Stable angina

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Summary of Stable angina

Stable angina is a type of chest pain related to myocardial ischemia. It usually occurs in individuals with atherosclerosis whose coronary arteries have been narrowed as a result. The chest pain is typically brought on physical activity or emotional stress and does not occur at rest. It is completely relieved by rest or the administration of sublingual nitroglycerine.

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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 56-year-old man comes to the emergency department because of chest pain and pressure he experienced an hour ago while shoveling snow. He has had recurrent bouts of this pain over the past year, and he says that it usually radiates to his jaw and left arm, and goes away when he sits down to rest. Today's episode lasted five minutes, he has come to the ED at the urging of his family. He has a 10-year history of hyperlipidemia and type 2 diabetes mellitus. Current medications include atorvastatin and metformin. His temperature is 37.1°C (98.8°F), pulse is 87/min, respirations are 19/min, and blood pressure is 130/85 mm Hg. Initial laboratory studies show a troponin I level of less than 0.01 ng/mL. Chest X-ray and ECG show no abnormalities. Which of the following is the most likely diagnosis?

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