What is angina and what is it caused by?

Angina is a discomfort in the chest or adjacent area that is associated with myocardial ischemia without myocardial necrosis. Angina is due to an imbalance in myocardial oxygen supply and demand.

What factors contribute to myocardial oxygen supply and demand?

Myocardial oxygen supply may be decreased by hypoxia, coronary arterial vasoconstriction, atherosclerotic narrowing of one or more coronary arteries, a nonocclusive intracoronary thrombus, or a combination of two or more of these conditions. Myocardial oxygen demand may be increased by physical exertion, eating (by shunting blood to the gut for digestion), emotional stress (by increasing sympathetic stimulation), and increased metabolic demands (fever, tachycardia, thyrotoxicosis, etc.). Cold weather increases myocardial oxygen demand by increasing peripheral vascular resistance, causing the heart to work harder to maintain adequate peripheral perfusion.

Can the history provide any helpful clues in establishing the diagnosis of angina?

Yes. With a careful history and physical examination, the etiology of the patient’s symptoms can be determined most of the time. The key features of the history that can help in making the diagnosis of angina are:

Character and quality of the chest pain

Location and radiation (if any) of the chest pain

Precipitating, exacerbating, and relieving factors

Duration of the chest pain

Associated symptoms

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