Myocardial Ischemia: The Lack Of Oxygen

2113 words - 8 pages

Angina is chest pain which results from inadequate oxygen flow to the myocardium. If the demand for myocardial oxygen surpasses the ability of the coronary arteries to provide the heart with oxygen, myocardial ischemia happens. Angina is the clinical manifestation of reversible myocardial ischemia caused by either an increased demand for oxygen or a decreased supply of oxygen that can lead to myocardial ischemia (Lewis et al., 2010). Angina is classified as either Chronic Stable Angina (CSA), Unstable Angina (UA) or Prinzmetal's angina. CSA, described as chest pain transpiring periodically over a period of time with an identical pattern of onset, duration, and intensity of symptoms. CSA can further be classified as silent ischemia, nocturnal angina, or angina decubitus (Lewis et al., 2010). Libby et al., refer to Silent ischemia as “ischemia that occurs in the absence of any subjective symptoms” (as cited in Lewis et al., 2010). Nocturnal angina happens at night only; however, not necessarily only when the person is lying down or during sleep. Angina decubitus refers to chest pain that a person experiences solely while lying down. A majority of the time, angina decubitus is relieved by standing or sitting. Prinzmetal's angina frequently occurs at rest, usually as a reaction to spasm of a major coronary artery. UA refers to an acute coronary syndrome (ACS) represented by unpredictable chest pain with occurrences that are new in onset, occur at rest, or have a worsening pattern. Unstable angina is easily provoked with minimal to no exertion, while sleep or rest and its frequency increases. UA represents a medical emergency (Lewis et al., 2010).
Angina is chest pain caused by a lack of oxygen to the myocardial tissues; therefore, the cardiovascular system is affected. The primary reason angina occurs is insufficient blood flow due to the constriction or narrowing of the coronary arteries by atherosclerosis. Ischemia, secondary to atherosclerosis, arises when a coronary artery is typically 75% or more stenosed (Lewis et al., 2010). Hypoxia occurs in the myocardium (heart muscle) within ten seconds of coronary obstruction because the need for oxygen is greater than the supply. In the presence of a total obstruction to the coronary arteries, contractility terminates after several minutes, denying the myocardial cells of oxygen and glucose, which is required for aerobic metabolism. Without the requirements for aerobic metabolism, anaerobic metabolism begins. Lactic acid accumulates from anaerobic metabolism and irritates the myocardial nerve fibers. The irritation communicates a pain signal to the cardiac nerves and the upper thoracic nerve roots. The location where the pain signal communicates causes a person to experience pain in the left shoulder and arm, referred to as cardiac pain (Lewis et al., 2010).
By far the most common contributing factor of angina is atherosclerosis; fatty deposits in the lining of arteries resulting in inadequate...

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