2. Angina pectoris is a clinical syndrome
usually characterized by episodes or
paroxysms of pain or pressures in the
anterior chest.
3. The cause is usually insufficient
coronary blood flow.
• The insufficient flow results in a
decreased oxygen supply to meet an
increased myocardial demand for
oxygen in response to physical
exertion
or emotional stress.
8. 1. Physical Exertion : Isometric exercise of
the arms (e.g., raking, lifting heavy objects,
snow shoveling) can cause exertional
angina.
2. Temperature Extremes : Blood vessels
constrict in response to a cold stimulus.
Blood vessels dilate and blood pools in the
skin in response to a hot stimulus.
9. 3. Strong Emotions : Stimulate the
sympathetic nervous system, activating
the
stress response.
4. Consumption of Heavy Meal : During
the digestive process, blood is diverted to
the GI system, reducing blood flow in the
coronary arteries.
10. 5. Tobacco Use, Environmental Tobacco
Smoke : Nicotine stimulates
catecholamine release, causing
vasoconstriction.
6. Sexual Activity : Increases the
cardiac workload and sympathetic
stimulation
11. 7. Stimulants (e.g., cocaine,
amphetamines): Increase HR and
subsequent myocardial oxygen demand.
8. Circadian Rhythm Patterns :
Manifestations of CAD tend to occur in
the early morning after awakening.
12. 1. Stable angina: predictable and
consistent
pain that occurs on exertion and is relieved
by rest.
2. Unstable angina (also called
preinfarction angina or crescendo
angina): symptoms occur more frequently
and last longer than stable angina. The
threshold for pain is lower, and pain may
occur at rest.
13. 3. Intractable or refractory angina:
severe incapacitating chest pain.
4. Variant angina (also called
Prinzmetal’s angina): pain at rest with
reversible ST segment elevation;
thought to be caused by coronary artery
vasospasm.
14. 5. Silent ischemia: objective evidence of
ischemia (such as electrocardiographic
changes with a stress test), but patient
reports no symptoms
6. Decubitus angina : Occurs on lying
down
7. Nocturnal angina : Occurs at night
and
may waken the patient from sleep
15. • Increased workload of heart
• Increased oxygen demand
• Narrowed vessels are unable to dilate
and supply the heart with this extra
blood and oxygen
• More work in less oxygen
16. • Anaerobic oxidation in myocytes
• Accumulation of lactic acid in cell
• Affects cell membrane permeability
17. • Releasing substances such as
histamine, and specific enzymes that
stimulate terminal nerve fibres in the
cardiac muscles
• Send pain impulses to the central
nervous systems (chest pain).
18. Chest Pain :
• Quality of pain : Pain or other symptoms,
varying in severity from a feeling of
indigestion to a choking or heavy sensation
in the upper chest that ranges from
discomfort to agonizing pain accompanied
by severe apprehension and a feeling of
impending death.
19. The patient often feels tightness or a
heavy, choking, or strangling sensation
that has a viselike, insistent quality.
• The patient with diabetes mellitus may
not have severe pain with angina
because the neuropathy.
20. CLINICAL MANIFESTATION
• Location : The pain is often felt deep in
the chest behind the upper or middle third
of the sternum (retrosternal area).
• Radiation : Typically, the pain or
discomfort is poorly localized and may
radiate to the neck, jaw, shoulders, and
inner aspects of the upper arms, usually
the left arm.
21. CLINICAL MANIFESTATION
• Feeling of weakness or numbness in the
arms, wrists, and hands.
• Shortness of breath
• Pallor
• Diaphoresis
• Dizziness
• Nausea and vomiting
• Anxiety
22. ECG is normal in most patients at rest and in
between attacks .
Most convincing evidence is demonstration
of reversible ST segment depression or
elevation ,with or without T wave inversion
during an attack of pain.
Patient may require exercise testing , e.g.
Treadmill testing or bicycle ergometry.
