Editing Angina (section)

==Diagnosis==
Angina should be suspected in people presenting tight, dull, or heavy chest discomfort that is:<ref name="cks.nhs.uk">NHS Clinical Knowledge Summaries (2009) Angina - stable. {{cite web|url=http://www.cks.nhs.uk/angina |title=Clinical topic - Angina |access-date=2010-01-04 |url-status = dead|archive-url=https://web.archive.org/web/20100310180036/http://www.cks.nhs.uk/angina |archive-date=2010-03-10 }} Date site accessed: 04/01/2009</ref>
# Retrosternal or left-sided, radiating to the left arm, neck, jaw, or back.
# Associated with exertion or emotional stress and relieved within several minutes by rest.
# Precipitated by cold weather or a meal.

Some people present with atypical symptoms, including breathlessness, nausea, or epigastric discomfort, or burning. These atypical symptoms are particularly likely in older people, women, and those with diabetes.<ref name="cks.nhs.uk"/>

Anginal pain is not usually sharp or stabbing or influenced by respiration. [[Antacid]]s and simple [[analgesic]]s do not usually relieve the pain. If chest discomfort (of whatever site) is precipitated by exertion, relieved by rest, and relieved by glyceryl trinitrate, the likelihood of angina is increased.<ref name="cks.nhs.uk"/>

In angina patients momentarily not feeling any chest pain, an [[Electrocardiography|electrocardiogram]] (ECG) is typically normal unless there have been other cardiac problems in the past. During periods of pain, depression, or elevation of the [[Electrocardiography#ST segment|ST segment]] may be observed. To elicit these changes, an [[Cardiac stress test|exercise ECG test]] ("treadmill test") may be performed, during which the patient exercises to his/her maximum ability before fatigue, breathlessness, or pain intervenes; if characteristic ECG changes are documented (typically more than 1&nbsp;mm of flat or downsloping ST depression), the test is considered diagnostic for angina. Even constant monitoring of the blood pressure and the pulse rate can lead to some conclusions regarding angina. The exercise test is also useful in looking for other markers of myocardial ischemia: blood pressure response (or lack thereof, in particular, a drop in systolic blood pressure), dysrhythmia, and chronotropic response. Other alternatives to a standard exercise test include a [[Cardiac stress test|thallium scintigram or sestamibi scintigram]] (in patients unable to exercise enough for the treadmill tests, e.g., due to [[asthma]] or [[arthritis]] or in whom the ECG is too abnormal at rest) or stress [[echocardiography]].

In patients in whom such noninvasive testing is diagnostic, a [[Coronary catheterization|coronary angiogram]] is typically performed to identify the nature of the coronary lesion, and whether this would be a candidate for [[angioplasty]], [[Coronary artery bypass surgery|coronary artery bypass graft]] (CABG), treatment only with medication, or other treatments. In hospitalized patients with unstable angina (or the newer term of "high-risk acute coronary syndromes"), those with resting ischaemic ECG changes or those with raised cardiac enzymes such as [[troponin]] may undergo coronary angiography directly.