Errors in the Recognition and Treatment of Heart Disease

The diagnosis of angina pectoris is established by the presence of a characteristic history and does not depend upon the presence of electrocardiographic abnormalities. The pain is usually substernal and occurs characteristically during effort, emotional stress, exposure to cold or after a large meal. It is not well appreciated that it may occur on assuming the recumbent position. The duration is one to five minutes as a rule and relief may be prompt with rest or the administration of nitroglycerin. In inquiring regarding angina, it is not sufficient to ask about pain alone. Since pain may be denied, one should therefore ask about indigestion, tightness, squeezing, burning, heaviness or choking. Discomfort may occur in the arms, epigastrium, back or jaw without being present in the anterior chest. While precordial pain is rare in angina pectoris, it may occur. The sudden onset of angina for the first time or the change in its frequency or severity usually signifies coronary occlusion and rarely myocardial infarction. Judicious periods of rest when such changes occur may allow collateral circulation