Lect 2 angina

Coronary artery disease (CAD) is a

condition in which plaque builds up

inside the coronary arteries.

Plaque is made up of fat, cholesterol,

calcium, and other substances found i

n 

the blood, and narrows the arteries an

d 

reduces blood flow to the cardiac mu

scle.

Atheroschlerosis also increases the risk of bl

ood clotting. CAD can lead to angina, myoc

ardial infarction and even death

Angina

Angina–also sometimes called angina pectoris. It means

that the heart is not getting enough blood and as a

result, not enough oxygen. This decrease of oxygen being

delivered to the muscle of the heart happens if one or

more coronary arteries are narrowed or blocked, a

condition called atherosclerosis.

Definition

is a clinical syndrome

characterized by discomfort in the

chest, jaw, shoulder, back, or

arms, typically elicited by exertion

or emotional stress and relieved

by rest or nitroglycerin

Angina can be:Stable

occurs when the heart has to work harder than

normal, during exercise.

Once you stop exercising, or take medication

(usually nitroglycerin) the pain goes away.

Unstable caused

by unstable plaque,

occurs at rest,

unpredictable, pain can

increase for no obvious

reason

Less common kinds of angina include: • variant angina • microvascular angina • atypical angina

Variant angina ,the spasm is most likely to occur near a

buildup of fatty plaque in an artery.

Microvascular angina —sometimes referred to as Syndrome X

—occurs when tiny vessels in the heart become narrow and

stop functioning properly

Atypical angina often doesn’t cause pain, but you may feel a

vague discomfort in your chest. Women are more likely than

men to have feelings of vague chest discomfort

Stable angina pectorisProvoked by physical exertion,

especially in cold weather, after meals and commonly aggravated by anger or excitement

The pain fades quickly with rest

Myocardial ischemia is caused by an imbalance between myocardial oxygen supply and myocardial oxygen consumption

Risk factors for angina

High blood pressure Diabetes Mellitus Unhealthy cholesterol levels Smoking Lack of exercise Obesity

Risk factors for angina

Too much salt in your diet Excessive use of alcohol Family history of CAD or strokeBeing male Being a postmenopausal woman Age - the risk increases for men

over the age of 45 and for women over the age of 55

Clinical symptoms

Patient history is a˝golden standard˝

Retrosternal pain??may also be silentDyspneaNauseaArrhythmiaRestlessness

Physical examination

HypertensionObesityHyperglycemiaHyperlipidemiaAuscultation

InvestigationsLaboratory tests (leukocytes, hemoglobin,

thyroid hormones, troponin I and T, CKMB (creatine kinase myocardial band)to exclude myocardial injury.

Resting ECGExcercise ECG (stress test)EchocardiographyCoronary angiography

Treatment

Medications

Surgical procedures

Nitrates are available in a number of different forms. Headache

is a possible side effect.

Beta-blockers are a to treat several kinds of heart disease. They

work by lowering blood pressure, and slowing heart rate which

means your heart class of medicines used doesn’t have to work

as hard.

Calcium channel blockers or calcium antagonists also work

by lowering blood pressure and slowing heart rate, and are

often used if you cannot take a beta-blocker. They may be

useful to treat coronary artery spasm.

Antiplatelet medications are blood thinners that

work by preventing blood clots from forming and

blocking arteries. The most commonly used

antiplatelet medication is aspirin, which works by

preventing platelets from sticking to blood vessel

walls. An enteric-coated aspirin is generally

recommended because it is easier on the stomach.

Surgical proceduresAngioplasty

If several arteries are severely blocked, coronary artery bypass surgery (also sometimes referred to as coronary artery bypass grafting or CABG)

Living well with anginaStop smoking.

Exercise regularly.

Watch your alcohol intake.

Watch what you eat. You should try to stop eating

unhealthy fats and sugars as much as you can, and

instead eat more fresh fruits and vegetables, grains

and grain products, lean poultry, beef or fish.

Limit your salt intake.

Watch your weight

Have your cholesterol levels checked

Control high blood pressure

Patients with stable angina are at risk of developing an Acute coronary

syndrome (ACS)

ACUTE CORONARY SYNDROME

Acute coronary syndrome (ACS) is the umbrella term

for the clinical signs and symptoms of myocardial

ischemia: unstable angina, non–ST-segment elevation

myocardial infarction, and ST-segment elevation

myocardial infarction

In an MI, an area of the myocardium is

permanently destroyed, typically because

plaque rupture and subsequent thrombus

formation result in complete occlusion of

the artery.

Clinical ManifestationsChest pain that occurs suddenly and continues

despite rest and medication is the presenting

symptom in most patients with ACS

Patients may present with a combination of

symptoms, including chest pain, shortness of breath,

indigestion, nausea, and anxiety. They may have cool,

pale, and moist skin

Laboratory TestsCardiac enzymes and biomarkers are used to

diagnose an acute MI. Cardiac biomarkers, which

include myoglobin and troponin, can be analyzed

rapidly, expediting an accurate diagnosis. These tests

are based on the release of cellular contents into the

circulation when myocardial cells die.