The Variability of Anginal Radiation

Aims: The goal of this study was whether we could clinically anticipate the extent of CAD and whether we could determine the frequency of less common angina radiation in the population of stable angina group. We hypothesized that the extent of angina radiation (AR) may be related to ischemic burden. Methods: One hundred (100) consecutive patients referred for coronary arteriography were divided into 2 groups according to anginal radiation. The patients were divided into 2 broad categories. Those whose anginal discomfort limited to chest and back were assigned to group 1. If the anginal radiation was more widespread, then those patients were placed in group 2. Results: Forty-four (44) patients who had AR limited to chest and back radiation were classified to group 1. Fifty-six (56) were in more extensive radiation and were classified as group 2. In group 2, there were 15 patients whose AR extended to lower jaw, wrists or head. We labeled these 15 patients as remote radiation. Although group 1 and 2 differed clinically, no differences existed in the distribution of CAD. However, the 15 patients with remote AR had high sensitivity for multi-vessel CAD; but specificity was only 50%. Conclusions: Extensive radiation of anginal discomfort does not necessarily reflect diffuse disease of coronary vessels. However, if anginal discomfort reaches the lower jaw, wrists and head, it carries high sensitivity (93%) for multi vessel CAD. The radiation to remote sites constitute 15% of patients referred for coronary arteriography.