Case Study Of Angina Pectoris

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INTRODUCTION:
The word angina is well derived from origin of Latin word “Angere” which means “to choke” and “pectus” means “chest” or it is also derived from origin of Greek word “Ankhone” which means a “strangling”. (Marc D Haber, Feb 18, 2015)
Angina is mostly caused by myocardial ischemia. Coronary atherosclerosis mostly causes reduction in the oxygen delivery. During exercise or hard working heart need more oxygen rich blood. If coronary arteries are unable to supply oxygen rich blood to heart because of its narrowing, than there will arise chest pain known as angina. (shenozaki et al 2008)
Angina pectoris is, deadly strangling painful feeling generally present in the retro-sternal region. The pain spread out to the neck, jaws, shoulders
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(Tobin, 2010)
When the symptoms last for two months at least, without any alteration in nature, severity or activating conditions, than such type angina is known is “chronic stable angina”. Stable angina usually result when there is an imbalance between demand of myocardial oxygen and supply of coronary blood, which is not always related with coronary artery disease presence. There may or may not be classical symptoms present in the patient having stable angina. Patients having diabetes mellitus and in the elderly patients may present with silent myocardial ischemia. (Jason M Tarkin 2013)
Clinical characteristics of stable angina
 Chest tightness, heaviness, or pressure like discomfort or constriction radiating to left arm, neck, jaw, back or epigastrium
 Trigger by physical activity, excitement, emotion or sexual
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In epicardial vessels there is not enough resistance to blood flow in healthy heart. Due to the presence of atherosclerotic plaques in the arteries or vessels, blood flow is slow down, but autoregulation process can pay off to a certain degree. Autorgulation is the process of myocardial vessel dilation in response to diminish supply of oxygen. By autoregulation process, there are rapid changes in blood flow to heart because of increase in demand. Adenosine which is potent vasodilator, are the key mediators that are involved in myocardial perfusion. Other mediators are nitric oxide (NO), prostaglandins (PGE2), carbon dioxide (CO2) and hydrogen ions. Obstruction as result of atherosclerosis can be fixed to coronary blood flow, or dynamics as with coronary

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