Angina



Angina







  • Evaluation



    • Description—chest pain in conjunction with myocardial ischemia, not myocardial necrosis


    • Types



      • Typical (all three are present) versus atypical (two are present) versus noncardiac (one present)



        • Pain located in chest, shoulder, arm, or jaw


        • Worsens with stress (physical or emotional)


        • Relieved by nitroglycerin


  • Differential diagnosis of acute chest pain



    • Cardiovascular



      • Stable angina


      • Acute coronary syndrome (ACS)—need hospital admission and cardiology care



        • Unstable angina—myocardial ischemic pain at rest, of new onset, or increase in severity


        • Non-ST elevation myocardial infarction (NSTEMI)



          • Evidence of myocardial infarction (MI) (+ troponin), but no ST elevation on electrocardiogram (EKG)



        • ST elevation myocardial infarction (STEMI)



          • Evidence of myocardial infarction (MI) (+ troponin)


          • Equal to or greater than 1 mm of new ST segment elevation in more than two leads


      • Aortic dissection—acute sharp chest pain that radiates to the back


      • Pericarditis/myocarditis—sharp, pleuritic pain that is positional


    • Non-cardiovascular



      • Pulmonary (eg., pulmonary embolism—pleuritic chest pain, dyspnea, cough, hemoptysis)


      • Gastrointestinal (eg., gastroesophageal reflux disease (GERD), heartburn, etc.)


      • Musculoskeletal (eg., costochondritis—this pain may be reproducible on examination)


      • Psychiatric (eg., anxiety, etc.)


  • Management of stable angina



    • Order



      • EKG—get within 5 minutes of the patient presenting with symptoms suggestive of angina.



        • Q waves in concordant leads suggest prior infarct.


        • EKG signs are suggestive of ACS.



          • ST-segment elevation or depression


          • Inverted T waves, including “pseudonormalization” of previously flipped T waves


      • Stress testing—it is used to risk-stratify patients with angina.



        • May also use stress testing to diagnose coronary disease as a cause of chest pain


    • Pathophysiology—patients with angina experience chest pain when O2 demand is greater than O2 supply.


    • Treatment—aims to reverse the pathophysiological imbalance described in the preceding text.

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Aug 28, 2016 | Posted by in PSYCHIATRY | Comments Off on Angina

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