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Information

Angina

  • A symptom of myocardial ischemia
  • Occurs when the myocardium needs more oxygen than the coronary arteries can deliver

Stable Angina

  • Provoked by exertion or stress
  • Usually lasts 2 to 10 minutes
  • Typically relieved by rest
  • Repeats in this pattern

Unstable Angina

  • Provoked more easily than stable angina
  • Commonly wakes the patient
  • Unpredictable
  • Worsens over time
  • Classified as an acute coronary syndrome with MI
  • Treated as a medical emergency
  • Usually signals an MI
ECG changes in angina
Some classic ECG changes involving the T wave and ST segment that you may see when monitoring a patient with angina are illustrated below.

Prinzmetal Angina

  • A relatively uncommon form of unstable angina
  • Usually occurs at rest or wakes the patient from sleep

ECG changes in Prinzmetal angina

This illustration shows a 12-lead ECG of a patient with Prinzmetal angina. Marked ST-segment elevations appear in leads that are monitoring the heart area where the coronary artery spasm occurs. The elevation occurs during chest pain and resolves when pain subsides. T waves are usually of normal size and configuration.



What causes it

  • Decreased blood flow results from narrowing of the arteries from coronary artery disease (CAD), which may be complicated by platelet clumping, thrombus formation, or vasospasm.
  • In Prinzmetal angina, vasospasm results from a focal episodic spasm of a coronary artery, with or without an obstructing coronary artery lesion.

What to look for

Stable Angina

  • Predictable pain pattern
  • Substernal or precordial burning, squeezing, or tightness
  • May radiate to left arm, neck, or jaw
  • Relieved by nitrates or rest

Unstable Angina

  • Chest pain that may radiate
  • Greater intensity and duration than stable angina
  • Also pallor, diaphoresis, nausea, or anxiety

Prinzmetal Angina

  • Substernal chest pain from heaviness to crushing discomfort
  • Usually occurs at rest or wakes the patient from sleep
  • Also dyspnea, nausea, vomiting, or diaphoresis

How It's Treated

  • Give nitrates to reduce myocardial oxygen consumption.
  • Give beta-adrenergic blockers to reduce the heart's workload and oxygen demands.
  • Give calcium channel blockers to treat angina caused by coronary artery spasm.
  • Give antiplatelet drugs to minimize platelet aggregation and the risk of coronary occlusion.
  • Give antilipemic drugs to reduce elevated serum cholesterol or triglyceride levels.
  • Anticipate coronary artery bypass surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for obstructive lesions.