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Pathology
Pain caused by myocardial ischaemia when myocardial oxygen demand exceeds supply
Aetiology
Usually coronary stenosis due to atheroma, but can result from anything that causes demand-supply mismatch including tachycardia, anaemia, left ventricular hypertrophy, aortic stenosis, and hypotension
Signs
Patients usually identify ischaemic pain with an open palm or fist over the centre of the chest (Levine’s sign), rather than by pointing
Symptoms
Central chest heaviness or tightness precipitated by exertion or emotional stress and relieved by rest
Heavy arms, nausea, fatigue, breathlessness
Investigations
Bloods: FBC, U&E, lipid profile, blood glucose
ECG: ST depression
Exercise Tolerance Test: Assesses severity of disease
Stress Echo: Assesses adequacy of blood supple when heart rate increased
Coronary CT: Non-invasive method to image coronary arteries
Coronary Angiography: Invasive method to image coronary arteries
Myocardial Perfusion Scan: Assesses blood flow to cardiac muscle.
Treatment
Lifestyle adjustment
Reverse precipitants
Aspirin
Anti-anginal medication (nitrates, nico
randil, β-receptor antagonists)
Aggressive risk factor control - hypertension, diabetes and hyperlipidaemia
Prognosis
Acute coronary syndromes, arrhythmias, heart failure
Annual risk of non-fatal MI 12% and mortality rate 15%
Key Facts
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Key Images
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Key References
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