Walking through angina I20.8

Walking through angina is an angina pectoris that occurs at the beginning of a physical exertion and decreases in the course of the physical exertion (Siegenthaler 2005).

Walking through angina is a stable AP (Renz- Polster 2008).

The pathophysiological mechanism shows different explanations.

According to Siegenthaler (2005), the recruitment of collaterals occurs under stress, which after a certain time supply the ischemic area of the myocardium with sufficient oxygen.

Douglas (2013) considers increased peripheral vasodilation at the beginning of physical exertion to be the cause of AP attacks.

Recent literature describes the release of vasodilatory metabolites (Herold 2020).

Initially, there is a typical symptomatology of angina pectoris under physical strain with

• retrosternal localized pain, which can radiate in
  • Neck / Neck
  • Lower jaw
  • Teeth
  • Shoulder area
  • both (!) arms (with focus on the ulnar sides of the forearms), which can radiate into the ulnar fingertips
• Pain in the epigastrium (rarely also below the navel) (Kasper 2015)

The symptoms typically disappear again on their own under constant physical strain - without drug treatment (Herold 2020).

If a short-acting nitro preparation is administered immediately after the occurrence of AP, an immediate improvement occurs (Schunkert 2013). In earlier literature an extended warm-up phase is recommended to avoid the initial period of ischemia (Schulte 1991).

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2. Herold G et al (2020) Internal medicine. Herold Publisher 240
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4. Renz- Polster et al. (2008) Basic textbook on internal medicine: compact, tangible, understandable. Elsevier Urban and Fischer 64
5. Schulte K L et al (1991) Cardiac risk at Sprot Steinkopff Verlag 85
6. Schunkert H et al (2013) Rational diagnosis and therapy of coronary heart disease. Springer Publishing House 85
7. Siegenthaler W et al (2005) Siegenthaler's differential diagnosis: Internal diseases - from symptom to diagnosis. Georg Thieme Publisher 227