Lesson 3, Topic 4

Angina – Chest Pain – Part 4

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A 69 year old male presents to the emergency room complaining of increasingly severe chest pain for the past 2 hours. He has a 45 pack year history of cigarette smoking. Medications include thiazide, captopril and atorvastatin.


    • Describe the patient.
    • What is the chief complaint and differential diagnosis?
    • Describe the blood supply of the heart.
      • Normal structure and local regulation
      • Adaptation
      • Ischemia (supply vs demand)
      • Atherosclerosis
        • Pathogenesis
    • Describe types of plaque
      • Stable plaque (& CPC)
      • Unstable plaque (& CPC)
    • Describe the clinical-pathologic correlation:
      • What next?
      • EKG results:
        • What is the interpretation and next action? (3)
    • Describe the natural history for an acute STEMI (CPC)
    • How should the patient be treated?


QU Angina.chest pain 8.14.20



- ACS:


    - regulation of blood pressure:
    Note that you should have the molecular pathways for vasodilation, which is local only and via NO and vasoconstriction, which is endothelin for local effect and V1, ATII, alpha1 for system control. These are all Gq so it is worth knowing.
  - lymphatic drainage. Make sure that you understand the importance of Virchow node (#3 in the image)
    - general pathology of ischemia:
    Reversible = loss of Na/K ATPase and swelling
    Ireversible = pay attention to the different nuclear patterns
- Presentation of heart disease:
This should now be usable as a summary of heart disease. Note the list of causes of dyspnea at the very bottom. When you can explain Presentation, pathophysiology and Natural history for all of these, you are good to go.