Development of retrosternal chest discomfort is the classical symptom of angina pectoris. Retrosternal chest discomfort is characterized by feeling of heaviness, pressure, choking or burning sensation in the chest. The areas where the pain is experienced are the back, neck, epigastrium, jaw or shoulders. In some cases, the pain may radiate to the arms, neck and shoulders.

Angina pectoris develops during physical exertion such as exercise, cold climate or extreme psychological stress. The pain lasts for about 1 – 5 minutes and is relieved only by administration of nitroglycerin. The pain, which lasts for just about few seconds, is not angina pectoris. In angina pectoris, the intensity of the pain does not change with respiration, cough or by changing one’s position.

Individuals with angina pectoris, also suffer from breathlessness, fatigue, dizziness, sweating, and nausea [6].

• Pain

  However, unlike the chest pain associated with a heart attack, the pain from angina usually goes away within a few minutes with rest or with the use of a cardiac prescription medication (i.e., nitroglycerin). [stanfordhealthcare.org]

  Multidisciplinary Treatment Depending on the cause of your pain, your pain specialist will decide whether or not to embark on physical treatment. [pijn.com]

  Angina pectoris, or just angina, is temporary chest pain or discomfort caused by decreased blood flow to the heart muscle. Because of the decreased flow of blood, there is not enough oxygen to the heart muscle resulting in chest pain. [radiologyinfo.org]

  Diffuse esophageal spasm is the extracardiac condition that is confused most often with ischemic cardiac chest pain. This pain presents as a deep thoracic pain that may be present over most of the thorax. [pubmed.ncbi.nlm.nih.gov]

  Unstable Angina In unstable angina, chest pain can occur at any time—often while a person is resting. The discomfort may be more severe and last longer than in typical angina. [nitromist.com]

• Coronary Atherosclerosis

  Reporting coronary atherosclerosis in ICD-10-CM presents some differences from current ICD-9-CM coding that are worth noting. Coronary atherosclerosis codes in ICD-9-CM are found in subcategory 414.0. [codeitrightonline.com]

  Low-dose aspirin usage at evening meals while fasting for Ramadan is prudent for primary cardiovascular protection of males who may have non-obstructive coronary atherosclerosis to mitigate the risk for rupture of potentially vulnerable plaques. [ncbi.nlm.nih.gov]

  Among these are a pre-existing plaque based on coronary atherosclerosis, the development of fissures or dissections of the plaque (often combined with thrombus formation at the site of the plaque) coronary vascular tone, and theoretically primary aggregation [doi.org]

  These recommendations are applicable for people who want to avoid developing coronary atherosclerosis (primary prevention) and for people who have already been diagnosed with this condition (secondary prevention). [icm-mhi.org]

• Arm Pain

  Previous or current symptoms described as chest pain or pressure, jaw pain, arm pain, or other equivalent discomfort suggestive of cardiac ischemia. [icd9data.com]

  NIH: National Heart, Lung, and Blood Institute Definition (NCI) Previous or current symptoms described as chest pain or pressure, jaw pain, arm pain, or other equivalent discomfort suggestive of cardiac ischemia. [fpnotebook.com]

  […] of arm (especially the left arm) Pain in the chest and/or arm which tends to be severe and intermittent Cold limbs Cyanosis of lips and nails T: Dark red with purple spots or Purple body C: Little P: Minute (scarcely perceptible) and thready or Knotted [americandragon.com]

• Dyspnea

  The patient was admitted to our hospital because of dyspnea and pretibial edema 7 years after the diagnosis of variant angina. [ncbi.nlm.nih.gov]

  • Pain does not depend on body position or respiration • No chest wall tenderness • Angina may be absent, particularly in younger patients • Often gradual progression • Can also present as gastrointestinal discomfort Dyspnea Dizziness, palpitations [youtube.com]

  Symptoms include chest discomfort with or without dyspnea, nausea, and diaphoresis. [msdmanuals.com]

  Angina equivalent is a term used to describe atypical symptoms due to ischemia, such as dyspnea or syncope. These atypical symptoms are seen more often in women and in elderly and diabetic patients. [visualdx.com]

• Exertional Dyspnea

  The pain may be absent in patients with an anginal “equivalent,” particularly exertional dyspnea; however, it may be challenging to distinguish the anginal equivalent from a pulmonary cause. [empendium.com]

