Angina is a symptom, which must be recognized by its clinical manifestations.
Etiology:
The most common is atherosclerotic narrowing of one or more epicardial coronary arteries.
The epicardial coronary arteries serve as conductance vessels, while the intra-myocardial arteries normally exhibit striking changes in tone and are therefore referred to as resistance vessels. Abnormal constriction of these vessels can cause ischemia, this condition is referred to as microvascular angina. This constriction can also occur in vasculitis and coronary embolization. Despite normal pericardial coronary arteries, myocardial ischemia can develop due to increase in myocardial oxygen demand because of myocardial hypertrophy, e.g hypertension, aortic stenosis, hypertrophic cardiomyopathy and aortic regurge. - A reduction in oxygen carrying capacity of blood as in severe anemia.
- Atherosclerosis of coronary artery is the most common cause.
- Thrombi, spasm, and coronary emboli cause limitation of coronary blood flow.
- Hypertension where the myocardial O2 demands is increased due to ventricular hypertrophy.
- Reduction in the O2 carrying capacity of the blood as in severe anemia.
Clinical Classification of Chest Pain
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Typical angina (definite)
- Substernal chest discomfort with characteristic quality and duration that is …
- Provoked by exertion or emotional stress and
- Relieved by rest or NTG
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Atypical angina (probable) meets 2 of the of characteristics
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Noncardiac chest pain meets 1 of the typical angina characteristics