CHD - clinical manifestations and pathology

CORONARY HEART DISEASE: CLINICAL MANIFESTATIONS AND PATHOLOGY

Angina

Angina pectoris is the symptom complex caused by transient myocardial ischaemia and constitutes a clinical syndrome rather than a disease.
It may occur whenever there is an imbalance between myocardial oxygen supply and demand.
Coronary atheroma is by far the most common cause of angina.
The symptom may also be a manifestation of other forms of heart disease, particularly aortic valve disease and hypertrophic cardiomyopathy.


Stable Angina

Occurs when coronary perfusion is impaired by fixed or stable atheroma of the coronary arteries.

Activities precipitating angina
Common
Physical exertion
Cold exposure
Heavy meals
Intense emotion
Uncommon
Lying flat (decubitus angina)
Vivid dreams (nocturnal angina)

Clinical Features

Chest discomfort/pain-
usually described as heaviness, pressure, squeezing, smothering, or choking, and only rarely as frank pain.
typically lasts 2–5 min, and can radiate to either shoulder and to both arms (especially the ulnar surfaces of the forearm and hand).
typically caused by exertion (e.g., exercise, hurrying, or sexual activity) or emotion (e.g., stress, anger, fright, or frustration) and are relieved by rest, they may also occur at rest.

Physical findings
Usually negative
Evidence of valve disease (particularly aortic)
Important risk factors (eg. Hypertension, diabetes.)
Evidence of left ventricular dysfunction (cardiomegaly and gallop rhythm)
Other conditions- carotid bruits, peripheral vascular disease, anemia and thyrotoxicosis (unrelated conditions)