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Chronic stable angina clinical subset- nocturnal angina pectoris

Introduction

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Overview

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Overview

Nocturnal angina is the occurrence of anginal discomfort either during the initial few hours of sleep or during the early morning hours. It is speculated that discomfort caused during the first hour of sleep is due to increased venous return, whereas the discomfort caused during the early morning hours is due to increased vascular tone.

Treatment

Medical Therapy

The treatment of nocturnal angina pectoris is same as the chronic stable angina. If increased coronary vascular tone is felt to be the underlying mechanism, the calcium channel blockade may be of benefit.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

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Pathophysiology

  • Among patients who develop nocturnal angina within one to two hours of falling asleep, the mechanism of angina in this group is likely to be an increase in venous return and hence an increased intracardiac volume, with a resulting increase in myocardial oxygen requirements.
  • Among patients who develop nocturnal angina in the early morning hours, increased coronary vascular tone causing a primary reduction in coronary blood flow has been postulated as the potential underlying mechanism. This is due to the diurnal increase in sympathetic activity which occurs in the early morning hours causing increased heart rate, blood pressure, and vascular tone.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

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References

Differentiating Nocturnal Angina Pectoris from other Diseases

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References

Epidemiology and Demographics

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Risk Factors

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Natural History, Complications and Prognosis

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References

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Related Chapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Cafer Zorkun, M.D., Ph.D. [2]