Stenocardia tension: symptoms

Angina pectoris may manifest as vague discomfort, pain, or intense, rapidly increasing "tearing" sensations in the heart. This sensation is rarely described as pain. Discomfort is most often felt behind the sternum, although localization may vary. These sensations can radiate into the left shoulder and down the inner surface of the left hand, down to the fingers; through the chest in the back; in the neck, jaw and teeth; sometimes down the inside of the right hand. Discomfort can also be felt in the upper abdomen.

Some patients develop atypical angina (manifestations in the form of flatulence, belching, unpleasant sensations in the abdomen), often attributed in accordance with signs of digestive disorders; the patient may feel that eructation reduces symptoms. In other patients, dyspnea appears due to an acute reversible increase in the left ventricular filling pressure, which often accompanies ischemia. Often descriptions of the patient are so inaccurate that it is very difficult to determine the cause of the sensations (angina pectoris, dyspnea or their combination). Since ischemic episodes are resolved within a minute or more, brief episodes rarely represent angina pectoris.

Between attacks of angina pectoris (and even during them) the physical condition can be normal. However, during an attack, the heart rate may slightly increase, the blood pressure often rises, the heart sounds become more deaf, the apical push is more diffused. With palpation of the precordial region, a limited systolic impulse or paradoxical movement may be detected as a reflection of segmental myocardial ischemia and limited dyskinesia. The second heart tone may become paradoxical, because during the episode of ischemia the period of expulsion from the LV is prolonged. Often find IV heart tone. Noise at the top in the middle or late systole (coarse, but very loud) occurs if ischemia leads to the development of dysfunction of the papillary muscles, which in turn leads to mitral regurgitation.

With angina pectoris, the attack usually occurs with physical activity or strong emotions, lasts no more than a few minutes and passes at rest. The response to the load is quite predictable, but in some patients the physical load, previously normally tolerated, at some point in time can trigger the development of an angina attack, which is associated with changes in the tone of the arteries. Manifestations of angina pectoris increase if physical exertion follows food intake or occurs in cold weather; walking in windy weather or first contact with cold air after leaving a warm room can also cause an attack. The severity of angina pectoris is classified according to the degree of exercise that causes an attack.

The frequency of seizures can range from several episodes a day to long intervals with their absence (weeks, months or years). The frequency of seizures may increase (so-called increasing angina pectoris) until the fatal outcome or gradually decrease (possibly even the disappearance of seizures) in the event that a sufficient collateral coronary blood flow develops, and if a myocardial infarction occurs, circulatory insufficiency or intermittent limb patient.

Nighttime attacks of angina may occur if sleep leads to sudden changes in the frequency of breathing, pulse, and blood pressure. Night attacks of angina may also appear as a result of repeated episodes of left ventricular failure as equivalent to nocturnal dyspnea.

Classification of angina pectoris of the Canadian Cardiovascular Society

Class	Physical stress, leading to an attack of pain in the chest
1	Tense, fast or prolonged physical activity, unusual physical activity (for example, brisk walking, climbing stairs)
2	Fast walk. Walking on a surface with a lift. Fast climbing the stairs. Walking or climbing the stairs after eating. Cold. Wind. Emotional Stress
3	Walking on small distances on a horizontal surface even at the usual pace, climbing to the first floor on the stairs
4	Any physical activity, sometimes attacks occur at rest

Angina can arise spontaneously at rest (the so-called stenocardia of rest). It is usually accompanied by a slight increase in heart rate and a significantly greater increase in blood pressure, which increases the need for myocardium in oxygen. The increase in these indices can be both the cause of resting angina and the consequence of ischemia caused by rupture of an atherosclerotic plaque and the formation of a thrombus. If the attack does not stop and there is a further increase in myocardial oxygen demand, the likelihood of myocardial infarction increases.

Since the manifestations of angina pectoris are quite typical for each patient, any changes in its manifestations (for example, the appearance of rest angina, new symptoms of the onset of an attack, increasing angina) should be considered as serious symptoms. Such changes are called unstable angina.

[1], [2], [3], [4], [5], [6]