- chest pain syndrome which reflects a reversible myocardial ischemia (does not cause permanent myocardial injury).
NB : ischemia is not always painful.
- L’coronary insufficiency results from an inadequacy between the intakes and the oxygen requirements of the myocardium : the amount of blood and / or d’insufficient oxygen to the myocardium, at rest and / or at rest’effort.
- The mechanisms can be :
A permanent shrinkage (atherosclerotic stenosis, dissection, extrinsic compression).
a spasm : temporary shrinkage.
A decrease coronary flow or perfusion pressure.
1/- atherosclerosis : plates atherosclerotic obliterans.
2/- Risk factors :
3/- other etiologies :
- coronary spasm
- Abnormal coronary birth
- Stenosis secondary to radiation therapy
- aortic stenosis
- aortic regurgitation
CHARACTERISTICS SEMIOLOGICAL :
Seat : retro-sternal +++, medium-thoracique, bi-mammary ;
Irradiations : left arm, left wrist, mandible ;
Type : constrictive, squeezed, distressing ;
Intensity : variable ;
Circumstances of appearance : effort ;
calmed by : rest and glyceryl trinitrate ;
Contributing factors : cold, vent, emotion, postprandial period ... ;
scalability : prevents further effort, regresses in minutes ;
Frequency of occurrence : variable, depending on the importance of physical activity ;
equivalents : Blockpnée d’effort.
Functional Classification of pain (CCS) :
Classe I : No pain in the physical activities of daily living
Class II : Moderate limitation in the efforts of everyday life
class III : significant limitation in the efforts of everyday life
class IV : Pain at the slightest effort, or rest
PARTICULAR CASE : UNSTABLE ANGINA
1/- Angor de repos :
spontaneous pain, without triggering factor +++
particular form : spastic angina.
2/- Angor growing :
Appearing for less effort and less important (aggravation of exertional angina).
3/- Angor again :
new onset of severe outset.
In these cases there is an evolutionary threat to a heart attack or sudden death.
PHYSICAL EXAMINATION :
More often than normal, unless :
- Presence of clinical signs associated with risk factors (xanthélasmas, xanthomes tendineux).
- Achievement of an organ by atherosclerosis (stroke, trophic disorders of the lower limbs, missing peripheral pulse, vascular blasts).
- Heart disease associated : valvulopathie, especially aortic stenosis.
- Heart failure associated.
Resting electrocardiogram :
- Normal : most of the time (critical inter).
- sequels dïnfarctus : Q waves of necrosis.
- under- ST segment or negativity of the T wave in per-critical.
Course of Dr H Foudad – Faculty of Constantine