Description Chest pain that is ...
Description
Chest pain that is caused by insufficient blood supply through the coronary arteries that feed oxygen and nutrients to the heart. Stable angina is pain that occurs with a fixed amount of exercise. Unstable angina is pain that now occurs with less exertion or at rest. The disorder is very serious since it is a warning sign of an imminent heart attack. This is a medical emergency. Untreated it can lead to rapid death.
Symptoms
Chest pain (the pain can also be in the shoulder, back, arm, jaw or abdomen), chest pain that occurs at rest or with less exertion, shortness of breath, sweating, feeling faint, nausea, vomiting. The chest pain may be described as tightness, squeezing, crushing, burning, choking, or aching.
Tests
Common tests used for diagnosis and treatment
Workup:
A history and physical exam will be performed. Initial testing includes an electrocardiogram (EKG) and blood test for troponin (a heart muscle protein released into the blood if heart muscle damage has occurred). A coronary angiogram can identify the site of coronary artery blockage. A high resolution chest CT scan can also demonstrate blockages. CT scans can also rule out other diseases that can clinically mimic unstable angina. An echocardiogram may be done to see well the heart is pumping.
Tests:
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG), X-ray, Cholesterol panel (LDL, HDL, total cholesterol, triglyceride)
Other Specific Tests: Troponin, coronary angiography, echocardiography, standard stress test, radionucleotide stress test, high resolution chest CT scan, CPK (creatine phosphokinase), BNP (brain natriuretic peptide)
Do I need this test?
Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI). Stent placement in a noninfarct artery during primary PCI for STEMI in a hemodynamically stable patient may lead to increased mortality and complications. While potentially beneficial in patients with hemodynamic compromise, intervention beyond the culprit lesion during primary PCI has not demonstrated benefit in clinical trials to date.
Specialists:
Cardiothoracic Surgery, Cardiology
Workup:
A history and physical exam will be performed. Initial testing includes an electrocardiogram (EKG) and blood test for troponin (a heart muscle protein released into the blood if heart muscle damage has occurred). A coronary angiogram can identify the site of coronary artery blockage. A high resolution chest CT scan can also demonstrate blockages. CT scans can also rule out other diseases that can clinically mimic unstable angina. An echocardiogram may be done to see well the heart is pumping.
Tests:
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG), X-ray, Cholesterol panel (LDL, HDL, total cholesterol, triglyceride)
Other Specific Tests: Troponin, coronary angiography, echocardiography, standard stress test, radionucleotide stress test, high resolution chest CT scan, CPK (creatine phosphokinase), BNP (brain natriuretic peptide)
Do I need this test?
Don't perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI). Stent placement in a noninfarct artery during primary PCI for STEMI in a hemodynamically stable patient may lead to increased mortality and complications. While potentially beneficial in patients with hemodynamic compromise, intervention beyond the culprit lesion during primary PCI has not demonstrated benefit in clinical trials to date.
Specialists:
Cardiothoracic Surgery, Cardiology
Treatment
Therapy is directed at relieving the pain by increasing the blood supply to the heart and preventing blood clot formation inside the coronary arteries. Anti-platelet drugs, such as aspirin and clopidogrel/Plavix, and nitroglycerin are given immediately. Coronary (heart) artery blockages are reduced by the following: balloon angioplasty, stent placement, surgical bypass, and/or blood thinners. Other medications also given usually include a high dose statin to lower cholesterol, a beta blocker to slow heart rate and an angiotensin enzyme inhibitor (ACEI) that helps the heart remodel appropriately.