In this essay “Evolution of Stable Angina into Acute Myocardial Infarction,” the author will conduct a critical review of several studies in order to assess factors that influence the recognition and progression of stable angina pectoris into a more serious condition…
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It is a very variable symptom that varies when is described by different patients, and this makes it one of the most controversial symptoms in the medicine (Melvyn et al. 2010). Stabile angina pectoris is usually first recognized during a general practice (GP) doctor visit or is noticed by a nurse during a home visit or other occasion. GP doctors often must decide if the acute symptoms described by the patient are due to heart problems or some other less acute condition and have limited resources in GP ambulance to do complete more detailed diagnostic tests like a stress test, laboratory findings, angiography or other procedures that are less often found in GP office. Initial recognition of this symptom but also the future monitoring and treatment of these patients is important for the preventing progression of evolution of the coronary artery disease and progression of stable angina pectoris into unstable angina or myocardial infarction (Adam et al. 2007). In this essay, we will conduct a critical review of several studies in order to assess factors that influence the recognition and progression of stable angina pectoris into a more serious condition. Review of studies in relevance to stable angina pectoris in primary care As we mentioned above angina pectoris is a symptom defined by the patient in his own words. This condition can often cause changes like ST depression on EKG strip but very often angina pectoris can occur without any changes on the ECG strip (Hausmann et al. 1991). Because more accurate methods for confirmation of angina pectoris are often unavailable in pre-hospital or pre-clinical settings, anamnesis has an important function as a factor for initial recognition of this disease. But as we mentioned above angina pectoris is a subjective symptom and description of the patients often vary significantly. This condition was researched by Melvyn et al. 2010 who tried to recognize the variations of presentation of these symptoms. For this task, they recruited patients from two general practice institutions and only included patients that had a diagnosis of angina pectoris or other ischemic cardiovascular (CV) condition or patients that were taking some form of nitrates. All of the participants were subjected to interview conducted by medical professionals and all of the participants were asked the same questions: did they have any chest, jaw or neck discomfort in the last year and how would they describe this discomfort. A total of 64 patients were interviewed. There are a set of widely accepted individual interpretations of angina pectoris that are called angina “canon”. These symptoms are (Somerville et al. 2008): - association of the symptoms with physical exercise. - positive reaction after administration of medication, - general duration of symptoms during a single attack.
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