TYPE OF ANGINA- Uncommon pattern occurs at rest and due to coronary artery spasm.- Responds promptly to vasodilators, such as nitroglycerin and CCBs.
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A 45-year-old engineer presents to the ER complaining of severe, intense, precordial crushing sensation with pain radiation to the left shoulder and down the side of the left arm, triggered by exercise. The chest discomfort brought on by the exertion is relieved by rest. ER examination results are the following: heart rate of 98 beats/min, blood pressure of 160/110 mmHg, and the respiratory rate of 24 breaths/min. An EKG is performed and reveals ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as ST segment depression and decreased R-wave height. An exercise tolerance test is performed which demonstrates a downward sloping ST segment. Coronary angiography shows luminal obstruction >75% (91%) in three major coronary vessels, including the left anterior interventricular (descending) coronary artery. The patient is started on nitroglycerin, beta-blockers, and calcium channel blockers. Angioplasty is scheduled for the next morning. What is the term used to describe chest pain experienced by this patient? Describe the mechanism for chest pain. Describe the different types of chest pain. Explain the mechanism of action and the rationale for administering nitroglycerin, beta-blockers, and calcium channel blockers.
Madhur L.
Cardiovascular Case History #1: A 50-year-old airline pilot complained of severe, intense, precordial, crushing sensation with room examination resulted in the following information: Heart rate: 98 bpm Blood Pressure: 160/110 mm Hg ECG: ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as S-T segment depression and decreased R wave height. The following day, an exercise tolerance test was performed to test the functional response to graded stress. This symptom-limited test gave an ischemic ECG response during exercise, characterized by a downward-sloping S-T segment. Mild exertion resulted in chest pain, which was relieved by sublingual nitroglycerin. Coronary angiography showed luminal obstruction >70% (88%) in three major coronary vessels, including the left anterior interventricular (descending) coronary artery. Nitroglycerin, beta-blockers, and calcium channel blockers were tried as pharmacologic therapy. Angioplasty, the procedure in which a balloon-tipped catheter is inserted into the partially obstructed vessels, was able to increase coronary flow to near normal values. 1a. What is the term for the chest pain experienced by this individual? 1b. What is the cause of this pain? 3. What is the site of action for each of the pharmacologic drug therapies? a. Nitroglycerin. b. Beta-blockers. c. Calcium channel blockers. 4. Describe the gross anatomy of normal coronary arteries.
Supreeta N.
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