Cardiovascular Conditions Overview

Angina

• Characterized by chest pain caused by reduced blood flow to the heart muscle
• Typically described as a tight, squeezing, constricting, or heavy sensation
• Can also be described as burning, aching, choking, dull, or constant
• Often lasts for 2-5 minutes
• Relieved by rest, position change, or nitroglycerin

Acute Coronary Syndrome (ACS)

• Umbrella term encompassing a spectrum of conditions related to unstable coronary plaques
• Includes unstable angina and myocardial infarction (heart attack)

Acute Myocardial Infarction (MI)

• Characterized by a complete blockage of blood flow to the heart muscle
• Can cause irreversible heart damage if not treated promptly
• Typically results from a ruptured atherosclerotic plaque
• Symptoms
  • Crushing, severe tightness or burning in the chest
  • Heavy pressure or squeezing sensation
  • Can radiate to the shoulders, neck, jaw, or arms
  • Often lasts for more than 15-20 minutes
  • Often associated with:
    • Dyspnea
    • Diaphoresis
    • Cool, mottled skin
    • Tachycardia
    • Hypotension or hypertension
    • Nausea and vomiting
    • Anxiety and a sense of impending doom
    • Decreased level of consciousness

Precipitating Factors

• Angina: Exercise or activity, strong emotion, stress, cold, or heavy meal
• ACS: Generally unknown; ruptured atherosclerotic plaque plays a role
• MI: Generally unknown; ruptured atherosclerotic plaque plays a role

Relieving Factors

• Angina: Rest, position change, or nitroglycerin
• ACS: None; must treat underlying event
• MI: None; must treat underlying event

Location of Pain

• Angina: Substernal or precordial (across the chest wall)
• ACS: Substernal or epigastric chest pain
• MI: Starts in the center of the chest (substernal) and can radiate to the shoulders, neck, jaw, or arms

Length of Pain

• Angina: 2–5 minutes
• ACS: At least 10–20 minutes
• MI: More than 15–20 minutes

Angina

• Chest pain that occurs when the heart muscle doesn't get enough oxygen.
• Often described as tightness, squeezing, constricting, or heavy sensation.
• May also be described as burning, aching, choking, dull, or constant.
• Usually lasts for 2–5 minutes.
• Relieved by rest, position change, or nitroglycerin.

Acute Coronary Syndrome (ACS)

• Umbrella term for a range of conditions caused by a sudden blockage of a coronary artery.
• Includes unstable angina, NSTEMI, and STEMI.
• Chest pain may be new onset or represent a pattern of increasing frequency and severity of anginal pain.
• Can be caused by exertion or stress, but often the cause is unknown.

Acute Myocardial Infarction (AMI)

• Heart attack.
• Occurs when there is a complete blockage of a coronary artery leading to death of heart muscle.
• Often starts in the center of the chest and radiates to the shoulders, neck, jaw, or arms.
• Lasts more than 15–20 minutes.
• Characterized by intense crushing, tightness, or burning pain, severe pressure, or a squeezing sensation that is more severe than angina pain.
• Associated with symptoms like nausea, vomiting, dyspnea, diaphoresis, anxiety, palpitations, and irregular heart rhythms.
• Requires immediate medical attention.

Angina

• The most prominent symptom of angina is chest pain.
• Angina pain can be triggered by physical activity, strong emotions, stress, heavy meals, or exposure to cold.
• The classic pattern of angina is pain during activity and relief during rest.
• Angina pain can manifest as tightness, squeezing, heavy pressure, or a constricting sensation in the chest.
• The pain can radiate to the jaw, neck, shoulder, or arm.
• In some cases, angina pain can also be felt in the jaw, epigastric region, or back.
• Men typically experience more characteristic patterns of angina pain.
• Women frequently present with atypical symptoms, including indigestion, nausea, vomiting, fatigue, and upper back pain.
• Anginal pain usually follows a crescendo-decrescendo pattern, increasing to a peak, then gradually decreasing.
• Anginal pain typically lasts 2 to 5 minutes and is usually relieved by rest.
• Other symptoms of angina can include shortness of breath, pallor, rapid heart rate, anxiety, and fear.
• The severity of angina is categorized into classes that reflect its impact on physical activity:
  • Class I Angina: Mildest class, occurring with strenuous or prolonged exertion.
  • Class II Angina: Develops with rapid or prolonged walking or stair climbing.
  • Class III Angina: Significantly limits ordinary physical activities.
  • Class IV Angina: Most severe, occurring with minimal exertion or at rest.

Acute Coronary Syndrome (ACS)

• The primary symptom of ACS is substernal or epigastric chest pain.
• The pain can radiate to the neck, left shoulder, and/or left arm.
• Pain can occur with rest or activity and typically lasts at least 10 to 20 minutes.
• ACS can manifest as new onset pain or an increase in frequency and severity of anginal pain.
• Other symptoms include shortness of breath, sweating, paleness, cool skin, rapid heart rate, and low blood pressure.
• Nausea or dizziness can also occur.

Acute Myocardial Infarction (AMI)

• Chest pain that is more severe than previously experienced angina is the most common symptom of AMI.
• This pain has a sudden onset, is not usually associated with activity, and is continuous in nature.
• AMI typically occurs in the early morning.
• Individuals with a history of angina may experience escalating angina events leading up to an AMI.
• Chest pain associated with AMI is often described as crushing, severe, tightness or burning, heavy pressure, or a squeezing sensation.
• The pain can start in the center of the chest (substernal) and may radiate to the shoulders, neck, jaw, or arms.
• The duration of pain is typically longer than 15-20 minutes and is not relieved by rest or nitroglycerin.
• Other symptoms can develop due to the loss of myocardial oxygenation, including:
  • Anxiety, rapid heart rate, and vasoconstriction: Caused by the sympathetic nervous system stimulation.
  • Rapid breathing: Triggered by pain and blood chemistry imbalances.
  • Elevated temperature and increased white blood cell count: Reflect the inflammatory reaction to tissue necrosis.
  • Release of cardiac enzymes: Caused by injured or necrotic myocardial cells.
• The location and extent of the infarction can influence additional symptoms like high or low blood pressure, or heart failure.
• Nausea, vomiting, slow heart rate, and low blood pressure can manifest from vagal stimulation.
• Diaphragmatic irritation can cause hiccups.
• Sudden death can occur if a large vessel is occluded.
• Individuals experiencing chest pain for the first time may attribute it to indigestion.
• It is crucial for healthcare providers to emphasize the potential implications of chest pain to promote prompt emergency medical service (EMS) activation.
• Immediate emergency department (ED) evaluation is essential if thrombolytic medications are being considered.
• The risk of complications following AMI is dependent on the size and location of the affected area.
• Potential complications include:
  • Irregular heartbeats (dysrhythmias)
  • Heart failure (pump failure)
  • Cardiogenic shock
  • Infarct extension
  • Structural defects
  • Pericarditis
  • Dressler syndrome