The body’s response to a lack of oxygen in the heart muscle is pain, called angina. Although the heart muscle does not have any pain fibers a substance called substance P is released from ischemic myocardial cells, and pain is felt wherever substance P reacts with a pain receptor. For many people this is the chest, and for others it is the left arm; still others have pain in the jaw and teeth. The basic response to this type of pain is to stop whatever one is doing and to wait for the pain to go away. In cases of minor limitations to the blood flow through vessels, stopping activity may bring the supply and demand for blood back into balance. This condition is called stable angina. There is no damage to heart muscle, and the basic reflexes surrounding the pain restore blood flow to the heart muscle. This process can go on for a long time with no resultant myocardial infarction (MI). This is called chronic angina, and this condition can severely limit a person’s activities and quality of life.
If the narrowing of the coronary arteries becomes more pronounced the heart may experience episodes of ischemia even when the patient is at rest. This condition is called unstable angina or preinfarction angina. Although no damage to heart muscle occurs the person is at increased risk of a complete blockage of blood supply to the heart muscle if the heart needs to work harder or the oxygen demand increases.
Prinzmetal angina is an unusual form of angina because it seems to be caused by spasm of the blood vessels and not just by vessel narrowing. The person with this type of angina has angina at rest, often at the same time each day, and usually with an associated electrocardiogram (ECG) pattern change.
1. A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:
A. Unstable angina
B. Variant angina
C. Stable angina
D. Prinzmetal angina 2. Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient’s symptoms? Select-all-that-apply.
A. EKG
B. Stress test
C. Heart catheterization
D. Balloon angioplasty
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答案 Answer 1. C. Stable angina Rationale: Stable angina occurs during activities but goes away when the patient rests. Variant and Prinzmetal angina are the same and occur at rest during cycles. Unstable angina is chest pain felt during rest and is more severe. 2. A and B. Rationale: If the patient is experiencing STABLE angina (which in question 4 the patient's symptoms are stable) an EKG or stress test would be ordered to investigate if there are any EKG changes (ST depression) during exercise. These tests are usually ordered first and then the doctor may proceed with a heart catheterization. A balloon angioplasty is sometimes performed during a heart cath.
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