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The Continuing Dilemma Of Angina Pectoris

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The continuing dilemma of angina pectoris.
Look beyond the obvious!

“There is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length and of which I do not recollect any mention among medical authors. The seat of it, and sense of strangling, and anxiety with which it is attended, may make it not improperly be called Angina pectoris” (1)

Since the end of the eighteen century, when William Heberden published and presented in the Royal College of Physicians in London his brilliant paper titled “Some Account of the Disorder of the Breast” (1) and the subsequent theory of “the important of the coronary
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Moreover, they are one of the main sources of health care spending and one of the principal determinants of disability. According to recent data from the United States, direct and indirect costs associated with cardiovascular disease are estimated at over $312 billion per year. Despite the fact that real prevalence of stable angina pectoris is unknown and differs widely among different major population studies, at present, angina prevalence remains high and is the most common initial symptomatic presentation of cardiovascular disease. (5-6)

In past decades, clearly the interest in deeper understanding of this entity has increased and considerable number of studies have emerged suggesting that angina might be consequence of different clinical conditions that include, mainly, obstructive atherosclerosis of epicardial coronary arteries but also a heterogeneous group of disorders related with abnormalities in the function and structure of the coronary microcirculation.

Are we doing enough?

It is relatively common in our daily practice to deal with patients complaining of chest pain in the absence of obstructive coronary artery diseases and without other clinical condition that might either limited myocardial oxygen delivery or increased myocardial metabolic demand such as severe aortic stenosis, anaemia or hypertrophic cardiomyopathy. It has been reported that up to one-half of patients presenting with signs and
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