Practice diagnosis and treatment of angina

2021-02-05 12:00 AM

Determine the nature of the pain. Characteristics of angina are pain from the centre of the chest, feeling like being weighed down, spreading to the jaw, to the back and to the arm (usually the left arm).


Angina is a type of chest pain that occurs due to ischemia of the heart muscle. Blood supplies the heart muscle with oxygen, anemia leads to a lack of oxygen. Therefore, angina often occurs during times of high oxygen demand, such as during heavy work or overwork.


Coronary diseases such as coronary artery stenosis due to atherosclerosis, coronary artery spasm ...

Aortic valve stenosis.

Heart rhythm disturbances.

Severe anaemia.



A physical examination cannot be confirmed, but the following factors should be considered:

Determine the nature of the pain. Characteristics of angina are: pain from the centre of the chest, feeling like being weighed down, spreading to the jaw, to the back and to the arm (usually the left arm).

Determine the increase in pain. Characteristics of angina are increased when the patient exerts more effort, such as climbing a slope, going against the wind, tolerating cold weather, working or exercising immediately after a full meal ...

Determine the remission of the pain. A characteristic feature of angina is remission when the patient is resting or given nitrate.

The following factors increase your risk of an angina attack:

Men over 50 years old.

Tobacco addiction.

A history of coronary artery disease, diabetes, high blood pressure.

Increased blood lipids.

Having a family member with cardiovascular diseases (genetic factors).

Look for signs of heart failure (such as ankle swelling, difficulty breathing, increased carotid venous pressure) or atrial fibrillation.

Complete blood count test to rule out the possibility of serious anaemia.

The ECG records the baseline performance for reference in subsequent diagnostics. An electrocardiogram should be performed both at rest and immediately after exertion. The resting electrocardiogram, although not showing any signs of angina, may indicate previous heart damage.

Chest x-rays are not valid for diagnosis unless heart failure is suspected.


If the pain appears steadily after each exertion and goes away at rest, and there is no other development:

Treatment is mainly using drugs of the nitrate group. You can start with GTN lozenges (glycerine trinitrate), 1 to 2 tablets per pain. Warn patients of headache medication side effects.

Switch to oral medication if the patient needs to take medication every day, such as isosorbide dinitrate 10-20mg, 3 times a day.

You can also add beta-blockers such as atenolol 50-100mg, once a day if there is no sign of heart failure.

Patients should be given aspirin pain relievers with a dose of 75mg per day unless they are taking anticoagulants or are allergic to aspirin.

Follow up for a week to evaluate the effectiveness of treatment. If the patient still needs to continue therapy or has contraindications to the above drugs, it is possible to switch to a calcium-channel blocker, such as nifedipine 10 mg, daily 3 times, or amlodipine 5 - 10mg, once a day.

Educate patients about a healthy lifestyle, eliminate possible aggravating risks, and notify their doctor immediately if angina shows signs of progressing.

If pain progresses from worsening, occurs with an unstable frequency of change, not entirely dependent on the patient's exertion, especially the patient may experience pain at rest and at night, consideration should be given to immediate referral to a cardiologist, or to suggest the patient to a hospital for monitoring and treatment.