Angina Pectoris

• Angina pectoris is due to

  Discrepancy between Myocardial oxygen demand and supply
• Grading of Angina name

  Canadian Heart association Grading of Angina
• CHAGA= Angina grading

  1. Angin on severe exertion
  2. Angina on walking uphills or climbing more than one flight of ordinary stairs
  3. Angina on walking on level ground
  4. Angina at Rest
• Characteristic of Anginal Pain

  Site: Substernal
• Angina Pain Nature

  Pressing

  Squeezing

  Strangling

  Constricting
• Radiation- Angina

  Both shoulders

  epigastrium

  Back

  Neck

  Jaw

  Teeth
• Main radiation of Angina

  Left shoulder

  Ulnar Aspect of Left arm
• Levine test

  For angina

  Relief of Anginal pain by carotid sinus massage
• Prinzmetal Angina

  Type of angina

  Occurs at Rest

  May recur in nightly cyclic pattern
• Nocturnal Angina

  Occurs during sleep at night.

  Due to Coronary Ostial Stenosis

  In Cardiovascular Syphilis
• Causes of Angina Pectoris

  Coronary artery Disease

  Aortic Stenosis

  Aortic Regurgitation

  Hypertrophic Obstructive cardiomyopathy

  Systemic Hypertension

  Severe anaemia

  Arteritis

  Extreme Tachyarrhythmias
• Why CAD causes Angina

  Narrowing/Spasm of Coronary artery
• Why aortic stenosis causes Angina

  Due to decreased stroke volume, reducing coronary perfusion and compression of coronaries by hypertrophied myocardium.

  Decreasing O2 demand and Increased O2 demand by the Hypertrophied myocardium
• Why Aortic Regurgitation causes Angina

  Decreased Coronary perfusion due to run-off of blood back into LV and periphery during Diastole.

  Syphitic AR- Coronary Ostial Stenosis
• Why systemic Hypertension causes Angina

  Decreased diastolic coronary perfusion as a result of left ventricular hypotrophy.