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Questions and Answers
Which of the following are mechanical causes of coronary obstruction?
What is the primary cause of myocardial ischaemia?
Which condition is NOT associated with increased myocardial oxygen demand?
What characteristic describes the chest pain associated with angina?
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What typically provokes angina discomfort?
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Which symptom is commonly associated with unstable angina?
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What is the significance of the mortality rate associated with acute angina symptoms?
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Which of the following best describes the relief from angina pain?
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What is a mechanical cause of coronary obstruction that is directly related to blood clot formation?
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Which condition is least likely to increase myocardial oxygen demand?
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In what situation might chest pain associated with angina typically be relieved?
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Which of the following symptoms is most commonly associated with unstable angina?
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Which factor could potentially decrease the flow of oxygenated blood to myocardial tissue?
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What is a common psychological sign associated with high levels of distress during an angina episode?
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Which symptom is typically NOT associated with a myocardial ischaemia episode during physical exertion?
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What is the typical prognosis for patients experiencing unstable angina according to mortality statistics?
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Study Notes
Myocardial Ischemia
- Occurs when there is an imbalance between oxygen supply (and other essential nutrients) and myocardial demand.
Mechanical Causes of Coronary Obstruction
- Atheroma: Buildup of plaque in coronary arteries.
- Thrombosis: Blood clot formation in a coronary artery.
- Spasm: Sudden narrowing of a coronary artery.
- Embolus: A blood clot or other substance that travels through the bloodstream and lodges in a coronary artery.
- Coronary ostial stenosis: Narrowing of the opening of a coronary artery.
- Coronary arteritis: Inflammation of the coronary arteries, often seen in conditions like systemic lupus erythematosus (SLE).
Other Factors Affecting Oxygen Supply
- Anemia: Low red blood cell count or hemoglobin levels, reducing oxygen carrying capacity.
- Hypotension: Low blood pressure, decreasing coronary perfusion pressure.
Factors Increasing Oxygen Demand
- Increased cardiac output: As seen in conditions like thyrotoxicosis (overactive thyroid).
- Myocardial hypertrophy: Enlargement of the heart muscle, often occurring in conditions like aortic stenosis.
Angina Pectoris
- Chest pain often described as "heavy," "tight," or "gripping."
- Usually located in the center of the chest (retrosternal) and may radiate to the jaw and/or arms.
- Can range from mild ache to severe pain associated with sweating and fear.
- Often accompanied by shortness of breath.
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Provoked by:
- Physical exertion, especially after meals.
- Cold, windy weather.
- Anger or excitement.
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Relieved by:
- Rest.
- Nitrates (medications).
Unstable Angina
- Newly occurring angina (within the past 20 minutes), often associated with nausea, sweating, shortness of breath, and palpitations.
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Signs:
- Distress.
- Anxiety.
- Pallor (paleness).
- Sweating.
- Increased pulse.
- Low blood pressure.
Mortality from Unstable Angina
- 50% of deaths occur within 2 hours of onset of symptoms.
- Up to 7% die before discharge from the hospital.
Myocardial Ischemia
- Occurs when there is an imbalance between the supply and demand of oxygen and essential nutrients to the heart muscle.
Causes of Coronary Obstruction
- Atheroma: A buildup of plaque in the coronary arteries.
- Thrombosis: A blood clot forming in the coronary arteries.
- Spasm: A sudden narrowing of the coronary arteries.
- Embolus: A blockage in the coronary arteries caused by a traveling clot.
- Coronary Ostial Stenosis: Narrowing of the opening of the coronary arteries.
- Coronary Arteritis: Inflammation of the coronary arteries, often seen in conditions like Systemic Lupus Erythematosus (SLE).
Other Causes
- Anemia: Reduced oxygen-carrying capacity in the blood.
- Hypotension: Low blood pressure.
- Increased Cardiac Output: Conditions like thyrotoxicosis increase the heart's workload.
- Myocardial Hypertrophy: Increased heart muscle size (e.g., due to aortic stenosis).
Signs and Symptoms
- Chest pain: Often described as "heavy", "tight", or "gripping" and may radiate to the jaw or arms.
- Angina: Can vary from mild ache to severe pain, sometimes associated with sweating, fear, and shortness of breath.
Angina Triggers
- Physical exertion: Especially after meals and in cold or windy weather.
- Emotional stress: Anger or excitement.
Angina Relief
- Rest
- Nitrates
Types of Angina
- Unstable Angina: New onset of angina, often presenting with nausea, sweating, shortness of breath, and palpitations.
Unstable Angina Presentation
- Distress
- Anxiety
- Pallor (pale skin)
- Sweating
- Increased pulse or low blood pressure
- Signs of heart failure may be present.
Mortality
- 50% of deaths from unstable angina occur within the first 2 hours of onset.
- Up to 7% of patients die before being discharged from the hospital.
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Description
Explore the causes and mechanisms of myocardial ischemia, focusing on coronary obstruction due to factors like atheroma, thrombosis, and spasms. Additionally, understand how anemia and hypotension affect oxygen supply and how increased cardiac output can raise oxygen demand. Test your knowledge on this critical aspect of cardiovascular health.
