Chronic Coronary Syndromes Signs and Symptoms

Cập nhật: 20 February 2025
Được đánh giá bởi

Giới thiệu

  • Also known as stable coronary artery disease (CAD), stable ischemic heart disease (SIHD), chronic stable angina or stable angina pectoris 
  • Clinical syndrome resulting from structural and/or functional changes related to chronic diseases of the coronary arteries and/or microcirculation leading to transient, reversible myocardial demand versus blood supply mismatch culminating in hypoperfusion (ischemia) usually but not always precipitated by exertion, emotion or other stress and presenting as angina or constricting discomfort in the chest, neck, jaw, shoulder, back or arms, dyspnea or may be asymptomatic    
  • Stable for long periods of time but most often progressive and may destabilize at any time with acute coronary syndrome (ACS) development 
  • Angina is stable when it is not a new symptom and when there is no deterioration in frequency, duration or severity of episodes

Dịch tễ học

  • Leading cause of death worldwide
  • Global prevalence of IHD in 2020 is 138/100,000 in males and 90/100,000 in females
  • Prevalence in 2020 ranges from 1556-<3345/100,000 in Southeast Asia

Nguyên nhân

  • Can be attributed to myocardial ischemia of which atherosclerotic CAD is the most common cause 
    • Obstructive CAD has ≥50% stenosis while non-obstructive CAD has <50% stenosis 
    • Patients (mostly women) may also present with ischemic manifestations without epicardial coronary artery narrowing or obstruction (ie microvascular angina) 
  • Non-atherosclerotic cardiac causes of chronic IHD include coronary artery abnormalities (eg congenital abnormalities of the coronary arteries, coronary artery dissection, coronary arteritis in association with systemic vasculitides, coronary spasm, and radiation-induced coronary disease), myocardial bridging

Sinh lý bệnh

  • Due to inadequate blood supply to the myocardium as a result of obstruction of the epicardial coronary arteries usually resulting from atherosclerosis
  • Pathogenetic mechanism includes an imbalance in the myocardial oxygen supply (ie reduced blood flow and oxygen delivery to the myocardium) and demand (ie increased workload and myocardial oxygen requirements) 
  • Other mechanisms include mural thrombosis, microvascular dysfunction, vasoconstriction at the site of a dynamic stenosis, and non-coronary or non-vascular processes (eg myocardial energy derangements, blood rheology abnormalities, or extravascular microcirculatory compression)

Signs and Symptoms

  • Chest discomfort
    • Quality 
      • Patients having chest discomfort described as strangling, constricting, squeezing, pressure or heaviness have increased likelihood of chronic coronary syndrome (CCS)  
      • Patients having chest discomfort described as burning, sharp, tearing or ripping, pleuritic or aching have decreased likelihood of CCS   
    • Location and size
      • Patients with retrosternal, extending to left arm or to jugular or intrascapular region or fist-size chest discomfort have increased likelihood of CCS   
      • Patients with right, shifting, large area or fine spot of chest discomfort have decreased likelihood of CCS
    • Duration    
      • Patients with short (up to 5-10 minutes) chest discomfort if precipitated by physical exertion or emotion have increased likelihood of CCS  
      • Patients with lasting chest discomfort have decreased likelihood of CCS    
    • Precipitating factors/trigger    
      • Chest discomfort triggered on effort, more frequent in cold weather, strong winds or after a heavy meal or emotional distress (eg anger, anxiety, excitation or nightmare) is most likely CCS  
      • Chest discomfort triggered at rest, on deep inspiration or when coughing or when pressing on ribs or sternum is less likely CCS    
    • Alleviating factors  
      • Chest discomfort subsiding within 1-5 minutes after effort discontinuation or relief is accelerated by sublingual Nitroglycerin is most likely CCS    
      • Chest discomfort relieved by antacids or drinking milk is less likely CCS     
  • Dyspnea  
    • Quality    
      • Patients with difficulty catching breath are most likely to have CCS   
      • Patients with difficulty exhaling or with wheezing are less likely to have CCS    
    • Precipitating factors/trigger 
      • Dyspnea triggered on effort is more likely CCS 
      • Dyspnea triggered both at rest and on effort or while coughing is less likely caused by CCS  
    • Alleviating factors   
      • Dyspnea rapidly subsiding after effort discontinuation is more likely CCS   
      • Dyspnea slowly subsiding at rest or after inhalation of bronchodilators is less likely caused by CCS

Yếu tố nguy cơ

Conditions that Exacerbate or Provoke Ischemia

Non-cardiac Diseases
  • Hyperthyroidism
  • Hyperthermia
  • Anxiety
  • Anemia
  • Hyperviscosity
  • Leukemia
  • Hypertension
  • Sympathomimetic toxicity (eg cocaine toxicity)
  • Arteriovenous fistulae
  • Sickle cell disease
  • Polycythemia
  • Thrombocytosis
  • Pheochromocytoma 
  • Carbon monoxide poisoning
  • Hypergammaglobulinemia
  • Hypoxemia secondary to pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary hypertension, obstructive sleep apnea, interstitial pulmonary fibrosis
Cardiac Diseases  
  • Aortic stenosis
  • Dilated cardiomyopathy
  • Arrhythmias (eg supraventricular tachycardia, ventricular tachycardia)
  • Hypertrophic cardiomyopathy
  • Significant coronary obstruction
  • Microvascular disease