Signs and Symptoms of’Angor

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  • chest pain syndrome which reflects a reversible myocardial ischemia (does not cause permanent myocardial injury).

NB : ischemia is not always painful.

  • L’coronary insufficiency results from an inadequacy between the intakes and the oxygen requirements of the myocardium : the amount of blood and / or d’insufficient oxygen to the myocardium, at rest and / or at rest’effort.
  • The mechanisms can be :

A permanent shrinkage (atherosclerotic stenosis, dissection, extrinsic compression).

a spasm : temporary shrinkage.

A decrease coronary flow or perfusion pressure.

etiologies :

1/- atherosclerosis : plates atherosclerotic obliterans.

2/- Risk factors :

  • Age,
  • male,
  • HTA,
  • tobacco,
  • diabetes,
  • dyslipidémie,
  • obesity.

3/- other etiologies :

  • coronary spasm
  • Abnormal coronary birth
  • Stenosis secondary to radiation therapy
  • aortic stenosis
  • aortic regurgitation

CHARACTERISTICS SEMIOLOGICAL :

Seat : retro-sternal +++, medium-thoracique, bi-mammary ;
Irradiations : left arm, left wrist, mandible ;
Type : constrictive, squeezed, distressing ;
Intensity : variable ;
Circumstances of appearance : effort ;
calmed by : rest and glyceryl trinitrate ;
Contributing factors : cold, vent, emotion, postprandial period ... ;
scalability : prevents further effort, regresses in minutes ;
Frequency of occurrence : variable, depending on the importance of physical activity ;
equivalents : Blockpnée d’effort.

If l’one of these 3 gestures is used by the patient to describe pain’she D’either cardiac origin is from 77 % – B. With. J.,1995,311:1660-1661

Functional Classification of pain (CCS) :

Classe I : No pain in the physical activities of daily living
Class II : Moderate limitation in the efforts of everyday life
class III : significant limitation in the efforts of everyday life
class IV : Pain at the slightest effort, or rest

PARTICULAR CASE : UNSTABLE ANGINA

1/- Angor de repos :

spontaneous pain, without triggering factor +++

particular form : spastic angina.

2/- Angor growing :

Appearing for less effort and less important (aggravation of exertional angina).

3/- Angor again :

new onset of severe outset.

In these cases there is an evolutionary threat to a heart attack or sudden death.

PHYSICAL EXAMINATION :

More often than normal, unless :

  • Presence of clinical signs associated with risk factors (xanthélasmas, xanthomes tendineux).
  • Achievement of an organ by atherosclerosis (stroke, trophic disorders of the lower limbs, missing peripheral pulse, vascular blasts).
  • Heart disease associated : valvulopathie, especially aortic stenosis.
  • Heart failure associated.
Xanthome
Xanthélasmas

Resting electrocardiogram :

  • Normal : most of the time (critical inter).
  • sequels dïnfarctus : Q waves of necrosis.
  • under- ST segment or negativity of the T wave in per-critical.

Course of Dr H Foudad – Faculty of Constantine