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Chronic Coronary Syndrome Symptoms Guidelines

Let’s find out about chronic coronary syndrome symptoms guidelines!

Chronic Coronary Syndrome Definition

Chronic Coronary Syndrome meaning – What is a chronic coronary syndrome? The chronic coronary syndrome is a term that describes coronary artery disease as a long-term, progressive disease that can be changed, stabilized or made better by making changes to your lifestyle, taking medicine, and revascularizing your coronary arteries.

chronic coronary syndrome symptoms guidelines - chronic coronary syndrome classification

Chronic Coronary Syndrome Causes

What causes chronic coronary syndrome? What is the most common cause of chronic coronary syndrome?

The chronic coronary syndrome can be caused by more than one pathophysiological mechanism. However, atherosclerotic epicardial coronary artery obstruction is the most common.

Angina pectoris is a sign of stable coronary artery disease or chronic coronary syndromes, usually caused by atherosclerotic heart disease. Coronary vasospasm can happen where there is a lesion or, less often, in vessels that look normal. Ischemia or infarction can also be caused by things that aren’t common, like congenital abnormalities, emboli, arteritis, or dissection.

Angina can also happen when there isn’t a blockage in the coronary arteries. This can be caused by severe myocardial hypertrophy, severe aortic stenosis or regurgitation, or higher metabolic demand, such as hyperthyroidism, severe anemia, or paroxysmal tachycardias with fast ventricular rates.

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Chronic Coronary Syndrome Diagnosis

  • Stress or physical activity usually causes precordial chest pain, quickly relieved by rest or nitrates.
  • During pain or stress testing, an ECG or scintigraphy shows signs of ischemia.
  • Angiography shows that major coronary vessels are blocked in a big way.

Chronic Coronary Syndrome Symptoms

Signs and symptoms of chronic coronary syndrome – What are some symptoms of chronic coronary syndrome?

Angina pectoris is mostly diagnosed based on the patient’s history, which should include information about what causes and relieves the pain, how it feels, where it is and how far it spreads, how long the attacks last, and how nitroglycerin works.

Circumstances that precipitate and relieve angina

Angina usually happens when you are doing something, and resting makes it go away. Patients may prefer standing instead of lying down because lying down makes the heart work harder because the preload is higher. Suppose you have similar physical and emotional conditions. In that case, the amount of activity you need to do to get angina may be fairly consistent or change daily. Most people have a lower threshold for angina after eating, when they are excited, or when they are exposed to cold. It is often lower in the morning or after a strong emotion. Strong emotions can cause attacks even when the person isn’t doing anything. The coronary spasm can cause pain during sexual activity, rest, or sleep.

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Characteristics of the discomfort

Patients often don’t describe angina as “pain,” but as tightness, squeezing, burning, pressing, choking, aching, bursting, “gas,” indigestion, or a vague discomfort. It’s often shown by making a fist over the middle of the chest. Angina pain is usually not sharp and does not come and go.

Location and radiation

The pain can be in many different places in different people. Still, it is usually the same for everyone unless unstable angina or MI happens. Most of the time, the pain is felt behind or just to the left of the middle of the sternum. When it starts further to the left or, less often, on the right, it usually moves toward the center of the chest. Even though angina can spread to any dermatome from C8 to T4, it usually starts in the left shoulder and upper arm and moves down the inner volar side of the arm to the elbow, forearm, wrist, or fourth and fifth fingers. It may also spread to the right arm, shoulder, lower jaw, neck, or back.

Duration of attacks

Angina usually lasts for a short time and goes away completely without leaving any pain behind. If the attack is brought on by exertion and the person stops to rest right away, it usually doesn’t last more than 3 minutes. Most attacks after a big meal or because of anger last between 15 and 20 minutes. Attacks that last more than 30 minutes are rare and may signify a new condition called acute coronary syndrome with unstable angina, myocardial infarction (MI), or something else.

Effect of nitroglycerin

The diagnosis of angina pectoris is supported if sublingual nitroglycerin stops an attack quickly and always shortens it and if prophylactic nitrates let you work harder or stop angina from happening at all.


During angina, a physical exam often shows a significant rise in systolic and diastolic blood pressure. However, hypotension can also happen, which may signify more severe or inferior ischemia (especially with bradycardia) caused by a Bezold-Jarisch reflex. Sometimes, pain is the only time a gallop rhythm and an apical systolic murmur are present. This is because papillary muscle dysfunction can cause temporary mitral regurgitation.

There may be supraventricular or ventricular arrhythmias, either because of the cause or due to ischemia.

It is important to look for signs of diseases that can cause or go along with atherosclerotic heart diseases, such as diabetes mellitus (retinopathy or neuropathy), xanthelasma tendinous xanthomas, hypertension, thyrotoxicosis, myxedema, or peripheral artery disease. In addition, it’s important to look for aortic stenosis or regurgitation, HCM, and mitral valve prolapse, as they can cause angina or other chest pain.

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Laboratory Findings

Blood tests do not help diagnose chronic angina unless they are used to check for acute coronary syndrome (troponin and CK-MB) and factors that contribute to ischemia (like anemia) and to look for risk factors that may increase the likelihood of true CHD (like hyperlipidemia and diabetes mellitus).


The ECG is often normal when a patient with angina is at rest. In the rest, abnormalities include an old MI, ST-T changes that aren’t very specific, and changes in LVH. Anginal episodes and asymptomatic ischemia are both marked by a horizontal or downward-sloping ST-segment depression on the ECG, which goes away when the ischemia goes away. T waves can also get flattered or flip around. Less often, transient ST-segment elevation is seen. This finding suggests severe (transmural) ischemia from coronary occlusion, which can happen with coronary spasms.

I hope you understand chronic coronary syndrome symptoms guidelines.

About Micel Ortega

Dr. Micel Ortega, MD, PhD, is a highly respected medical practitioner with over 15 years of experience in the field of internal medicine. As a practicing physician, Dr. Micel has built a reputation for providing compassionate and evidence-based care to his patients. He specializes in the diagnosis and management of chronic conditions, including diabetes, hypertension, and heart disease. In addition to his clinical work, Dr. Micel has published extensively in top-tier medical journals on the latest advancements in internal medicine and has played an instrumental role in the development of innovative treatment options.

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