• Vomiting

  Severe vomiting of Phlegm and/or thin fluids Severe pain Migrating and shooting pain throughout the upper and lower back Chest pain Precordial pain T: Pale C: Greasy and white P: Deep and wiry Treatment Principle Dry Dampness Dissolve Phlegm Regulate [americandragon.com]

  […] presentation --------------------------------- Angina at rest or with minimal exertion New-onset angina Severe, persistent, and/or worsening angina (crescendo angina) Autonomic symptoms may be present: diaphoresis, syncope, palpitations, nausea, and/or vomiting [youtube.com]

  Nota bene: Signs of recovery: pain subsides, vital signs return to baseline values Signs of deterioration: persistent pain, unstable vital signs, altered mentation Adverse reaction to nitroglycerin includes flushing, headaches, dizziness, nausea, and vomiting [dentalcare.com]

• Abdominal Pain

  […] in the abdomen Pain is not severe Pain is relieved by pressure Edema of the feet Urinary difficulty Slight edema (primarily of the lower limbs) Symptoms generally occur during pregnancy Pale face Fatigue Heaviness of head Lassitude Lower abdominal pain [americandragon.com]

  Hence, regular check-up of the heart is imperative when women experience nausea, abdominal pain or shortness of breath. [hamiltonchiropractor.co.nz]

  It may refer specifically to: Angina pectoris, chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle Abdominal angina, postprandial abdominal pain that occurs in individuals with insufficient blood flow to meet visceral [en.wikipedia.org]

  There are other diseases that can cause chest pain, abdominal pain, shortness of breath, sweating, and nausea and vomiting. Questions may be asked to determine whether other possibilities other than angina exist. [medicinenet.com]

  Hemochromatosis can result in serious damage to the body's tissues, including cirrhosis of the liver, heart failure, diabetes, abdominal pain, and arthritis. [web.archive.org]

• Dyspepsia

  Dyspepsia is a sensation of pain or discomfort in the upper abdomen; it often is recurrent. [msdmanuals.com]

  However, when a patient’s history is suggestive of angina in the absence of any other causative factor (anaemia, dyspepsia, musculoskeletal pain), the lack of demonstrable myocardial ischaemia should not absolutely preclude a diagnosis of RA. [ecrjournal.com]

• Jaw Pain

  Previous or current symptoms described as chest pain or pressure, jaw pain, arm pain, or other equivalent discomfort suggestive of cardiac ischemia. [icd9data.com]

  For most people, it feels like chest pain or pressure. But people can feel angina in different ways. Angina can feel like: Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms. [stanfordhealthcare.org]

  Common symptoms of angina pectoris include: Uncomfortable pressure in the chest Fullness or squeezing sensation around the heart area Pain in the center of the chest Jaw pain Back pain Shoulder or neck pain Not all chest pain is heart-related. [brookhavenheart.com]

  Chest pain that begins suddenly or lasts only a few seconds is less likely to be angina. Women are somewhat more likely than men to have other symptoms like nausea and back or jaw pain. [healthy.kaiserpermanente.org]

• Chest Pain

  CT of the chest: Chest CT is a more sensitive test than chest x-ray that can identify other causes of chest pain such as aortic disease or blood clots in the blood vessels of the lungs. [radiologyinfo.org]

  Angina vs. heart attack Angina may have similar symptoms as a heart attack, such as a crushing, squeezing pain in the chest; a feeling of pressure in the chest; or pain radiating in the arms, shoulders, jaw, neck, and/or back. [stanfordhealthcare.org]

  The differential diagnosis contains several causes of nonischemic cardiac chest pain. Dissecting aortic aneurysm may cause severe anterior chest pain that can be mistaken for myocardial infarction. [pubmed.ncbi.nlm.nih.gov]

  Unstable Angina In unstable angina, chest pain can occur at any time—often while a person is resting. The discomfort may be more severe and last longer than in typical angina. [nitromist.com]

  The evaluation of chest pain is a common clinical challenge. [erj.ersjournals.com]

• Heart Disease

  National Heart Lung and Blood Institute, Diseases and Conditions Index. http://www.nhlbi.nih.gov. Accessed May, 2010. 2. Heart disease guide. Heart disease and angina (chest pain). [nitromist.com]

