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Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
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IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
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Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
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Definition and Symptoms: Angina (angina pectoris) is chest pain or discomfort caused by myocardial ischemia, which occurs when the heart muscle receives insufficient oxygen-rich blood. It typically manifests as pressing, squeezing, or crushing sensations in the chest and may radiate to the shoulders, arms, neck, jaw, or back.Primary Cause: In a healthy state, the coronary arteries can dilate (widen) to increase blood flow and meet the increased oxygen demand during physical activity or...
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Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
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Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled

Fiyyaz Ahmed-Jushuf1,2, Michael J Foley1,2, Shayna Chotai1,2

  • 1National Heart and Lung Institute, Imperial College London, UK (F.A.-J., M.J.F., S.C., C.A.R., D.W., F.A.S., K.M., K.C., S.M., S.S.N., H.S., J.P.H., D.P.F., M.J.S.-S., R.K.A.-L.).

Circulation
|May 8, 2026
PubMed
Summary
This summary is machine-generated.

Physiological thresholds for angina, measured by fractional flow reserve (FFR) and resting full-cycle ratio (RFR), are individualized and vary with exercise. These angina thresholds are lower than current ischemia-based guidelines for percutaneous coronary intervention (PCI).

Keywords:
angina pectoriscontrolled clinical trials as topiccoronary artery diseasecoronary circulationfractional flow reserve, myocardialischemiapercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Physiology

Background:

  • Percutaneous coronary intervention (PCI) aims to relieve symptoms in stable coronary artery disease.
  • Fractional flow reserve (FFR) and resting full-cycle ratio (RFR) guide revascularization but lack validation against angina onset.
  • Physiological thresholds for angina (FFRangina, RFRangina) at rest and during exercise are undefined.

Purpose of the Study:

  • To define the physiological thresholds for angina during rest and exercise.
  • To compare these angina thresholds with established ischemia-based cut points.
  • To assess the relationship between angina thresholds and symptom relief after PCI.

Main Methods:

  • The ORBITA-FIRE study randomized patients with stable angina undergoing PCI.
  • An in-stent balloon was inflated to induce angina at rest and during low- and high-intensity exercise.
  • FFRangina and RFRangina were recorded at symptom onset and compared to placebo.

Main Results:

  • Median FFRangina increased from 0.29 at rest to 0.45 during high-intensity exercise; RFRangina increased from 0.22 to 0.32.
  • Angina thresholds were significantly lower than clinical diagnostic cut points (P<0.001).
  • Lower angina thresholds correlated with greater symptom reproducibility and predicted higher baseline angina burden and greater symptom relief with PCI.

Conclusions:

  • Angina thresholds (FFRangina, RFRangina) are highly individualized and workload-dependent.
  • These thresholds are consistently lower than current ischemia-based guidelines.
  • Personalized, symptom-linked physiology can refine patient selection and improve PCI symptomatic response.