Atypical Pain in Angina Pectoris

Abstract

In its typical form the syndrome of angina pectoris seldom offers difficulty in diagnosis. The pain or discomfort is situated in the sub-sternal region, is precipitated by exertion, may or may not radiate from its site of origin, and is relieved promptly by rest and nitroglycerine. Atypical forms of the syndrome, however, are not so well recognized and often are responsible for erroneous diagnoses. It is the purpose of the present report to emphasize the frequency with which the pain of angina pectoris arises in regions other than the substernal area and to point out the more common of the atypical sites of origin.

MATERIAL AND RESULTS

Five hundred cases of angina pectoris due to coronary artery disease were analyzed. The cases constituted a consecutive series except for the fact that a few records were excluded because of insufficient information in the clinical history or because no electrocardiogram had been made.

In the entire series of 500 cases there were 378 instances in which the pain or discomfort originated in the substernal region and 122 in which it arose in some other area. The pain, therefore, was atypical in its site of origin in 24.4 per cent of the patients. The ages of the patients, distribution according to sex, and the incidence of arterial hypertension are shown in Tables 1 and 2. None of these factors appeared to be of significance in relation to the occurrence of atypical pain. The initial location of the pain in the atypical cases is. . .