  Angina is a symptom of coronary heart disease (CHD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis. [stanfordhealthcare.org]

  Do people with heart disease suffer from breathing too much air? Let us consider Western clinical evidence. Warning : include(.. [normalbreathing.com]

  Definition (CHV) chest pain caused by coronary heart disease Definition (CHV) chest pain caused by coronary heart disease Definition (CHV) chest pain caused by coronary heart disease Definition (CHV) chest pain caused by coronary heart disease Definition [fpnotebook.com]

• Exertional Chest Pain

  In addition, there was no exertional chest pain, and treadmill exercise electrocardiographic results were negative. This finding was confirmed by coronary computed tomographic angiography. [ncbi.nlm.nih.gov]

  A 61-year-old Caucasian female presented with exertional chest pain for 3 months, radiating into neck and shoulders. Twenty years ago, she had undergone surgical closure of an atrial septal defect and had been asymptomatic since then. [revespcardiol.org]

  This “stable angina” syndrome, predictably produced ECG evidence of myocardial ischaemia when myocardial oxygen demand exceeded supply, manifesting as exertional chest pain. [escardio.org]

• Retrosternal Chest Pain

  Triggers include exertion or stress, which results in increased myocardial oxygen demand. • Typically retrosternal chest pain or pressure • Pain can also radiate to left arm, neck, jaw, epigastric region, or back. • Pain does not depend on body position [youtube.com]

  Computed tomography coronary angiography in patients without known coronary artery disease can demonstrate possible non-cardiovascular causes of non-acute retrosternal chest pain. [pubmed.ncbi.nlm.nih.gov]

• Sweating

  Individuals with angina pectoris, also suffer from breathlessness, fatigue, dizziness, sweating, and nausea. [symptoma.com]

  Other symptoms can include numbness or tingling, anxiety, fainting, dizziness, sweating, shortness of breath, pale skin, irregular heartbeat, nausea, or fatigue. [study.com]

  In general, symptoms of angina pectoris include: Shortness of breath Dizziness Sweating Fatigue Nausea Chest discomfort or pain Pain radiating to arms, neck, jaw, back, or shoulder Risk Factors for Angina Pectoris Some of the risk factors of angina pectoris [melbournecardiology.com.au]

  SLIDESHOW Heart Disease: Symptoms, Signs, and Causes See Slideshow From Healthy Heart Resources Signs Psoriasis May Be Affecting Your Heart Diagnosing Hypertrophic Cardiomyopathy Exercising With HCM: How to Sweat Safely Featured Centers What Are the Best [rxlist.com]

• Increased Sweating

  Angina typically causes uncomfortable pressure in the chest, neck, jaw, shoulders, or back, fullness or a squeezing sensation in the center of the chest, increased sweating, and shortness of breath. [mytherapyapp.com]

• Arthritis

  Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/chest-pain-and-angina-pectoris-in-rheumatoid-arthritis-frequency-and-prediction-of-cardiovascular-mortality/. [acrabstracts.org]

  Monoket Drug class: antianginal agents For consumers: dosage, interactions, For professionals: A-Z Drug Facts, Prescribing Information aspirin Rx/OTC N N X Add review 1.0 Generic name: aspirin systemic Brand names: Bayer Aspirin, Ecotrin, Aspir 81, Arthritis [drugs.com]

  Hemochromatosis can result in serious damage to the body's tissues, including cirrhosis of the liver, heart failure, diabetes, abdominal pain, and arthritis. [web.archive.org]

  J Chron Dis. 1969; 22: 49 Adler E Abramson JH The use of questions as an indication of active rheumatoid arthritis. Isr J Med Sci. 1968; 4: 210 Abramson JH Terespolsky L Brook JG et al. [amjmed.com]

• Shoulder Pain

  Chest pain and electrocardiographic changes were resolved after administration of coronary dilator and coronary stenting, but shoulder pain persisted. At 6 hours after stenting, left hemiparesis was found with deteriorated shoulder pain. [ncbi.nlm.nih.gov]

  ) lumbar region pain ( M54.5 ) pelvic and perineal pain ( R10.2 ) shoulder pain ( M25.51- ) spine pain ( M54.- ) throat pain ( R07.0 ) tongue pain ( K14.6 ) tooth pain ( K08.8 ) renal colic ( N23 ) pain disorders exclusively related to psychological [icd10data.com]

