Case of the Month #19: Refractory Angina by Dr Sonia Pierce
Further Relevant Information
Additional exploration of her symptoms described. She has two types of pain, one associated with activity and another without any triggers. Further exploration of the second symptom, the patient describes this pain as a severe sharp central chest pain with occasional difficulty in breathing and no pattern of radiation. Mrs A describes feeling frightened by these symptoms with an occasional feeling that she is going to die during an episode. Exploration of her fears identified that she was frightened that her angina symptoms would lead to a heart attack.
Mrs A’s symptoms improved for 6 months following her stents with symptoms returning to pre-stent levels.
On examination, Mrs A’s blood pressure and heart rate is within normal limits, and she has normal neurology in her upper limbs. She has an area of dysesthesia over her anterior chest wall upon sensory testing. She is able to provide a detailed medication history and, as well as her usually cardiac medication. She is on optimal angina pharmacotherapy and is taking co-codamol 30/500 as needed, usually three times per day when she feels her chest becoming tight, which she finds helpful . She had been given a diagnosis of refractory angina but was unsure what this meant for her. Her cardiology team had referred her to their tertiary cardiology service to review the option of additional medical therapies and she is awaiting that appointment.