Definition: chest ache which is a translation clinic fickle myocardial ischemia. coronary angiography permits the diagnosis of certainty, and, occasionally, treatment with angioplasty. Distinction is made between
A - Steady angina:
B - Unstable angina:
Crescendo angina
Novo angina
Rest angina
Prinzmetal Angina: is a specific type of spontaneous angina: nocturnal schedules, distinguishing ECG (sus-ST-phase offset), frequent problems ventricular rhythm, the mechanism is a coronary spasm.Prinzmetal
Epidemiology: Danger components:
Excessive ldl cholesterol (LDL elevated, decreased HDL)
Tobacco smoking
Hypertension HTA
Diabetes
Age: after forty years, chez l'enfant: discover main Dyslipidemia, an irregular rise of coronary, Kawasaki syndrome.
Male: forty to 70 years: man > girl after 70 years: man = woman. Search Takayasu disease with angina of a young woman.
Genetics: f hereditary actors: polyfactorielle coronary inheritance
Bodily inactivity, stress
Obese BMI obesity
Hypertriglyceridemia
Hyperfibrinogénémie
Typically related to an aneurysm of the stomach aorta, diffuse atherosclerotic (decrease limbs, neck vessels).
Etiology:
The commonest mechanism: myocardial ischemia of effort on coronary caliber by atherosclerotic plaque reduction
Arterial spasm (Prinzmetal, chemotherapy, cocaine)
Practical angina (aortic stricture, hypertrophic cardiomyopathy, arrhythmia, aortic insufficiency, anemia)
Rare causes: lupus erythematosus, disease Takayasu and other Vasculitis, rheumatoid arthritis, haematological diseases, congenital anomalies of coronary (delivery anomaly)
Medical signs: precordialgies associated with a potential anxiety syncope, dyspnea, nausea, pallor.
Typical shape: ache substernal, constrictive, elected to the hassle (or brought on by emotions, defecation), sometimes triggered cold calmed down by rest, and the trinitrine. Doable irradiation in the jaw (especially left arm), two-arm on the back.
(Frequent) atypical varieties: thoracic Burns, blocpnée, belly pain.
Differential analysis: 4 on foot (PPPP I E D).
Infarction (making ECG successive and enzyme assay)
Aortic dissection
Pulmonary embolism
Acute pericarditis (pain, postural and amended by respiration, friction pericardial, sus-offset ST concave upwards)
Esophageal spasm
Pancreatitis
Radiculopathy
Parietal ache
Mitral valve prolapse
Complementary examinations:
1 - Biological steadiness: balance of risk factors, total ldl cholesterol and LDL cholesterol usually increased, typically low cholesterol HDL, fasting glucose, plasma Fibrinogen.
Pathological anatomy: atherosclerotic coronary arteries
2- Electrocardiogram ECG:
Per-critique: Repolarization localized sort issues of: ischemia subepicardial (T wave adverse, symmetric)
subendocardial lesion (below offset ST)
lesion subepicardial (sus-offset of the ST section of Prinzmetal Angina)
Normal put up-critique, it doesn't eradicate the diagnosis
in any other case, it could show equal signs from these described in per-crucial, most frequently STEMI and/or T wave changes.
3 - Echocardiography in 2 dimensions and M mode: very helpful to visualise abnormalities segmental kinetics and the worldwide left ventricular function (sequelae of myocardial infarction)
4 - Stress test: interpretable provided that the theoretical most rate (220 minus age) is reached. Main endpoint of positivity: sous-décalage of 1 mm or extra for at the very least 0.08 second ST section
5- Imaging:
Chest radiography: generally regular, looking for signs of congestive heart failure
Scintigraphy with thallium effort (and/or dipyridamole)
Ultrasound of stress (especially echocardiography dobutamine, typically echo below dipyridamole, typically echo in effort) to provoquables the left ventricular segmental kinetics problems
Coronary angiography finds; coronary stenosis contingent curiosity test metherginé to coronary spasm within the case of normal coronary angiography (in keeping with the teams).
Therapy: hospitalization in the intensive care unit of Cardiology for angina, unstable; otherwise, outpatient
Targets: primarily based on a number of rules:
Enhance myocardial oxygen supply and reduce consumption
Remedy of danger elements (tobacco judgment, remedy of hypercholesterolemia, diabetes…)
Preventive measures: limitation of activity when angina is stable, it encourages common reasonable depth physical activity.
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