Angina Pectoris with Pain of Atypical Distribution

Abstract

An occasional patient with angina pectoris caused by coronary artery disease suffers from pain of such atypical distribution that, in order to establish the diagnosis beyond doubt, it becomes important to obtain objective evidence of organic heart disease. T he electrocardiogram taken at rest furnishes the desired information in some of these patients, but in a considerable number no significant electrocardiographic changes are present. In the latter group, an electrocardiogram taken during an induced attack of pain usually shows changes in the S-T segment or the T wave of greater degree than occur in the tracings of normal individuals after the same amount of exercise. The value of these changes as a corroborative diagnostic measure is demonstrated in the following case report.

REPORT OF CASE

A businessman, 56 years of age, c a me to the Clinic because of attacks of stiffness in the neck and “congestion” in the substernal region. The symptoms had appeared first eighteen months earlier, and during the last seven weeks had become much worse. Both the stiffness in the neck and the sense of congestion in the chest were induced by exertion. The patient was unable to walk more than half a city block at a moderate pace without experiencing such distress that he would find it necessary to stop. With rest the symptoms would subside in about ten minutes. Exposure to cold air appeared to be an important predisposing factor in the development of the attacks and, at times, the symptoms were brought on. . .