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Table of Contents

Stable Angina

Chronic stable angina refers to the chest discomfort that occurs occasionally at a predictable manner and reproducibly at certain levels of exertion (1,2). This is relieved with rest or nitroglycerin (1). The goals of therapy for chronic stable angina is to minimize ischemia, improve survival, prevent or slow disease progression, prevent future cardiac events and limit treatment related adverse events (3).

The pathophysiology behind CSA occurs when the myocardial oxygen demand is greater than the myocardial oxygen supply, which will result in chest pain (1). Factors that increase the myocardial oxygen demand include increase heart rate, increase systolic blood pressure (due to increased afterload), increase myocardial contractility, increase myocardial wall tension by increase preload and myocardial muscle mass (1). Factors that can decrease the oxygen supply is a decrease of the oxygen carrying capacity, decreased degree of oxygen unloading from Hb to the tissues, and decreased coronary artery blood flow and perfusion pressure as a result of atherosclerosis, vaspospam, fibrosis and embolism (1). Risk factors include inadequate control of hypertension, diabetes, dyslipidemia, cigarette smoking, family history of coronary artery disease, age >65 years, sedentary lifestyle, cocaine use, mental stress or depression, obesity, estrogen deficiency, and male gender (1,2). Signs and symptoms of CSA include discomfort (heaviness, squeezing tightness, dull ache or pressure in the chest) that can radiate to the left arm, neck and jaw (3). Symptoms are gradual in onset and reach max intensity over several minutes before resolving (1). Discomfort can be relieved after rest or 2-3 minutes taking sublingual nitroglycerin (1). Chest tightness and shortness of breath are also present (1). Precipitating factors include cold environment, walking after meal, exercise, emotional upset, anger and fright (1). Patients may also have dyspnea, profound fatique, weakness, nausea, sweating, altered mental status and light-headedness (1).

References

  1. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: a pathophysiologic approach. 7th ed. Toronto: McGraw-Hill; 2007. p. 249
  2. Chisholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, Kolesar JM, Rotschafer JC, Dipiro JT. Pharmacotherapy: Principles and Practice. McGraw-Hill: 2008. p. 64.
  3. Fraker TD Jr, Fihn SD, 2002 Chronic Stable Angina Writing Committee, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 2007; 50:2264.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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