  Angina may be more difficult to identify in some elderly people when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain (which may be attributed to arthritis). [labtestsonline.org]

  […] neck, jaw, or shoulders Pain precipitated by exertion, eating, exposure to cold, or emotional stress, lasting for about 1-5 minutes and relieved by rest or nitroglycerin Pain intensity that does not change with respiration, cough, or change in position [emedicine.medscape.com]

• Back Pain

  • Typically retrosternal chest pain or pressure • Pain can also radiate to left arm, neck, jaw, epigastric region, or back. • Pain does not depend on body position or respiration • No chest wall tenderness • Angina may be absent, particularly in younger [youtube.com]

  Signs and Symptoms Chest pain or discomfort Shortness of breath Tiredness Pain or discomfort in the arms, neck, jaw shoulder or back Pain similar to indigestion or heartburn Nausea or vomiting Sweating It is important to appreciate that women may have [hamiltonchiropractor.co.nz]

  Common symptoms of angina pectoris include: Uncomfortable pressure in the chest Fullness or squeezing sensation around the heart area Pain in the center of the chest Jaw pain Back pain Shoulder or neck pain Not all chest pain is heart-related. [brookhavenheart.com]

  Signs and symptoms of angina include: chest pain or discomfort, often described as squeezing pressure, fullness, tightness, or a heavy weight in the centre of the chest pain or discomfort in the arms, neck, jaw, shoulder or back pain similar to indigestion [southerncross.co.nz]

  Applicable To Angina NOS Anginal syndrome Cardiac angina Ischemic chest pain The following code(s) above I20.9 contain annotation back-references Annotation Back-References In this context, annotation back-references refer to codes that contain: Applicable [icd10data.com]

• Neck Pain

  Common symptoms of angina pectoris include: Uncomfortable pressure in the chest Fullness or squeezing sensation around the heart area Pain in the center of the chest Jaw pain Back pain Shoulder or neck pain Not all chest pain is heart-related. [brookhavenheart.com]

  Symptoms Symptoms of angina vary but typically include: A pressing, squeezing or crushing pain, usually in the chest underneath the breastbone or in the upper back, the arms or neck Pain radiating in the arms, shoulders, jaw, neck or back from the chest [wexnermedical.osu.edu]

  Side effects may include back or neck pain and skin abrasions. Spinal cord stimulators to block the sensation of pain. [nhlbi.nih.gov]

• Stroke

  The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. [ncbi.nlm.nih.gov]

  Olympic sprinter shares his stroke story Learn the warning signs of stroke No bones about it: It’s time to fight heart disease with Best Friend Fridays The American Heart Association’s new effort looks to put pets in the workplace, while helping raise [americanheart.org]

  Although it is not life-threatening, it does mean that the heart is not functioning optimally and that there is an increased risk of having a heart attack or stroke. [mytherapyapp.com]

  Mozaffarian D, Benjamin EJ, Go AS, et al, for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2015 update: a report from the american heart association. [emedicine.medscape.com]

• Vertigo

  Heaviness of head Lassitude Lower abdominal pain Dizziness Tinnitus Lumbago Edema Abdominal pain with edema during pregnancy due to Blood Deficiency and abnormal water circulation Oliguria Palpitations Cold feet Extreme coldness of the hands and feet Vertigo [americandragon.com]

  Side Effects : Orthostatic Hypotension, Headaches, Dizziness, Vertigo, Flushing, Sweating Medical Uses : To treat angina quickly. [www2.nau.edu]

The following tests are employed for diagnosing angina pectoris:

Electrocardiogram: This is done to check for blood flow to the heart or to detect a heart attack.

Stress test: In this test, the heart functioning of the individual is monitored during stress. The individual is asked to walk on a treadmill, and the heart rate is monitored through ECG during exercise.

Nuclear stress test: In nuclear stress tests, the individual is not asked to undergo physical exercise, instead a radioactive substance is injected, and heart functioning monitored subsequently [7].

Angiography: In this method, a dye is injected into the body, and x-ray machine takes several images that would provide detailed information about the blood vessels.

