8. Etiology
Atherosclerosis
Coronary artery spasm
Use of cocaine
Blockage of coronary artery by blood clot or compression
Inflammation or infection of coronary artery
Injury to coronary artery
Poor functioning of tiny blood vessels
9.
10. Pathophysiology
Myocardial ischemia results from imbalance between
myocardial energy supply(oxygen and energy substrates
like glucose and free fatty acids)and myocardial oxygen
demand.
11. Or a fixed reduction in the diameter of the
coronary arteries by at least 70% leads to reduction
in coronary blood flow.
Inability to increase oxygen extraction or
coronary blood flow, together with elevated
myocardial demand, leads to angina.
12. Clinical Features
Pain - over sternum and spreads
down the left arm
also to backsides , upper abdomen,
neck , jaw or even teeth.
Type –dull ache , heaviness or
a crushing sensation .
14. Investigations
Resting ECG – Usually normal but during pain there
will be elevation or depression of ST segment with
or withoutT wave inversion.
Exercise ECG - >1mm of flat or down sloping ST
depression .
19. Treatment
A . Medical
Antiplatelet therapy –Aspirin , clopidogrel Reduces risk of MI
Antianginal drug therapy –
Nitrates – glyceryl trinitrates , isosorbide mononitrate
Beta blockers – metaprolol ,atenolol
Calcium channel blockers – nifidipine ,amlodipine
Potassium channel activators – nicorandil
20. B. Surgical
Percutaneous Coronary Intervention
CoronaryArtery Bypass Grafting
C. General measures
Do not smoke
Reduce overweight
Regular exercise
Avoid severe exertion after heavy mealor in very cold
weather
21. Reference
Textbook of Pathology by Harshmohan – sixth
edition 2010
Davidson’s Principles and practice of Medicine
by Brain R Walker
Nicki R . Colledge – 21st edition 2010