Angina differential diagnosis

For angina pectoris, a common disease among middle-aged and elderly people, the general way to judge it is the occurrence of heart pain and arrhythmia. In severe cases, shock may also occur. Moreover, angina pectoris lasts for a relatively long time, so patients need to seek medical treatment in time, otherwise it will affect the patient's life safety. Regarding the differential diagnosis method of angina pectoris, it is recommended that everyone can understand the content of the article and treat the symptoms of angina pectoris correctly.

Differential diagnosis of angina pectoris:

1. Acute myocardial infarction: The pain is similar to that of angina pectoris, but more severe in nature, often lasting more than 30 minutes and up to several hours, and may be accompanied by arrhythmia, heart failure or (and) shock, which cannot be relieved by nitroglycerin. The ST segment of the lead facing the infarction site in the electrocardiogram is elevated, and there may be abnormal Q waves (non-ST-segment elevation myocardial infarction is often manifested as ST segment depression or T wave changes). Laboratory tests show increased white blood cell count, increased erythrocyte sedimentation rate, and increased myocardial necrosis markers (myoglobin, troponin I or T, CK-MB, etc.).

2. Other diseases causing angina pectoris: including severe aortic valve stenosis or insufficiency, coronary arteritis, hypertrophic cardiomyopathy, syndrome X, myocardial bridge, severe anemia, hyperthyroidism and other diseases can all cause angina pectoris.

3. Intercostal neuralgia and costochondritis: The pain in the former often involves 1-2 intercostal spaces, but is not necessarily limited to the chest. It is a stabbing or burning pain, mostly continuous rather than paroxysmal. Coughing, forceful breathing and body turning can aggravate the pain. There is tenderness along the course of the nerves, and local pulling pain when raising the arms; the latter causes tenderness in the costal cartilage.

4. Cardiac neurosis: Patients often complain of chest pain, but it is a short-term (a few seconds) stabbing pain or a continuous (a few hours) dull pain. Patients often like to take a deep breath or sigh from time to time. The location of chest pain is mostly near the apex of the heart under the left breast, or it changes frequently. Symptoms often appear after fatigue rather than at the time of fatigue. People feel comfortable with light physical activity, and can sometimes tolerate heavier physical activity without experiencing chest pain or tightness. The use of nitroglycerin is ineffective or takes more than 10 minutes to "take effect", and is often accompanied by palpitations, fatigue, dizziness, insomnia and other neurotic symptoms.

5. Reflux esophagitis: Due to the relaxation of the lower esophageal sphincter, acidic gastric acid refluxes, causing esophageal inflammation and spasm, manifested as a burning sensation behind the sternum, which may radiate to the back and may be suspected of angina pectoris. However, this disease often occurs in the supine position after a meal, and antacids can relieve it. The acid infusion test can reproduce chest symptoms: the patient sits, a gastric tube is inserted for 30 minutes, and 0.1N hydrochloric acid (HCL) is dripped in 100 drops/minute, which can reproduce the symptoms.

6. Hiatal hernia: often accompanied by gastric reflux, its symptoms are similar to esophagitis, often occur after a full meal when bending over or lying down, with a feeling of blockage and pressure behind the sternum, gastrointestinal radiography can confirm the diagnosis.

7. Diffuse esophageal spasm: This is a neuromuscular motor disease that can also occur with reflux esophagitis. Symptoms include pain behind the sternum, radiating to the back, upper limbs and jaw, and lasting for minutes or hours. The pain may be contractile or sharp. Nitroglycerin is effective, but ergonovine may induce it, so it is easy to suspect that it is an angina attack. The difference from angina pectoris is that it often occurs when eating, especially drinking cold drinks, or after meals, and there is difficulty in swallowing during the attack, and it is not related to labor. Esophagoscopy, esophageal radiography, and esophageal manometry to monitor changes in esophageal pressure can provide a clear diagnosis.

8. Biliary colic: often occurs suddenly, with severe pain, usually located in the right upper abdomen. If there is cholecystitis, there may be tenderness in the right upper abdomen. Sometimes the pain is located in the upper abdomen and precordial area, and may radiate to the right subscapular area or along the rib margin to the back. It may be accompanied by scleral icterus, fever, and leukocytosis, and abdominal B-ultrasound can usually confirm the diagnosis.

9. Mitral valve prolapse: Chest pain and other manifestations of neurocirculatory weakness are common. ST segment depression may be shown on the electrocardiogram, which is more common in leads II, III, and AVF. Clicks and/or systolic murmurs may be heard upon careful auscultation. Echocardiography can further clarify the diagnosis.

10. Pericarditis: The pain is located in the sternum or beside the sternum, precordial area, and may extend to the neck and shoulders. The pain may be aggravated by coughing, deep breathing, or lying flat. If pericardial friction sound is detected during careful auscultation, the diagnosis can be confirmed.

11. Herpes zoster: chest pain, local skin allergy, fever, fatigue, and headache may occur before the visit. Herpes zoster will appear 4-5 days later and the diagnosis can be confirmed.

12. Cervical spondylosis: The distribution of pain is consistent with the course of the nerves, which can cause pain in the left upper limb and chest pain, and can be induced by neck movement or other operations. Regardless of physical activity, anteroposterior and lateral cervical spine X-rays can show cervical lip hyperplasia and intervertebral disc herniation.