• Hypertriglyceridemia

  Abstract Postprandial hypertriglyceridemia and hyperglycemia may promote endothelial and hemorheological dysfunction. [ncbi.nlm.nih.gov]

  […] attack -, obesity [body mass index (BMI) > 25 kg/m2], central obesity (> 102 cm for men, and > 88 cm for women), arterial hypertension (systolic BP > 140 mmHg and diastolic BP > 90 mmHg), hyperglycemia (> 100 mg/dL), hypercholesterolemia (> 200 mg/dL), hypertriglyceridemia [scielo.br]

  […] has been characterized by the presence of hyperinsulinemia (fasting glucose level, ≥100 mg/dL), abdominal obesity (waist circumference, >40 in for men or >35 in for women), decreased HDL cholesterol levels (< 40 mg/dL for men or < 50 mg/dL for women), hypertriglyceridemia [emedicine.medscape.com]

• T Wave Inversion

  Whereas for patients who have myocardial infarction, it illustrates a T-wave inversion and ST-segment depression or elevation. 8.Angina pectoris can be confirmed using a stress test during exercise. [differencebetween.net]

  During an attack, ST depression or T-wave inversion may be seen. Plain radiograph Plain radiograph of the chest will usually be normal unless there is another co-existing pathology (such as cardiac failure ). [radiopaedia.org]

  An EKG should always be performed in cases in which patients seek medical attention – signs of coronary ischemia may include ST-segment depression and T-wave inversion; occasionally ST-segment elevation is seen, particularly when associated with coronary [cancertherapyadvisor.com]

  Assessment and Diagnostic Findings The diagnosis of angina pectoris is determined through: ECG: Often normal when a patient at rest or when pain-free; depression of the ST segment or T wave inversion signifies ischemia. [nurseslabs.com]

  The 12-lead electrocardiogram is monitored for ST-segment elevation or depression, T-wave inversion, and cardiac arrhythmias. A health care provider should remain with the patient and provide emotional support throughout the episode. [medical-dictionary.thefreedictionary.com]

• Ischemic Changes

  Cardiac ischemic changes in arrhythmias induced by hypothalamic stimulation. Am J Cardiol. 1963; 12: 781 Greenhoot JH Reichenback DD Cardiac injury and subarachnoid haemorrhage—a clinical, pathological and physiological correlation. [amjmed.com]

  If done during an angina attack, ECG is likely to show reversible ischemic changes: T wave discordant to the QRS vector ST-segment depression (typically) ST-segment elevation Decreased R-wave height Intraventricular or bundle branch conduction disturbances [msdmanuals.com]

  The original definition of cardiac syndrome X also mandated that ischemic changes on exercise (despite normal coronary arteries) were displayed, as shown on cardiac stress tests.[9] The primary cause of cardiac syndrome X is unknown, but factors apparently [en.wikipedia.org]

Nictroglycerin remains the major treatment regime for angina pectoris. It is a vasodilator that increases the oxygen supply to the heart. In addition, beta blockers and calcium channel blockers are also indicated in the treatment of angina pectoris. Another class of drugs, known as If inhibitors, such as ivabradine, is also administered to patients with angina pectoris [8].

In patients who have been suffering from narrowed arteries; balloon angioplasty is considered, which is a method that helps in widening the arteries. If severe blockage is detected, then by pass surgery is opted for.

Once the symptoms have been brought under control, then the individuals are advised to make certain life style changes, and are also given various medications, which may have to be taken on a long term basis [9].

Lifestyle changes such as decreasing weight, avoiding smoking and adopting relaxation techniques to keep stress at bay are advised. Angina pectoris is also triggered by exertion, and therefore, individuals are also advised to take rest and breaks in between.

Prognosis of the condition is not favorable with adverse outcomes, such as development of unstable angina, myocardial infarction and death. With advancing age, the condition may worsen, and the severity of the symptoms may also increase. However, those with stable angina and 3-vessel disease, the prognosis of the condition are good if the ventricular function is normal [5].

Reduced blood supply to the heart can cause development of angina pectoris. The various factors, that are responsible for triggering such attacks, include the following:

Age: Men aged 45 years and above, and women aged 55 years and above, are at an increased risk of developing angina pectoris.

