ANGINA-CARDIAC ISCHEMIA

SUMMARY

1. Angina is chest pain caused by a "supply-demand" mismatch between coronary perfusion & cardiac workload.

2. Can be stable or unstable. Obstructive atherosclerotic coronary artery lesions (supply problem) are the most common cause of stable angina.

3. Demand vs. supply problems:
- Increased myocardial O₂ demand: hyperthyroidism, cocaine use, uncontrolled HTN, AS, HCM
- Decreased myocardial blood supply: anaemia, hypoxia, thrombocytosis, polycythemia

4. Plaque rupture or erosion with superimposed thrombosis is the most common underlying process triggering ACS.

5. Only 20% of patients actually have classic angina at the moment of ischemic ST changes. Silent ischemia is seen in diabetic patients & those with prior ischemia.

6. Most important prognostic factor in patients with CAD is the degree of LV dysfunction.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].