypical symptoms such as fatigue or faintness, nausea, burping, restlessness or a sense of impending doom These atypical symptoms are more likely to be seen in women, older patients and in diabetic patients (2)

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
  • 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


  • 1. NICE. Stable angina: management. Clinical guideline [CG126]Published: 23 July 2011 Last updated: 25 August 2016
  • 2. Von H. et al. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms? Journal of the American Heart Association March 2020. Vol. 9, No. 7.

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