Stable angina pectoris （SAP)
Dept. of Geriatrics
Junling Huang
One night of winter heavy dinner Chest pain lasted about 10 mimutes
What happened？
Stable angina pectoris
definition:
acute and transient myocardial ischemia and anoxaemia usually caused by coronary insufficiency during exertion Characteristics: paroxysmal squeezing-like chest pain, behind the mid sternum or precordium radiate to left shoulder and upper arm precipitated by stress or exertion relieve rapidly by rest or nitrates
Precipitation
During stress or exertion, other than after that
Clinical manifestation
•location
behind
the mid sternum
no
definite borderline
neck
Behind the sternum Inner upper arm
mechanism
Oxygen supply
Oxygen demand
Pathology
75% pts have significant coronary lesion with diameter stenosis > 70% 10% pts have left main disease 10-15% pts have no significant stenosis， Ischemia may be related to coronary spasm or microvascular dysfunction.
radiate
to any dermatome from C8 to T4, most often to the left shoulder and upper arm
Atypical
location: lower jaw, the back of neck
Precordium
Below the xiphoid
Clinical manifestation
Typical and common symptom
chest pain or oppression
Precipitation Location and radiation characteristics duration remission
Clinical manifestation
•remission
•Rapidly relieve after rest or using nitroglycerin
Clinical manifestation
Physical examination
increased HR, elevated BP anxiety occasionally a gallop rhythm，transient systolic murmur Supraventricular or ventricular arrythmias (precipitating factor or a result) The signs of diseases may contribute to or accompany atherosclerotic heart disease
force the patient stop the activity till the symptom relieved
Clinical manifestation
•duration
Precipitated by exertion and promptly stops to rest, lasts less than 3mins Following a heavy meal or brought on by anger, lasts 15-20mins More than half an hour is unusual can occur once a few days or several weeks, also several times a day
One night of winter heavy dinner Chest pain lasted about 10 mimutes
What happened？
Laboratory Diagnosis
Differentiation
Treatment
Thank you
Clinical manifestation
Байду номын сангаас
•characteristics
tightness, squeezing, burning, pressing, choking, bursting,an ill-characterized discomfort
rarely sharply localized, not spasmodic