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What is Angina Pectoris?

Angina is a discomfort in the chest and adjacent area due to myocardial ischaemia. It is due to a mismatch between myocardial oxygen demand and supply.
Functional Classification of Angina (by Canadian Cardiovascular Society)
Class 1- Angina resulting from strenuous or prolonged exertion at work
Class 2- Angina resulting from walking or climbing stairs rapidly, walking uphill
Class 3- Angina resulting from ordinary physical activities like dressing oneself and taking bath
Class 4- Angina present at rest or inability to carry out day to day activity without pain.
Factors resposible for angina are - vascular, myocardial or combination of both
What are the characteristics of Anginal Pain?
Site- Retrosternal in location
Nature of pain - Pressing, squeezing, strangling, constricting, a band across the chest, a weight in the centre of the chest. The patient is unable to pinpoint the site of pain.
Radiation of pain - To both the shoulders, epigastrium, back, neck, jaw, teeth. Anginal pain can radiate in all directions, as mentioned above, but it more commonly radiates to the left shoulder and ulnar aspect of the left arm
Duration of pain -5 to 15 minutes
Aggravating factors - Exertion, emotion, after a heavy meal, or exposure to cold
Relieving factors -Rest, nitrates.
What is Levine Test
Relief of anginal pain by carotid sinus massage.
Depending on duration of pain myocardial pain can be 

  • Anginal where duration is > 2 min - < 20 min
  • Myocardial infarction duration of pain  >10 min