Page 13 - Clinical Pearls in Cardiology

Chapt er
1 History and
General Examination

1. What is the reason for angina?
Angina pectoris occurs whenever there is an imbalance
between myocardial oxygen supply and demand. The
pain of angina and myocardial infarction tends to be
similar in character. Following the partial or complete
occlusion of a coronary artery, there is accumulation of
various metabolites such as lactic acid from the ischemic
cardiac muscles. These metabolites stimulate the cardiac
sympathetic nerves and produce pain. Figure 1 shows
the sites of anginal pain.
Patients with cardiac transplants who develop
coronary disease in the transplanted heart do not feel

Fig. 1: Sites of anginal pain