Common presentation of ischaemic heart disease which is defined by 2/3 of: constriction-like pain in chest/arm/jaw, brought on by physical activity, alleviated by rest or GTN within minutes
Aetiology
Atherosclerosis
Pathophysiology
Narrowing of the coronary arteries reduces blood flow to the myocardium (heart muscle)
During times of high demand such as exercise there is insufficient supply of blood to meet demand, which causes symptoms the symptoms of angina
Clinical presentation
Central or left-sided chest discomfort – mild-severe
Usually described as a tight or crushing sensation
+/- dyspnoea
Usually results from exertion, and symptoms are relieved by rest (+ GTN)
Investigations
Angina is a clinical diagnosis - tests done look for coronary disease as the cause
Bloods: routine bloods including FBC to exclude anaemia, TFTs to exclude hyperthyroidism which can exacerbate angina
ECG: may be normal or may show pathological Q waves, LBBB or ST-segment and T wave abnormalities
CT Coronary Angiography (CTCA): diagnostic, indicated for atypical or typical angina pain or if ECG shows ischaemic changes in chest pain with <2 angina features
Other imaging if can’t diagnose on clinical basis alone and CTCA inconclusive: