Question

A 59-year-old male calls the paramedics after experiencing an episode of chest pain while shoveling snow. He describes his pain as a crushing, tight feeling that radiates to his left arm and jaw. What type(s) of heart disease is this patient experiencing (explain)? What diagnostic test would you expect the physician to order and why? What is the treatment?

Answer 1

Answer - The patient had Angina pectoris. Since the patient had a crushing right feeling which radiates to left shoulder is Angina . Pain in Angina radiates to left shoulder.

Angina occurs due to narrowing of the lumen of coronary arteries. This occurs because of atherosclerosis or deposition of atheromatous plaque inside the lumen of arteries. This decreases blood flow and oxygen supply. It is due to an imbalance between myocardial oxygen demand and supply.

* Diagnosis -

On palpation look for bruits on carotid arteries.

Evidence of any peripheral vascular disease.

Resting ECG.

Depressed St segment. Sometimes flattening of T waves.

Exercise ECG or stress test- patient is made to run on a treadmill and undergoes an increment in workload while ECG,, BP and symptoms are monitored.. Test is stopped at the onset of chest pain or fatigue. This test is done because Angina is precipitated by physical exertion and to differentiate it from other kinds of chest pains.

Marked ST segment depression more than 1mm below baseline and lasting longer than 0.08 second sis considered positive.

Echocardiography to assess ventricular function.

Coronary angiography-- to identify the extent of coronary artery disease. To locate the blocks in the arteries.

* Treatment -

* Drug therapy - aspirin, clopidogrel are Antiplatelet agents.

Lipid lowering agents such as atrovastatin.

Nitrates to reduce preload and afterload

Beta blockers and calcium channel blockers

* Surgical management

Coronary angioplasty

Coronary artery bypass grafting or CABG.