Types of Angina Pectoris

Stable angina• Chest or arm discomfort that may not be described

as pain but is associated with physical exertion or stess

• Relieved within 5-10 min by rest &/or sublingual nitroglycerin

• retrosternal region; radiates to or occasionally isolated to the neck, jaw, epigastrium, shoulder, or arms – usually the left

• tight, squeezing, heaviness, indigestion

• 2-10 min duration• precipitated by exercise, cold weather or stress• relieved by rest or nitroglycerin• P.E. Usually an S4 is appreciated• No permanent damage

Unstable angina• It has at least one of these three features:

1. it occurs at rest (or with minimal exertion), usually lasting >10 min;2. it is severe and of new onset (i.e., within the prior 4–6 weeks); and/or3. it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously).

• same location as angina• same quality as angina but may be more severe and

frequent• usually < 20 min duration• same precipitating factor as angina, with decreasing

tolerance for exertion or at rest• same associated symptoms and signs as angina, but

may be pronounced, transient cardiac failure can occur.

Prinzmetal (Variant) Angina• typically consisting of angina (cardiac chest pain) at rest

that occurs in cycles• caused by vasospasm, a narrowing of the coronary

arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis

• chest pain occurs without the usual precipitating factors• associated with ST segment elevation than depression

• often affects women below 50 yrs. old• characteristically occurs in the early morning,

awakening patients from sleep• tends to involve the RCA• associated with arrythmias or conduction defects• NO fixed stenosis• Ischemia results from coronary vasoconstriction

New York Heart Association Classification of Heart Failure

I No limitations during ordinary activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.

II Slight limitation during ordinary activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

III Marked limitation of normal activities, without symptoms or comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.

IV Confined to complete rest in bed or chair, Unable to undertake physical activity without symptoms; symptoms may be present at rest. If any physical activity is undertaken, discomfort is increased.