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Character The discomfort is often described as a squeezing, crushing, strangling, tightness, pressure, heaviness, or a vague ‘funny feeling’.

In a patient with severe coronary artery disease, even low levels of exertion will lead to myocardial oxygen debt because the limited amount of blood flow cannot meet the demand.However, when cardiac work is increased, the stiffened, diseased coronary arteries are unable to respond with an increase in diameter or with an augmented delivery of oxygenated blood to the heart muscle.In effect, demand is greater than available supply, and ventricular muscle becomes deprived of the oxygen necessary to maintain the work of pumping.Therefore, anginal pain will occur earlier and much more frequently.The main determinants of myocardial oxygen demand in the ischemic heart include: • Contractile state of the myocardium • Heart rate • Tension of the myocardial wall In addition, the risk of developing a myocardial infarction increases with the severity, extent, and duration of myocardial ischemia.The sensation noted in the neck is frequently described as choking; in the jaw, as a toothache; and in the arms, as a numbness or tingling sensation.

Exertion Angina is usually brought on by some form of exertion, often walking uphill.It is believed that ischemia causes the muscle to release lactic acid and other pain-promoting substances that are not cleared very rapidly due to diminished blood flow in the ischemic area.The concentrations of these substances build up and stimulate nerve endings in the cardiac muscle.Infarction is the end point of moderate to severe ischemia over a prolonged period of time.Normally you cannot feel your heart, but ischemic cardiac muscle does produce pain.Nitroglycerin relieves the anginal process within 5 to 10 minutes.

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