Angina Pectoris and Myocardial Infarction

The most common cause of death in the United States is coronary atherosclerosis ( ath ér-ō-skler-ō ́sis; athere = gruel, sclerosis = hardness), or coronary heart disease (see Clinical View, “Atherosclerosis,” in chapter 23).
This condition is characterized by narrowing of the coronary arteries that reduces blood flow to the myocardium and gives rise to chest pain.
Coronary atherosclerosis can lead to either angina pectoris or myocardial infarction.


Angina pectoris (an ́jı¯-nā , an-ji ́na) is not a disease, it is actually a symptom of coronary artery disease caused by narrowing or blockage of coronary arteries. Generally it results from strenuous activity, when workload demands on the heart exceed the ability of the narrowed coronary vessels to supply blood. The pain from angina is typically referred along the sympathetic pathways (T1–T5 spinal cord segments), so an individual may experience pain in the chest region or down the left arm, where the T1
dermatome is located. The pain diminishes shortly after the person stops the exertion, and normal blood flow to the heart is restored. Although many people are successfully treated for years with medications that cause temporary vascular dilation, such as nitroglycerine, the prognosis and longterm therapy for angina depend on the severity of the vascular narrowing.

Myocardial infarction (in-fark ́shūn) (MI), commonly called a heart attack, is a potentially fatal condition resulting from sudden and complete occlusion (blockage) of a coronary artery. A region of the myocardium is deprived of oxygen, and some of this tissue may die (necrose). The symptoms of MI are often different for men and women. Most men experiencing an MI report a sudden, excruciating, and crushing substernal chest pain, and marked sweating, Many women, however, have relatively little chest pain. When they experience pain, they describe it as an “aching,” “tightness,” or “pressure,” rather than pain, and the main locations are in the back and high chest. In addition, women more often experience shortness of breath, but because they do not exhibit t he traditional or classic symptoms that some doctors expect, it is likely for a female to be sent home from the ER with an incorrect diagnosis of heartburn or anxiety, rather than MI.

source : human anatomy

pericarditis - inflammation of the pericardium

Pericarditis (per ́i-kar-dı¯ ́tis; peri = around, kardia = heart, ite s = inflammation) is an inflammation of the pericardium typically caused by viruses, bacteria, or fungi. Whatever the cause of pericarditis, the pericardium is inflamed. The inflammation causes an increase in capillary permeability. Thus, the capillaries become more “leaky,” resulting in fluid accumulation in the pericardial cavity. At this point, the potential space of the pericardial cavity becomes a real space as it fills with fluid and pus. In severe cases, the excess fluid accumulation limits the heart’s movement and keeps it from filling with an adequate amount of blood. The heart is unable to pump blood, leading to a medical emergency called cardiac tamponade and resulting in heart failure and death.

Pericarditis typically occurs between the ages of 20 and 50. Fever and chest pain are frequent symptoms. Pericarditis pain is located over the center or left side of the chest, and may extend to the neck or left shoulder. Patients often describe the pain as piercing or “knifelike,” and say that breathing worsens it. In contrast, pain from a myocardial infarction typically is described as crushing. But although the two conditions are different, the diagnosis of myocardial infarction and pericarditis often may be confused, especially by the patients experiencing the symptoms. A helpful diagnostic finding in pericarditis is friction rub, a crackling or scraping sound heard with a stethoscope that is caused by the movement of the inflamed pericardial layers against each other. The inflammation results in the loss of the lubricating action of the serous membranes.

source : human anatomy