Nocturnal angina pectoris: Difference between revisions

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==Overview==
==Overview==
Nocturnal angina is the occurrence of anginal discomfort either during the early of sleep (likely due to increased venous return) or during the early morning hours (likely as a result of an increase in vascular tone).
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).


==Nocturnal Angina Pectoris==
==Pathophysiology==
In clinical practice, two types of nocturnal angina are observed.  
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.
*Some patients experience angina '''within an hour or two after sleeping'''.
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.
:*The mechanism of angina in this group of patients is likely to be an '''increase in venous return''' and hence increased intra cardiac volume with a resulting increase in myocardial oxygen requirements.  


*Other group of patients with nocturnal angina experience chest discomfort much later, in the '''early hours of the morning'''.  
==Diagnosis==
:*In this group of patients, a primary reduction in coronary blood flow owing to i'''ncreased coronary vascular tone''', more likely related to different stages of sleep, has been postulated as the potential underlying mechanism.
===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.


==References==
==References==

Revision as of 18:10, 25 July 2011

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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.

References


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