Stable angina is graded by Canadian cardiovascular society classification ( CCSC ) by 4 grades. Angina at rest usually denotes unstable angina. But, patients with stable angina may also experience rest angina according to CCSC , still this is not considered as unstable angina by many . Post prandial angina is one such example.
Few consider post prandial angina as unstable angina . This sort of reasoning can not be faulted .
In the logical sense , we are dealing with varied categories of unstable angina. The importance of diagnosing unstable angina is to intervene early , so that we can avoid major adverse outcome .
The problem in CAD is , often , the plaques and angina do not obey the conventional rules !
.The following permutations and combinations could be observed in any coronary care unit .
- Unstable angina – stable plaques – stable ECG – stable patient
- Unstable angina – unstable plaques – unstable patient
- Unstable Angina – unstable plaque – stable patient
- Stable Angina – unstable plaque – unstable patient
- Stable angina – stable plaque – stable patient
- Stable angina – unstable plaque – stable patient
Among the above 6 categories 2nd is probably the most dangerous group and category 5 is most benign.
Post prandial angina is a serious form of angina.It implies , even diversion of little blood to GI system immediately after a meal can provoke an episode of ischemia .This infers a very tight lesion somewhere in the coronary tree, very often it could be the left main or proximal LAD.
Of course , there is another mechanism for post prandial angina, namely GI neurotransmitters like gut peptides acting as a coronary vasoconstrictor.
Snippets on post prandial angina .
It is also recognised , post prandial angina occurs more often during dinner, followed by lunch and breakfast. Carbohydrate foods are more likely to precipitate it .
Does PPA cause ST depression ?
Logically it should .In reality It happens in few .
How to manage it ?
It is very important to recognise , even though this article argues for including PPA as UA, there is no acute thrombotic process during an episode of post prandial angina . In fact , it is more of a secondary UA due to altered blood flow pattern.
So , do not admit these patients in CCU and administer heparin or 2a 3b blockers. (Unless of course ,they have other forms of rest angina )
Link to reference
1 PP angina angiographic correlation
2.Effect of carbohydrate diet on postprandail angina
Final message
Post prandial angina has all the characters of a severe form of angina .There is every reason to label it as UA .It is suggested , ACC,ESC, AHA should consider including post prandial angina as UA or at least UA equivalent .This would help intervene this entity early.
Dr.S.Venkatesan MD 
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