 |
       |
|
|
ANGINA PECTORIS WITH NORMAL CORONARY ANGIOGRAM
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The diagnosis of angina pectoris must be made at the bed side, by history taking only. The moment, a patient having the known risk factors, complains of discomfort, which is typical of angina pectoris, the diagnosis is made. If it is slightly atypical, the nearest differential diagnosis of oesophageal and other pains may be ruled out.
I wish to stress that, if the coronary angiogram is reported normal, but you have made a definite diagnosis of angina pectoris, do not change the diagnosis. There are three conditions where the patient can have angina with normal coronary angiogram.
1. Coronary artery spasm of the big vessels which will respond to GTN tablet or spray.
2. Small vessel disease of the micro-circulation.
3. Endothelial Dysfunction - a proved entity.
The important point is, neither the patient nor the family physician, should get upset or afraid, because all the above patients, if their risk factors are dealt with, (reduce weight, stop smoking, omit tobacco), can safely be given GTN (Glyceryl Tri-Nitrate), Aspirin, and Statins, life time.
It should be stressed to them that there is no question of fear of death due to "this" coronary heart disease. The disease should be considered as if the patient has bronchial asthma, which he has to learn to live with.
 |