All chest pain event related to a “narrowing of the size” of one or more coronary arteries. The coronary arteries are the arteries that supply blood to the heart muscle.

Clinical Data

Clinical examination was unremarkable.
The resting ECG was completely normal except for a painful crisis.
Any interrogation can find angina:
with chest pain to left arm
to pain on exertion and rest
pain in 3 to 4 minutes,
took to heart in a vise.

Pathophysiology

Suffering infarction: ischemia is associated with a mismatch between needs and the oxygen supply of heart muscle:
is the input can not increase in proportion to needs: angina of effort
is in constant need, contributions are reduced: spastic angina.
The decrease in arterial size is secondary to a “collection” by atherosclerotic plaques.

Definition of risk factors for cardiovascular

No tobacco
No diabetes
No dyslipidemia,
No hypertension
No overweight
No heredity
No inactivity.

Methods of diagnosis
Physical examination and ECG are quite normal, thus not contributing outside of a crisis.

Further examination

• Stress Test,
• scintigraphy,
• stress echocardiography,
• angiography.

Stress Test

On bicycle ergometer or treadmill.
Maintain a constant pedaling speed while pedaling resistance is overcome by increased every 2 minutes.
The goal is to increase the intake of myocardial O 2 and leading to a mismatch between needs and contributions, thus triggering pain and ECG changes.

Myocardial scintigraphy

Uses of the exercise test.
Using isotopes: technetium or technetium MIBI.
Check whether there are differences in determining the isotope of the photographic effort and after 4 hours of redistribution.

Coronary

Opacification of coronary arteries using a contrast agent based on iodine.
First, femoral, radial or humeral priority.
Lets make a simple “inventory” of places of the coronary circulation, therefore best to discuss the establishment of a treatment.

Coronary Anatomy

Presence of 3 coronary arteries:
_ The interventricular anterior
_ circumflex artery,
_ right coronary artery.

Treatment

• Medical:
  • nitrates,
  • Anti-calcium,
  • potassium channel activator,
  • beta-blockers,
  • antiplatelet,
  • statins, lipid-lowering,
• Percutaneous trans-luminal
• Bypass surgery.

Prejudices

Fight against cardiovascular risk factors:

• smoking cessation,
• equilibration Diabetes
• lipid-lowering diet,
• weight loss,
• fight against physical inactivity.