Angina pathophysiology

Differentiate between the pathophysiology of chronic stable angina and acute coronary syndromes. 

PATHOPHYSIOLOGY OF ANGINA Determinants of Myocardial Oxygen Demand... 

To understand the evolution of therapy of the acute coronary syndrome (ACS), which includes unstable angina, acute myocardial infarction, and interventional therapy— percutaneous coronary intervention (PCI), it is most useful to trace the historical events that provided a rationale for the use of anticoagulant and antiplatelet drugs, The focus of this chapter is upon the explosion in knowledge of the physiology of the hemostatic mechanism and will trace the rational development of therapy based upon the pathophysiology of the ACS over the past 40 years. 

Sildenafil was the first oral treatment for ED and is the most extensively evaluated (35). Overall success rates in patients with cardiovascular disease of 80% or greater have been recorded with no evidence of tolerance, Patients with diabetes with or without additional risk factors, with their more complex, and extensive pathophysiology, have an average success rate of 60%. In randomized trials to date, open-label or outpatient monitoring studies the use of sildenafil is not associated with any excess risk of myocardial infarction, stroke, or mortality (38-40), In patients with stable angina pectoris there is no evidence of an ischemic effect due to coronary steal, and in one large, double-blind, placebo-controlled, exercise study sildenafil 100 mg increased exercise time and diminished ischemia (41), A study of the hemodynamic effects in men with severe CAD identified no adverse cardiovascular effects and a potentially beneficial effect on coronary blood flow reserve (42), Studies in patients with and without diabetes have demonstrated improved endothelial function acutely and after long-term oral dose administration, which may have implications beyond... 

Human and animal studies evidenced that polymorphonuclear (PMN) leukocytes are involved in the development of CHD, angina, and in a number of pathophysiological conditions related to chronic inflanunation and vascular injury. Leukotriens released by PMN under the challenge of various stimuli, promote chemotaxis, aggregation and degranulation of... 

In evaluating trials in which different forms of antianginal therapy are compared, careful attention must be paid to the patient population studied and to the pathophysiology and stage of the disease. The efficacy of antianginal treatment wiU depend on the severity of angina, the presence of coronary vasospasm, and myocardial demand. Optimally, the dose of each agent should be titrated to maximum benefit. 

Describe the pathophysiology of effort angina and vasospastic angina. 

Some pathophysiological states are characterized by perturbations in receptor dynamics. Prinzmetal s angina is thought to be characterized by an imbalance between vasodilatory P2-adrenoceptor function and vasoconstrictor -adrenoceptor function. In this disease state, the excessive alpha vasoconstriction of... 

The importance of the catecholamines for the pathophysiology of angina pectoris is especially stressed by Raab/ 1659-67) Noradrenaline and adrenaline increase the oxygen utilization of the myocardium i66s-... 

Peripheral arterial occlusion can be the initial manifestation of cardiac or systemic disease. At times, patients with chronic stable claudication may experience abrupt shortening of the distance at which claudication occurs, and this may be the only symptomatic evidence of an acute arterial occlusion either by embolization of by thrombus formation on a pre-existing arterial stenosis. The situation is not chronic and stable any more, but acute and unstable. As ischemia becomes more severe, the patient with chronic peripheral arterial disease develops ischemic pain at rest. The pathophysiologic mechanisms and the clinical presentation parallel the evolution of chronic stable angina pectoris to unstable angina and acute coronary syndromes. 

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