Angina nocturna I20.0

In the literature, angina nocturna is mainly defined as a nocturnal angina pectoris and/or sudden dyspnoea occurring during the night, from sleep or from a lying position (Herold 2020).

In a broader sense, this is understood to mean nocturnal thoracic pain occurring from sleep or from a lying position (Rajy 2005).

Angina nocturna is divided into two main groups:

• Angina decubitus
• REM sleep induced angina pectoris (Stierle 2017)

Angina decubitus initially belonged to the group of unstable angina pectoris (Roskamm 1988), but according to more recent literature it belongs to the group of stable AP (Renz- Polster 2002).

Information on the frequency of angina nocturna is not available.

Angina nocturna in the broader sense is caused by a sudden decompensation between the demand and supply of myocardial blood flow.

The causes can be:

• acute coronary syndrome
• attendant left ventricular failure
• vasospastic angina pectoris
• Diseases of the A. coronaria sinistra
• beta-blocker-induced vasospasm
• propanol-induced angina nocturna
• severe aortic regurgitation
• sudden rise in arterial blood pressure
• severe anemia
• Sleep apnea (according to a study by Franklin et al., sleep apnea is found in 9 of 10 patients with angina nocturna [Pack 2002 / Franklin 1997]) (Rajy 2005)

angina decubitus

Angina decubitus is caused by an overload of the already damaged heart muscles (Füeßl 2010). In a study by Chen (2000) it could be shown that patients with angina decubitus already have left ventricular dysfunction. Left ventricular dysfunction was found in comparison to the control groups (group I: no AP, group II: with CHD but without AD, group III: patients with AD):

• the 1st filling fraction (1/3 FF) was significantly lower in group III
• the late filling fraction was increased in group III
• left ventricular end-diastolic pressure was significantly increased in groups II and III before and after left ventriculography (Chen 2000).

Presumably, a fluid backflow while lying down causes an increased ventricular wall tension due to the increased preload (Stierle 2017).

REM sleep induced angina pectoris

This form of AP is triggered by strongly fluctuating blood pressure values and pulse frequencies in the dream phase. Myocardial damage is not usually found (Stierle 2017).

The symptoms of angina decubitus occur while lying down / sleeping - preferably in the first half of the night - where, on the other hand, REM sleep-induced angina pectoris occurs predominantly in the second half of the night (Stierle 2017).

The diagnosis consists of a detailed anamnesis and the exclusion of coronary heart disease or angina pectoris (see also detailed diagnosis).

angina decubitus

The symptoms of AD usually subside quickly after the patient is put on the chair, as does the administration of a short-acting nitrate (Stierle 2017). Prophylactically, the preload can be reduced by diuretics (Stierle 2017) or by other drugs used to treat heart failure (Kasper 2015).

REM sleep-induced angina pectoris

In REM sleep-induced AP, beta-receptor blockers can be used therapeutically for prophylaxis (Stierle 2017).

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