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Feature Article

Angina pectoris: why differentiating the type is so important

Su Ling Tee, John D Horowitz

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Abstract

Apart from the traditionally recognised conditions of stable and unstable angina, many other disease entities produce anginal-type chest pain. Each of these presents its own diagnostic challenges.

Key Points

  • It has now emerged that apart from the traditionally recognised conditions of stable and unstable angina, many other disease entities produce anginal-type chest pain.
  • Angina can be classified by type, taking into account the pathogenesis and clinical features in each patient and thus guiding management, or, for predominantly exertional angina, by severity, thus indicating the urgency for treatment.
  • The diagnosis of angina is mainly clinical; investigations are available to confirm the diagnosis but should be used only if the history is not clear-cut, or if there is a reason to evaluate the extent and localisation of ischaemia.
  • Although routine exercise stress testing rarely provides information on the presence of serious coronary disease, exercise perfusion imaging with various radionuclides yields more reliable data, including localisation and severity of reversible ischaemia.
  • It is vital not to miss a diagnosis of unstable angina because of the associated risk of the development of infarction.
  • Disorders of coronary vasomotor tone producing angina are often misdiagnosed as noncardiac chest pain.

    Picture credit: © Africa Studio/Stock.adobe.com

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