Internal Medicine (Theory) · MU Sofia

24. Ischemic heart disease - stable and unstable angina

Covers stable and unstable angina as reduced coronary blood flow from plaque, listing causes and risk factors such as hypertension, smoking and diabetes, then the pathogenic mechanisms of narrowing, raised oxygen demand and low cardiac output. It describes the symptoms and provoking factors of each form, the three criteria for unstable angina, physical findings, laboratory changes and the ECG, stress test, angiography, CT angiography, scintigraphy and Holter findings.

Inside: 10 sections · 5 labelled pictures · 1 table · 14 flashcards · 3 min

Topic 22 of 58 in the MU Sofia syllabus for Internal Medicine (Theory) (Medicine, Year 3). The free AceMed note covers it in 10 sections, about 277 words (3 min of reading), with 14 flashcards.

In this note

  1. Ischemic Heart Disease – Stable and Unstable Angina
  2. Definition
  3. Classification
  4. Etiology / Predisposition Factors
  5. Pathogenesis
  6. Symptoms
  7. Unstable Angina
  8. Physical Examination
  9. Laboratory Tests
  10. Instrumental Tests

Definition

  • Decreased blood flow to the heart muscle due to buildup of plaque in coronary arteries.

Classification

  • Stable angina
  • Unstable angina

Etiology / Predisposition Factors

  • Hypertension
  • Smoking
  • Diabetes
  • Obesity
  • Poor diet
  • High blood cholesterol
  • Lack of exercise
  • Depression, stress
  • Family history
  • Excessive alcohol consumption

Pathogenesis

  • Narrowing/obstruction of coronary artery lumen:
  • Atherosclerosis (main cause)
  • Thrombosis/embolism (rare)
  • Coronary artery spasm
  • Inflammation
  • Increased O2 demand:
  • Hypertrophy of myocardium
  • Tachycardia or tachyarrhythmia
  • Decreased cardiac output:
  • Aortic valve disease (aortic stenosis, regurgitation)

Symptoms

Stable Angina (Classic Angina)

  • Definition: Chest pain/discomfort that occurs during activity or emotional stress, most commonly due to coronary atherosclerosis.
  • Pathophysiology:
  • 70% coronary artery stenosis (narrowing).
  • At rest → blood flow is enough → no symptoms.
  • During exertion → increased O2 demand → inadequate blood supply → chest pain.
  • Symptoms
  • Pain, tightness, or discomfort in chest.
  • Often retrosternal, can radiate to:
  • Precordial area
  • Epigastrium
  • Back
  • Shoulder
  • Arm (especially last 2 fingers of left arm)
  • Jaw
  • Duration: ~20 minutes, subsides with rest.
  • Provoking factors:
  • Physical exercise
  • Emotional stress
  • Hypertension
  • Tachycardia or extreme bradycardia
  • Hypoglycemia
  • Cold weather (causes ↑ myocardial O2 demand)

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