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Common Congenital Heart Lesions - page 66 / 126

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Clinical Features of Stable Angina

  • Quality of pain

    • o

      Pressure

      • o

        Tightness

      • o

        Heaviness

      • o

        Not really pain

This is in contrast to other causes, described as: stinging, itching, stabbing, shooting.

  • Location of pain

    • o

      Diffuse, not localized

      • o

        Central, substernal chest

      • o

        Arm, jaw, throat: radiating

      • o

        Point to pain with clenched fist over sternum “LEVINE’s SIGN”

  • Accompanying symptoms

      • o

        Tachycardia

      • o

        Sweating

      • o

        Nausea

      • o

        Dyspnea

      • o

        Weakness

  • Precipitating Factors

    • o

      Physical exertion

      • o

        Anger, excitement

      • o

        Large meal

      • o

        Cold weather

  • Duration of Pain

      • o

        Usually relieved within minutes

      • o

        Lasts longer than a second or 2

      • o

        If pain lasts for days, it is unlikely to be ischemia

Physical Exam:

  • During anginal attack: may have no abnormal findings.

    • o

      Increased HR, BP

      • o

        Mitral regurg

      • o

        Bulging impulse

      • o

        S4 gallop, because ischemia decreases vent. complianceÆstiff

Diagnostic Studies

E C G i f d u r i n g a n i s c h e m i c a t t a c k , w e w o u l d s e e

  • o

    ST segment depression

    • o

      T wave flattening or inversion

7

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