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Chronic Angina Case Study

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Chronic Angina Case Study
Advanced Pathophysiology
2/2/14

1) Basis for diagnosis: Six month history of intermittent chest discomfort, described as lower substernal tightness with numbness of the left upper arm, only during exertion. + exercise stress test with pain and 1.5mm of ST segment depression.
Class of Angina: Class 1 Chronic angina is associated with a fixed or stable coronary obstruction that creates a disparity between coronary blood flow and the metabolic demands of the myocardium. It is usually precipitated by situations that increase the metabolic needs of the heart such as physical exertion, cold, and emotional stress and relieved within minutes by rest or nitroglycerin. These symptoms occur repeatedly over time, sometimes months to years. This fixed or stable plaque is commonly associated with chronic angina whereas the unstable plaque is associated with unstable angina and myocardial infarction. It is these unstable plaques that are most prone to abrupt plaque changes, followed by thrombosis, that lead to MI, stroke, and sudden cardiac death. These unstable plaques can be divided into three categories of Acute Coronary Syndrome: Unstable Angina, NSTEMI, and STEMI. The pathophysiology between UA and NSTEMI are similar and include these key features: development of an unstable plaque that ruptures or plaque erosion with superimposed non occlusive thrombosis, an obstruction by spasm, constriction, dysfunction, or adrenergic stimuli, severe narrowing of the coronary lumen, inflammation, or any physiological state causing ischemia related to decreased oxygen supply such as fever or hypotension. UA and NSTEMI differ in whether the ischemia is severe enough to cause enough myocardial damage to release detectable amounts of serum cardiac markers (CK, CK-MB, Troponin). The pain associated with both UA and NSTEMI typically occurs at rest or

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