Angina

Typical patient
• Middle-aged or elderly man or woman often with a family history of coronary heart disease and one or more of the major reversible risk factors (smoking, hypertension, hypercholesterolaemia)

Major symptoms
• Exertional chest pain and shortness of breath. Pain often described as 'heaviness' or 'tightness', and may radiate into arms, neck or jaw

Major signs
• None, although hypertension and signs of hyperlipidaemia (xanthelasmata, xanthomas) may be present
• Peripheral vascular disease, evidenced by absent pulses or arterial bruits, is commonly associated with coronary heart disease

Diagnosis
• Typical history is most important diagnostic tool
• ECG: often normal; may show Q waves in patients with previous myocardial infarction
• Stress test: exertional ST depression
• Isotope perfusion scan: exertional perfusion defects
• Coronary arteriogram: confirms coronary artery disease

Additional investigations
• Blood sugar and lipids to rule out diabetes and dyslipidaemia

Comments
• A careful history is the single most important means of diagnosing angina