Fast Five Quiz: Coronary Artery Atherosclerosis

Yasmine S. Ali, MD

Disclosures

November 11, 2019

High or low blood pressure may be noted in patients with atherosclerosis. Hypotension often reflects hemodynamic compromise and is a predictor of poor outcome in the setting of AMI. Diaphoresis is a common finding. Patients often have rapid breathing (ie, tachypnea). Signs and symptoms of congestive heart failure may indicate cardiogenic shock or a mechanical complication of AMI, such as ischemic mitral valve regurgitation.

The symptoms of coronary artery disease vary widely. Patients with mild atherosclerosis may present with clinically important symptoms and signs of disease and MI, or sudden cardiac death may be the first symptom of coronary heart disease. However, many patients with anatomically advanced disease may have no symptoms and experience no functional impairment. The spectrum of presentation includes symptoms and signs consistent with the following conditions:

  • Asymptomatic state (subclinical phase)

  • Stable angina pectoris

  • Unstable angina (ie, ACS)

  • AMI

  • Chronic ischemic cardiomyopathy

  • Congestive heart failure

  • Sudden cardiac arrest

Progressive luminal narrowing of an artery due to expansion of a fibrous plaque results in impairment of flow once at least 50%-70% of the lumen diameter is obstructed. This impairment in flow results in symptoms of inadequate blood supply to the target organ in the event of increased metabolic activity and oxygen demand. Stable angina pectoris, intermittent claudication, and mesenteric angina are examples of the clinical consequences of this mismatch.

Angina pectoris is characterized by retrosternal chest discomfort that typically radiates to the left arm and may be associated with dyspnea. Angina pectoris is exacerbated by exertion and relieved by rest or nitrate therapy. Unstable angina pectoris describes a pattern of increasing frequency or intensity of episodes of angina pectoris and includes pain at rest. A prolonged episode of angina pectoris that may be associated with diaphoresis is suggestive of MI.

An S4 gallop is a common early finding. The presence of an S3 gallop indicates reduced left ventricular function. Heart murmurs, particularly those of mitral regurgitation and ventricular septal defect, may be found after the initial presentation; their presence indicates a grave prognosis.

Read more about the presentation of patients with coronary artery atherosclerosis.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....