Stable angina

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Stable angina

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NOTES NOTES CORONARY ARTERY DISEASE STABLE ANGINA PECTORIS osms.it/stable-angina PATHOLOGY & CAUSES ▪ Episodic chest pain because of inadequate oxygen supply to the heart, most often due to obstruction in the coronary arteries ▪ Most common type of angina ▫ Angina pectoris refers to a speciﬁc type of chest pain caused by lack of blood ﬂow to the heart muscle. Pain often presents as pressure, fullness, squeezing pain in the center of the chest ▫ In angina → ischemia in the subendocardium → triggers release of adenosine and bradykinin → pain CAUSES Atherosclerosis ▪ Causes plaque buildup in vessel; blood ﬂow to heart muscle limited ▫ As plaque becomes larger and blocks more ﬂow, pain arises with lower levels of exertion Tachyarrhythmias ▪ Increased heart rate increases heart’s demand for oxygen that cannot be delivered, thus causing pain Pulmonary hypertension ▪ Left main coronary artery can become compressed by enlarged pulmonary artery trunk, leading to reduced perfusion and pain Increased myocardial oxygen demand ▪ Consequence of increased left ventricular mass secondary to concentric hypertrophy, and an increased afterload due to the ﬁxed obstruction to left ventricular outﬂow Genetic hypertrophic cardiomyopathy ▪ Cardiac hypertrophy leads to increased oxygen demand of heart muscle. In times of high exertion, the heart cannot supply enough oxygen and ischemia results RISK FACTORS ▪ Smoking, hypertension, diabetes, dyslipidemia (high LDL, low HDL, and high triglycerides), obesity, family history of coronary artery disease Protective factors ▪ Modest alcohol consumption (~one drink/ day), healthy diet (e.g., lots of vegetables, grains, and nuts), and regular exercise SIGNS & SYMPTOMS ▪ Chest pain coinciding with increased exertion or stress. Pain described as pressure, squeezing, burning, or tightness; can radiate to the either/both arms, jaw, shoulders, and back ▫ Pain usually lasts less than 20 minutes ▪ Other symptoms: Levine’s sign (a clenched ﬁst held over the chest), dyspnea, diaphoresis, fatigue, nausea, and epigastric pain ▫ Angina equivalent: These “other symptoms” felt without chest pain during periods of coronary ischemia (more common in diabetics, biologicallyfemale individuals, elderly) OSMOSIS.ORG 41

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Stable angina

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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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