Stable and unstable angina


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” What is the pathophysiologic difference between stable angina and unstable angina? “

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Angina is a coronary artery disease that occurs when there is an imbalance between oxygen supply and demand in the myocardium (McCance & Huether, 2019). When supply is impaired and doesn’t meet demand, myocardial ischemia happens (McCance & Huether, 2019). There are two important concepts of accumulation of fatty streaks and endothelial dysfunction that explain the process of coronary artery disease (McCance & Huether, 2019). The coronary artery is made up of vascular smooth muscle and lined with vascular endothelium (McCance & Huether, 2019). 

With normal function, low-density lipoproteins (LDL) circulate throughout the arteries and deliver triacylglycerol fuel to tissues (McCance & Huether, 2019). However, when under abnormal circumstances, a certain percentage of LDLs are mutated by oxidative damage (McCance & Huether, 2019). Normally, macrophages ingest the oxidized LDL, and the body wants to get rid of waste. However, macrophages become engorged and become foam cells (McCance & Huether, 2019).  The foam cells become very big and accumulate and lodge in the layer of the vascular smooth muscle (McCance & Huether, 2019). When the foam cells accumulate, it displays the fatty steaks in the artery (McCance & Huether, 2019). The foam cells and lipid deposits will burst through the endothelial lining of the artery and cause a break in the artery. Besides the accumulation of fatty streaks, the dysfunctional endothelial cells have been damaged for many years and are result in the development of atherosclerosis (McCance & Huether, 2019). They cannot produce nitric oxide and cause the reduction of vasodilatation (McCance & Huether, 2019). As a result, the blood blow through the artery becomes restricted, oxygen supply to the distal tissues is diminished, and causing angina and heart attack.

Angina is a type of chest pain caused by reduced blood flow to the heart with a condition called myocardial ischemia and is a symptom of coronary artery disease (Mayo Clinic, 2020). Stable angina is not a heart attack and association with transient ischemia and no permanent damage and no infarction (American Heart Association, 2020). Patients usually feel uncomfortable pressure, fullness, squeezing, and pain at the center of the chest (American Heart Association, 2020). Stable angina is caused by fixed obstruction with a high cholesterol level (Huff, Boyd, & Jialal, 2020). Stable angina can be predictable, and patients are familiar with pain patterns, prompted by physical exertion such as exercise, emotional stress, cold temperatures, and having heavy meals (American Heart Association, 2020). Stable angina is not happened at rest, subsides with rest, and responds well to medications (American Heart Association, 2020).

On the other hand, unstable angina is unpredictable, even at rest, with unexpected chest pain (American Heart Association, 2020). It changes pain patterns, more severe, lasts longer and doesn’t respond well to medications (American Heart Association, 2020). As the coronary arteries are narrowed by fatty buildups, they can rupture, causing blood clots and blockage the flow of the heart muscle (American Heart Association, 2020). When having plaque ruptured, patients could have a heart attack and should be treated as a medical emergency (American Heart Association, 2020). 

Patients with angina is usually having ST-segment depression during attacks that display on the electrocardiograms (Ginghina, Ungureanu, Vladaia, Popescu, & Jurcut, (2009).). Providers can refer patients to have a stress test to perform during exercise (Mayo Clinic, 2020). Using an angiogram can also help detect obstruction and show the abnormal coronary (Mayo Clinic, 2020). The treatment of angina by relieving symptoms reduces the frequency of future anginas and reduces the risks of heart attacks. Patients can take nitroglycerin, long-lasting nitrates, antiplatelet drugs such as aspirin to relieve and prevent the symptoms (Mayo Clinic, 2020). They should also have lifestyle changes that include stop smoking, limit alcohol, keep a healthy weight, healthy diet, and regular exercise, but avoid exertion, avoid stress, and avoid large meals (Mayo Clinic, 2020). There are surgical procedures to restore normal blood flow, including a balloon or stent, coronary bypass, to wider the effective artery (Mayo Clinic, 2020). 

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