Health Products usually caused by coronary artery disease. When an increase in myocardial oxygen requirement is not matched by a corresponding increase in coronary blood flow, visceral pain fibres of the autonomic nervous system cause the patient to experience sensory disturbance.

Health Products is usually appreciated as a retrosternal chest discomfort variously described as a burping or pressure sensation, or tightness occurring on exertion (physical or emotional), in cold whether or after food. Radiation to the neck, jaw, back or arms may occur.

Nevertheless, angina may be atypical in its presentation that is with discomfort in the back of the neck, jaw and hums, lower chest or upper abdomen. Less commonly, the sensation is of dyspnoea or burping. Symptoms are typically relieved with rest and glyceryl trinitrate spray.

Stable angina is characterized by a pattern of symptoms occurring predictably on exertion; unstable angina is the situation where symptoms are or recent onset, or occurring at rest.

Unstable angina betrays underlying plaque instability, and such patients are known to be at increased risk-that os, approximately 10 to 12% progress to myocardial infraction (MI) or death at six months. The condition should therefore be regarded as a medical emergency.

First Episode of Ischaemic Pain
The initial assessment of patients presenting with possible angina by the GP should include:
* Appropriate history taking with evaluation of symptoms and known cardiac risk factors, including hypertension, hypercholesterolaemia, diabetes mellitus, family history of ischaemia heart disease (IHD) and smoking history.

* Physical examination to exclude other possible causes of chest pain, such as anemia and aortic stenosis.

* First line investigations include hemoglobin, serum lipids and resting 12 lead ECG.

While a resting ECG has low sensitivity in diagnosting coronary artery disease, an abnormal ECG has been shown to identify a group at higher risk of subsequent cardiac events. Open access services extend this facility to community medical practise without in house ECG equipment.

While this arrangement facilitates this important investigation in patients with stable angina or other cardiac conditions, patients with unstable chest pain or chest pain at rest should continue to be refers to acute secondary care facilities, as time is of the essence in the prompt identification and management of these conditions.

Current guidelines on stable angina from the British Cardiac Society and the Royal College of Physicians recommended that all newly diagnosed patients with stable angina should be refereed for an objective assessment of myocardial ischaemia.

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