Unstable angina pathophysiology & etiology
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| Unstable angina pectoris Classification and external resources | |
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| Plaque rupture in a coronary artery at arrows yielding obstructive thrombus in red. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology | |
| ICD-10 | I20. |
| ICD-9 | 413 |
| DiseasesDB | 8695 |
| eMedicine | med/133 |
| MeSH | D000787 |
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Synonyms and related keywords: progressive angina, crescendo angina, accelerating angina, new-onset angina, pre-infarction angina, unstable angina pectoris, UAP, UA
The Pathophysiology of Unstable Angina Pectoris
Unstable angina occurs when myocardial oxygen demand exceeds myocardial oxygen supply at rest or with minimal exertion. This supply / demand mismatch can be caused by the following: [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1]
Conditions That Decrease Oxygen Supply
- Coronary thromboembolism in which there is rupture at the shoulder of a lipid laden, inflamed coronary artery plaque with formation of thrombus and distal embolization is the classic cause of unstable angina. The artery is open, so there is no ST elevation to suggest transmural injury. Embolization may yield subendocardial ischemia which results in ST segment depression.
- Dynamic obstruction (e.g., coronary artery spasm or coronary vasoconstriction) of epicardial and/or microvascular vessels
- Prinzmetal's angina of the large epicardial coronary arteries
- Syndrome X of the small downstream coronary microvasculature
- Coronary artery disease progression with a severe, lipid laden, atherosclerotic stenosis
- Myocardial bridge
- Vasculitis of the coronary arteries
- Coronary artery dissection
- Anomalous left coronary artery passing between the aorta and pulmonary artery
- Embolization into coronary arteries)
- Anemia
- Hypoxemia
- Polycythemia
Conditions That Increase Myocardial Oxygen Demand
- Amphetamine use
- Aortic stenosis
- Aortovenous shunts
- Cocaine use
- Congestive heart failure
- Fever
- High cardiac output
- Malignant hypertension
- Obstructive cardiomyopathy
- Pheochromocytoma
- Supravalvular aortic stenosis
- Tachyarrhythmias (e.g., atrial fibrillation or atrial flutter)
- Thyrotoxicosis
Features of Pain, which are not Characteristic of Myocardial Ischemia [1] [1]
- Pain which radiates into the lower extremities
- Pleuritic pain (sharp or knife like pain brought on by respiratory movements or cough)
- Primary or sole location of discomfort in the middle or lower abdominal region
- Pain that may be localized at the tip of one finger, particularly over the left ventricular apex or a costochondral junction
- Pain reproduced with movement or palpation of the chest wall or arms
- Very brief episodes of pain that last a few seconds or less
Differential Diagnosis of Unstable Angina Pectoris
Common Disorders
(In alphabetical order)
- Biliary disease
- Esophageal spasm
- Herpes zoster
- Mallory-Weiss tear
- Mediastinitis
- Peptic ulcer disease
- Pneumothorax
- Pulmonary embolism
Complete List of Differential Diagnosis of Unstable Angina Pectoris
Cardiac and Vascular Diseases
- Aortic aneurysm
- Aortic dissection
- Aortic stenosis
- Arryhthmias
- Bland-White-Garland Syndrome
- Cardiac tamponade
- Cor pulmonale
- Dressler's syndrome (postpericardiotomy)
- Hypertrophic obstructive cardiomyopathy
- Microvascular disease (syndrome X)
- Myocarditis
- Non ST Elevation Myocardial Infarction
- Pericarditis
- Pulmonary embolism
- Pulmonary hypertension
- Right ventricular strain due to severe pulmonary hypertension
- ST Elevation Myocardial Infarction
Pulmonary Diseases
Gastrointestinal Diseases
- Biliary disease
- Esophageal reflux
- Esophageal spasm
- Mallory-Weiss tear
- Pancreatitis
- Peptic ulcer disease
Musculoskeletal Diseases
- Arthritis of the shoulder or spine
- Cervical disk disease
- Costochondritis
- Intercostal muscle cramps
- Interscalene or hyperabduction syndromes
- Subacromial bursitis
Other Causes
References
See Also
- The Living Guidelines: UA/NSTEMI
- Chronic stable angina
- Non ST Elevation Myocardial Infarction
- ST Elevation Myocardial Infarction
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
