Nocturnal angina pectoris
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Alternative Therapies for Refractory Angina | ||
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Nocturnal angina pectoris On the Web | ||
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Risk calculators and risk factors for Nocturnal angina pectoris | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Nocturnal angina is the occurrence of anginal discomfort either during the early hours of sleep (likely due to increased venous return) or during the early morning hours (likely as a result of an increase in vascular tone).
Pathophysiology
1. Among patients who develop nocturnal angina within an hour or two of going to sleep, the mechanism of angina in this group of patients is likely to be an increase in venous return and hence increased intracardiac volume with a resulting increase in myocardial oxygen requirements. 2. Among patients who develop nocturnal angina in the early morning hours a primary reduction in coronary blood flow owing to increased coronary vascular tone, more likely related to different stages of sleep, has been postulated as the potential underlying mechanism.
Diagnosis
Symptoms
Two patterns of nocturnal angina are observed:
1. Some patients experience angina within an hour or two after sleeping.
2. Other group of patients with nocturnal angina experience chest discomfort much later, in the early hours of the morning.
Treatment
The treatment is similar to that of chronic stable angina. If increased coronary vascular tone is felt to be the underlying mechanism, the calcium channel blockade may be of benefit.