Page 14 - Clinical Pearls in Cardiology

2 Clinical Pearls in Cardiology

angina pain. This is because of the fact that in these
people, the transplanted heart is denervated. For the
same reason, patients with long-term diabetes with
neuropathy are more likely to develop “silent infarcts”
(i.e. infarction without chest pain).
2. What is microvascular angina?
Approximately 10% of patients who report stable angina
on effort will be found to have angiographically normal
coronary arteries. Abnormal contraction or failure of the
normal dilatation of the small intramyocardial capillary
vessels is the cause of myocardial ischemia in most of
these patients. This type of angina is called microvascular
angina.
The constellation of typical angina on effort, objective
evidence of myocardial ischemia on stress testing, and
angiographically normal coronary arteries is, sometimes,
referred to as Syndrome X.
3. What is angina decubitus?
Angina occurring at night when the patient is recumbent,
is called angina decubitus. There is expansion of the
intrathoracic blood volume with recumbency. This
causes increased venous return to the heart. This
increases the end diastolic volume and myocardial
wall tension and leads to increased myocardial oxygen
demand. This results in angina decubitus.
4. What is Prinzmetal’s angina?
Focal spasm of an epicardial coronary artery (the right
coronary artery is most commonly involved) can produce
severe myocardial ischemia. This results in a type of
angina which occurs even at rest. This type of angina
is referred to as Prinzmetal’s variant angina. It is more
common in males, smokers and typically occurs at night.