Diseases: Certain underlying disease conditions, such as diabetes mellitus, dyslipidemia, hypertension, family history of cardiovascular disorders, obesity and kidney diseases, all increase the risk of developing angina pectoris.

Stress: Prolonged duration of psychological stress is yet another factor that can cause angina pectoris.

Lifestyle habits: Cigarette smoking and physical inactivity, also significantly increases the risk of developing angina pectoris. A research study postulated the fact that, individuals who smoke and have coronary artery disease, suffer from increased level of sympathetic nerve activity [2].

It has been estimated that in the US, about 9.8 million individuals suffer from angina every year. In addition to this, approximately 500,000 new cases crop up annually. Statistics have also revealed that, every 25 seconds, an American will suffer from a coronary event, and every minute someone will die from it. In the year 2005, about 232,115 males and 213,572 females lost lives due to coronary artery disease [3].

The imbalance between the heart’s demand for oxygen-rich blood, and its supply, causes angina pectoris to set in. Development of myocardial ischemia causes the myocardial cells to switch, from aerobic to anaerobic metabolism, which in turn gives rise to injury of the metabolic and electrical functions. Such a phenomenon favors the development of angina pectoris.

Angina pectoris is a classical symptom of myocardial ischemia. The increase in demand of blood supply can occur in conditions of heavy physical activity, such as exercises or in cases of atherosclerosis, which causes narrowing of the arteries, due to plaque buildup.

Research has revealed that, adenosine is the main chemical mediator for angina. In conditions of myocardial ischemia, adenosine triphosphate is degraded to adenosine, which in turn causes dilation of arterial blood vessels, which finally leads to angina pain [4].

The following steps can be adopted to prevent angina pectoris [10]:

• Reducing stress levels
• Keeping weight under check
• Eating healthy diet low in fat and cholesterol and high in fiber and other nutrients
• Avoiding smoking
• Keeping other disease conditions such as hypertension and diabetes under control

It is an acute problem that needs prompt medical intervention. Angina pectoris is a relatively common condition that can occur due to several factors. An imbalance that occurs between the demand for oxygen, and myocardial blood supply, triggers the onset of angina pectoris. The condition is a common complain amongst individuals, who have developed coronary artery disease [1].

Definition: Angina pectoris is a condition, characterized by development of discomfort in the chest. Such a kind of discomfort is defined as feeling of fullness, heaviness, pressure and choking sensation in the chest.

Cause: Imbalance between the heart’s demand for blood and the supply causes angina pectoris to develop. This condition is a common occurrence amongst individuals, who have developed myocardial ischemia.

Symptoms: Symptoms of angina pectoris include development of discomfort in the chest, and pain in the shoulders, neck, jaws. Individuals also experience dizziness, sweating, fatigue, breathlessness and nausea.

Diagnosis: Preliminary physical examination of the signs, followed by blood tests and echocardiogram are carried out. Once the condition of the patient is stabilized, stress test, nuclear stress test and angiography are also indicated.

Treatment: Angina pectoris is treated with nitroglycerin, which works by increasing the oxygen supply to the heart. In addition, beta and calcium channel blockers are also administered. In patients with narrowed arteries, balloon angioplasty is considered, or in severe cases, bypass surgery is indicated.

1. Foreman RD. Mechanisms of cardiac pain. Annu Rev Physiol 1999; 61:143.
2. Campbell AR, Satran D, Zenovich AG, Campbell KM, Espel JC, Arndt TL. Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina. Am Heart J. Dec 2008;156(6):1217-22.
3. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 27 2009;119(3):e21-181.
4. Crea F, Pupita G, Galassi AR, et al. Role of adenosine in pathogenesis of anginal pain. Circulation. Jan 1990;81(1):164-72
5. Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival.Am J Cardiol. Feb 1972;29(2):154-63
6. Cook DG, Shaper AG. Breathlessness, angina pectoris and coronary artery disease. Am J Cardiol 1989; 63:921.
7. O'Keefe JH Jr, Barnhart CS, Bateman TM. Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing its severity. Am J Cardiol. Apr 13 1995;75(11):25D-34D.
8. Fox K, Ford I, Steg PG, et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372:807.
9. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.N Engl J Med. Jan 20 2000;342(3):145-53.
10. Deedwania PC, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation. Mar 1990;81(3):748-56.