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Usual Causes
Occurs when an oxygen demand-supply mismatch occurs in
the myocardium.
The MOST common cause of typical angina pectoris is
atherosclerotic disesase of the epicardial coronary arteries.
Other LESS common, cause include epicardial coronary
spasm, Kawasaki disease, microvascular coronary disease,
aortic stenosis, hypertrophic cardiomyopathy, coronary
fistulas, anomalous coronary origins, and intramyocardial
location (bridging) of epicardial coronary vessel.
Class II
Slight limitation or ordinary activity; angina occurs on climbing stairs
rapidly, walking uphill, walking or stair climbing after meals, in cold,
in wind, under emotional stress, or only during the few hours after
awakening
Angina occurs on walking more than two blocks on the level and
climbing more than one flight of ordinary stairs at a normal pace and in
normal condition
Class IV
Inability to carry on any physical activity without discomfort, anginal
symptoms may be present at rest
Electrocardiography
A resting 12-leads electrocardiogram (ECG) should be
obtained in all patients with symptoms suggestive of angina
pectoris.
The resting ECG is normal in approximately 50% of patient
with chronic stable angina.
ST-T changes are usually nonspecific.
Q waves may indicate previous MI.
LV hypertrophy may be caused by hypertension, aortic
stenosis, or hypertrophic cardiomyopathy.
Pathophysiology
Atherosclerotic plaque causing an important restriction to flow
may occur when luminal obstruction by the plaque is greater
than 50% for the left main artery or greater than 70% for the
remaining coronary arteries
Differential Diagnosis
The differential diagnosis of chest pain includes numerous cardiac and noncardiac causes
Common cardiac causes of chest pain not attributable to myocardial ischaemia are
pericarditis and aortic dissection.
Finally, chest pain may occur in patients with various psychiatric conditions, such as
anxiety and affective disorder
Complications
Stable angina can have significant adverse effect on a patient
quality of life and ,in its most severe forms, it negatively
affects an individuals exercise capacity and functional
independence.
Therapy
The goals of treatment are to relieve symptoms and to reduce the
risk of morbidity (e.g., MI) and mortality.
Ideally, succesful treatment result in a functional capacity of CCS
class I.
Contributing factors, such as anemia, hyperthyroidism, and poorly
controlled blood pressure, should be identified and treated.
The initial treatment program consists of the following:
A : aspirin, ACE inhibitors, antianginal therapy (nitrates, calcium channels
blockers, ranolazine)
B : blockers
C : cigarette-smoking cessation and cholesterol management
D : diet and diabetic therapy
E : education and exercise