The Diagnostic Significance of Anginal Symptoms

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Abstract
Data obtained from a detailed clinical history were correlated with findings at cardiac catheterization in 49 patients who had coronary artery disease and in 23 patients who had recurrent chest pain but normal coronary angiograms. Classical descriptions of angina pectoris were applicable to both groups. Certain combinations of factors including response to nitroglycerin, relationship to exertion, presence of a fourth heart sound, and radiation of pain to the left arm appeared to be of discriminatory value. In the group with coronary lesions, factors suggestive of extensive multiple-vessel involvement included the triad of rest-related, nocturnal, and postprandial pain, radiation of pain to regions other than the left arm, and poor responsiveness to nitroglycerin. (JAMA229:1196-1199, 1974)