Angina Pectoris Case Analysis

Many of the risk factors for cardiovascular disease cause problems because they lead to atherosclerosis. Atherosclerosis is the narrowing and thickening of arteries and develops for years without causing symptoms. It can happen in any part of the body. Around the heart, it is known as coronary artery disease, in the legs it is known as peripheral arterial disease. The narrowing and thickening of the arteries is due to the deposition of fatty material, cholesterol and other substances in the walls of blood vessels. The deposits are known as plaques. The rupture of a plaque can lead to stroke or a heart attack. (World Heart Federation).

To determine if the patient’s chest pain is related to cardiac ischemia, you would look for ST-segment depression and/or T wave inversion. If the ST-segment depression is at least 1mm (one small box) below the isoelectric line, it is significant and occurs in response to inadequate supply of blood and oxygen, which leads to an electrical disturbance. Once this is treated, adequate blood flow is restored, the ECG changes will resolve, and the ECG will return back to patient’s baseline.

Nevertheless, there is an understandable and noticeable link between circulatory related diseases and lifestyle diseases, such as Coronary Heart Disease. Coronary heart disease can occur when fatty acids, such as cholesterol in an inadequate diet, build up in the walls of the coronary artery. These fatty deposits collect minerals and harden to become a plaque. Eventually, this plaque grows and can swells up, forming an aneurism. In some cases, this aneurism may burst leading to instant death. As it continues to grow and swell up, it finally blocks the artery completely and forms blood clots. This is known as coronary thrombosis. A myocardial infarction, or in other words as heart attack, occurs when no oxygen is able to reach the coronary artery and thus it is unable to fulfil its role in providing the heart muscle with a sufficient supply of blood. Heart attacks are very common in the society nowadays, especially occurring in smokers or obesity related diseases (Millar, June 2014)

Coronary artery disease (CAD) is the commonest heart disease in the United States1. Approximately, 29% of patients with Myocardial Infarction ( MI ) present with ST- elevation Myocardial Infarction ( STEMI )2. STEMI is the result of complete occlusion of a major epicardial coronary artery due to thrombus formation. STEMI from a small coronary artery presenting as substantial EKG abnormalities similar to occlusion of a major artery and hemodynamic instability is a rare entity. The epidemiology, typical clinical presentation, outcomes, and optimal management in this group of patients are not sufficiently known.

Clearly differentiate the pathophysiology of angina and myocardial infarction, including signs and symptoms. (5 marks)

Chest pain is a frequent cause of emergency department presentation. Many times, chest pain can be an indicator of myocardial infarction. Yearly, about 600,000 people die of heart disease in the United States, with a total of about 700,000 having a myocardial infarction. The leading source of death for both men and women is heart disease ("Heart disease facts," 2014). Managing the challenging clinical problems of those presenting with chest pain can be demanding. While clinical judgment is imperative in managing these patients, rapid treatment protocols to evaluate risk

In Focus on Pharmacology Essentials For Health Professionals, Jahangir Moini states “angina pectoris is a common form of ischemic heart disease and often precedes and accompanies MI” (Moini, 2013. p.359). When having angina, a patient will feel pressure in the chest like a squeezing sensation and the pain can travel to the jaw, down the arm, into the neck, shoulders, or back.

On the other hand, a number of causes are being attributed to the infarct or to the tightening of the arteries and, according to a journal published by Ellis et al., (2015), the most widespread is thrombus formation. It happens when blood clots emerge from the fatty sediments formed in the arterial lining. As plaques mount up inside the coronary arteries, its passageway gets

Current Treatment and Consideration of Evidence Base: Upon admission, patient was most-likely suspected of having ACS (acute coronary syndrome) because of CHD (coronary heart disease) (NICE, 2014c). Troponin T High Sensitivity Test was carried out to distinguish whether chest pains were because of NSTEMI or unstable angina (NICE, 2014b). This led to diagnosis of unstable angina. His current treatment with regards to drug interactions is okay, except that enoxaparin has a clinically significant interaction with aspirin (2015, p. 1199). This can be discounted for due to his condition.

R: yes, patient is not going to be moving and is NPO with fluid restrictions.

Chest pain is a very common symptom, and around 20% to 40% of the general population will experience chest pain in their lives(149). In the UK, up to 2 % of visits to a general practitioner are due to new onset chest pain (150). Approximately 5% of visits to the emergency department are due to a complaint of chest pain, and up to 40% of emergency hospital admissions are the result of chest pain(149, 151). Approximately 52,000 new cases of angina per year are diagnosed in men and 43,000 in women. The incidence of angina increases with age(123).

When peripheral arteries begin to narrow there is a reduction of blood flow through the body. The tissues that these arteries supply begin to compensate for the lack of oxygen through vasodilation of these vessels or collateral sprouting of new vessels1. Lack of fresh oxygenated blood leads to ischemia and the tissues supplied by the narrowed vessels begin to die. The main factor that causes this disease development is atherosclerosis, which is a build-up of plaque in these peripheral arterial beds cause by lipids in the blood steam narrowing the lumens of these vessels3. The most common peripheral arteries affected by this disease process are those of the lower extremity which present in 90% of those diagnosed with PAD1. When the plaque builds up on the walls of arteries it not only narrows the blood vessels but the plaque begins to harden the walls of the arteries. It is the narrowing and hardening of peripheral arteries that contributes to reduction of blood flow and a built up of cellular wastes in the

784). The immune system attempts to attack the inflamed area in the artery with special white blood cells and “cells full of fatty nutrients, foam cells, begin to form there, too” (Sapolsky, 2004, p. 43). The white blood cells are unable to properly fight the affected area, and in turn, end up adding more substance to the build up. As this process continues, the affected area becomes inflamed and physically hardens. This produces a blockage in the artery and reduces blood flow, while also causing an increase in blood pressure. At this point of the atherosclerosis build up, many people, especially women, experience angina.

     In today’s society, people are gaining medical knowledge at quite a fast pace. Treatments, cures, and vaccines for various diseases and disorders are being developed constantly, and yet, coronary disease remains the number one killer in the world.

If you have signs and symptoms of acute coronary syndrome, your doctor may run several tests to see if your symptoms are caused by a heart attack or another form of chest discomfort. If your doctor thinks you 're having a heart attack, the first two tests you have are: