Angina diagnosis and differential diagnosis

According to the typical angina attack characteristics and signs, including use of nitroglycerin after mitigation, the combination of age and the presence of coronary heart disease risk factors, except for other causes of angina, in general to create the diagnosis. Attack electrocardiogram to check that the R-oriented in the lead, ST depression, T-wave flat or inverted (variant angina, then the lead ST-segment elevation), within minutes after the attack back. No change ECG of patients could be considered for load test. Attack is not typical, the diagnosis should rely on observation of the effects of nitroglycerin and attack ECG changes, if still not confirmed, can be reviewed several times electrocardiogram, or ECG stress test for 24-hour Holter monitor, such as the positive changes in ECG or load Test induced angina attack can be confirmed. Diagnosis can be difficult for radionuclide inspection or consider selective coronary angiography. Consider the purposes of surgical treatment is necessary for selective coronary angiography. Coronary ultrasound examination shows the wall lesions, the diagnosis may be more helpful In China, when the angina attack patients often not a typical performance, in the judgement of chest discomfort or pain is angina, the need to be careful. In recent years, foreign scholars also stressed the word angina is not fully representative of pain, patients on myocardial ischemia and hypoxia may be feeling the pain other than the others feel, which may deny feeling pain. The following aspects will help determine clinical angina: (1) nature: angina should be squeezing, tightening, oppression, suffocation, heavy, stuffy expansion of pain, rather than Daoge like grasping pain or acute pain, shortness of acupuncture-like or electric shock-like pain, or the non-stop day and night Chest tightness feeling. In a few patients for the burning sensation, tension or shortness of breath with throat or trachea at the top of tight pressing flu. Pain or discomfort at the beginning of lighter, gradually increasing drama, and then gradually disappear, with little change for the position by the impact or deep breathing. (2) site: pain or discomfort, often in the sternum or its vicinity, may also occur in the abdominal between the pharynx to any level, but rarely more than in the pharynx. Sometimes in the left shoulder or left arm, may also occasionally accompanied on his right arm, lower, lower cervical and thoracic spine on the left scapula, or shoulder blade area, but located in the left armpit or Zuoxiong under those very few. (3) period: 1 to 15 minutes, the majority of three to five minutes, sometimes up to 30 minutes (except for the middle syndrome), pain or discomfort only a few seconds (mostly nausea flu) continued throughout the day or a few Those days are not like angina. (4)-induced factors: more oriented to physical exertion, followed by emotional. Denglou, walk the ground quickly, meal after walking, walking against the wind, or even forced to defecate or give the arm a slight head movements, exposure to cold environment, into the cold, other parts of the body's pain and terror, tension, irritability, trouble, etc. Emotional changes can be evoked. Physical activity coupled with emotional activities, the more evoked. (5) the effects of nitroglycerin: sublingual nitroglycerin tablets containing such as effective, angina should be 1 to 2 minutes remission (also takes five minutes, taking into account the time patients may not accurately estimate ). The supine angina pectoris, nitroglycerin may be invalid. In assessing the effects of nitroglycerin, we must pay attention to patients using the drug is already close to failure or failure.