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ATYPICAL CHEST PAIN IN PATIENTS WITH HEART DISEASE

JAMA. 1963;184(3):235. doi:10.1001/jama.1963.03700160111020.
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That pains in the chest, which occur in the absence of effort, were not of cardiac origin was an assumption held by most cardiologists 40 years ago. Numerous exceptions to this definition were described as more was learned of cardiovascular disease. Nocturnal angina pectoris occurs when the patient has been sleeping, and in these instances the decubitus position, rather than exertion, precedes chest pain. Stimuli arising from the diseased stomach, gallbladder, or esophagus often serve as trigger mechanisms in production of anginal distress quite unrelated to exercise. Recently, Smith and Papp1 have described "angina of stooping" which occurs when patients stoop to perform household tasks. A rise of systolic and diastolic blood pressure occurred when the patients stooped and also during leg raising. Changes in blood pressure occur equally often in patients with postural angina and in healthy controls. The pulse rate during stooping appears to rise more consistently

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