ANGINA Done By: AHMAD MHD ALDHLAWIY

SOEPEL .. Subjective:

A 65 year old male present at emergency department with sever chest pain associated with sweating.

History:

The patient is smoker and have history of nausea and vomiting.

SOEPEL … Objective:

General and chest examination.

Evaluation (DD):

, Stable angina, Unstable angina, subendocardial MI.

Plan:

Electrocardiogram

Elaboration:

Percutaneous coronary intervention (PCI)

SOEPEL .. LEARNING GOALS:

Angina

Pathophysiology

Clinical features

Management

investigation

DEFINITIONS .. Stable Angina: is chest pain or discomfort caused when the heart muscle doesn't get enough oxygen-rich blood.

Unstable Angina: is defined as angina pectoris or equivalent ischemic discomfort

with at least one of three features:

(1) it occurs at rest(or with minimal exertion), usually lasting >10 min

(2) it is severe and of new onset (i.e.within the prior 4–6 weeks)

(3) it occurs with a crescendo pattern.

PATHOPHYSIOLOGY ..

• Plaque rupture or erosion with a superimposed nonocclusive thrombus.• Dynamic obstruction.• Progressive mechanical obstruction.• UA secondary to increased myocardial oxygen demand and/or decreased supply.

Erosion/Ulceration - Fissure/rupture - Intraplaque hemmorage

CONT.

CONT.

CONT.

CLASSIFICATION ..

CLINICAL PRESENTATION .. Stable Angina:The pain or discomfort:

• Occurs when the heart must work harder, usually during physical exertion

• Doesn't come as a Suddenly, and episodes of pain tend to be alike

• Usually lasts a short time (5 minutes or less)

• Is relieved by rest or medicine• May feel like gas or indigestion• May feel like chest pain that

spreads to the arms, back, or other areas

Unstable Angina:The pain or discomfort:

• Often occurs at rest, while sleeping at night, or with little physical exertion

• Comes Suddenly• Is more severe and lasts longer

than stable angina (as long as 30 minutes)

• Usually isn’t relieved by rest or medicine

• May get worse over time• May mean that a heart attack will

happen soon

INVESTIGATIONS… History and physical examination:

chest pain, typically located in the substernal region or sometimes in the epigastrium, that radiates to the neck, left shoulder, and/or the left arm.

dyspnea and epigastric discomfort may also occur

Electrocardiogram:

ST-segment depression, transient ST-segment elevation, and/or T-wave inversion occur in 30% to 50% of patients.

CARDIAC BIOMARKERS

MANAGEMENT Accident and emergency:

Aspirin

Sublingual glyceryl trinitrate 0.3–1 mg. Repeat

Oxygen – nasal cannula 2–4 L/min if hypoxia is present

Brief history/risk factors. Examination

Intravenous access + blood for markers

12-lead ECG

Intravenous opiate.

Beta-blocker (if no contraindication).

If primary PCI available

REFERENCES .. Harrisons Cardiovascular Medicine 2nd edition. Kumar & Clark’s Clinical Medicine 8th Edition.

THANK YOU .. !