Angina pectoris

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Angina pectoris

3rd year prop. int. dis.

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Angina pectoris

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Angina pectoris

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USMLE® Step 1 style questions USMLE

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A 60-year-old man is brought to the emergency department due to chest pain that started suddenly 15 minutes ago while playing with his grandchildren. The patient describes the pain as “pressure and tightness” located in the center of his chest. The patient reports that he occasionally experiences mild chest discomfort when going up the stairs. Medical history is significant for a 30-pack-year smoking history, hypercholesterolemia, and hypertension. The patient is given a sublingual medication while in the emergency department, and the symptoms resolve within a few minutes. Which of the following sets of hemodynamic changes is most likely to be seen in this patient following the administration of this medication?  

*(-) decrease, (0) no effect, (+) increase  

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Acebutolol p. 246

angina and p. 326

Angina

aortic stenosis p. 298

atherosclerosis p. 308

cilostazol/dipyridamole for p. 445

cocaine causing p. 594

contraindicated drugs p. 326, 329

drug therapy for p. 325, 326, 363

glycoprotein IIb/IIa inhibitors for p. 445

ischemic disease and p. 310

presentation p. 716

unstable/NSTEMI treatment p. 316

Intestinal angina p. 395

Angina pectoris

β -blockers for p. 247

Atherosclerosis p. 308

stable angina with p. 310

β -blockers p. 247

angina p. 326

Calcium channel blockers p. 325

angina p. 325

“Intestinal angina p. 395

myocardial O2 consumption/demand p. 292

angina treatment p. 326

Nitroglycerin p. 325

angina p. 310

Stable angina p. 310

Triptans p. 567

angina and p. 310

Variant angina p. 310

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Transcript

Content Reviewers

Fergus Baird, MA

Rishi Desai, MD, MPH

Contributors

Tanner Marshall, MS

Vincent Waldman, PhD

Angina comes from the latin angere, which means to strangle, and pectoris comes from pectus, meaning chest—so angina pectoris loosely translates to “strangling of the chest”, which actually makes a lot of sense, because angina pectoris is caused by reduced blood flow which causes ischemia to the heart muscle, or lack of oxygen to the heart, almost like the heart’s being strangled which causes terrible chest pain.

Stable angina or chronic angina is the most common type of angina and it usually happens when the patient has greater than or equal to 70% stenosis, meaning 70% of the artery is blocked by plaque buildup.

This small opening that blood flows through might be enough to supply the heart during rest, but if the body demands more blood and oxygen, like during exercise or stressful situations, the heart has to work harder, and therefore needs more blood and oxygen itself.

It’s during these time of exertion or emotional stress that people with stable angina have chest pain, since the blood flow isn’t meeting the metabolic demands of the heart muscle, or myocardium.

But the pain usually goes away with rest.

In the majority of cases, the underlying cause of stable angina is atherosclerosis of one or more the coronary arteries—arteries supplying blood to the heart muscles.

Other heart conditions that might lead to stable angina are ones that cause a thickened heart muscle wall, which would require more oxygen.

This increase in muscle size can be due to hypertrophic cardiomyopathy from a genetic cause, or as a result from the heart having to pump against higher pressures, as is the case in aortic stenosis, which is a narrowing of the aortic valve, or hypertension.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Pathogenesis of angina pectoris" undefined (1982)
  5. "Unstable angina pectoris: Pathogenesis and management" Current Problems in Cardiology (1989)
  6. "Management of Chronic Stable Angina" Critical Care Nursing Clinics of North America (2017)
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