🔥🔥🔥 Unstable Angina Case Study

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Unstable Angina Case Study



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Case Study #10: Presenting with Chest Pain - What's the Diagnosis?

Has multiple primary malignancies within 3 years, except adequately resected non-melanoma skin cancer, curatively treated in situ disease, superficial GI tract tumors and non-muscle invasive bladder cancer curatively resected by endoscopic surgery. Has a history of underlying pulmonary disorder including, but not limited to, pulmonary emboli within 3 months of the start of study treatment, severe asthma, severe COPD, restrictive lung disease, and pleural effusion. Any autoimmune, connective tissue or inflammatory disorders e. Prior complete pneumonectomy. Has an uncontrolled infection requiring systemic therapy. Has clinically significant pulmonary compromise or requirement for supplemental oxygen.

Has substance abuse or any other medical conditions that would increase the safety risk to the subject or interfere with participation of the subject or evaluation of the clinical study in the opinion of the Investigator. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials. More Information. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. This must be consistent with the principle of safeguarding study participants' privacy and consistent with provision of informed consent. Daiichi Sankyo Co. Layout table for MeSH terms Neoplasms. National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Drug: DSa. Phase 1 Phase 2.

Study Type :. Interventional Clinical Trial. Estimated Enrollment :. Actual Study Start Date :. Estimated Primary Completion Date :. Estimated Study Completion Date :. Experimental: Dose escalation All participants enrolled in the dose escalation part. Experimental: Dose expansion All participants enrolled in the dose expansion part. CTRinfo dsi. Contact: Nurse Coordinator. Contact: Site Coordinator. Contact: Clinical Research Manager. Contact: Principal Investigator. Contact: Clinical Research Associate. Atherosclerosis is the most common cause of stenosis narrowing of the blood vessels of the heart's arteries and, hence, angina pectoris. Some people with chest pain have normal or minimal narrowing of heart arteries; in these patients, vasospasm is a more likely cause for the pain, sometimes in the context of Prinzmetal's angina and syndrome X.

Myocardial ischemia also can be the result of factors affecting blood composition, such as the reduced oxygen-carrying capacity of blood , as seen with severe anemia low number of red blood cells , or long-term smoking. Angina results when there is an imbalance between the heart's oxygen demand and supply. This imbalance can result from an increase in demand e. However, the pathophysiology of angina in females varies significantly as compared to males. Angina should be suspected in people presenting tight, dull, or heavy chest discomfort that is: [34]. Some people present with atypical symptoms, including breathlessness, nausea, or epigastric discomfort, or burning.

These atypical symptoms are particularly likely in older people, women, and those with diabetes. Anginal pain is not usually sharp or stabbing or influenced by respiration. Antacids and simple analgesics do not usually relieve the pain. If chest discomfort of whatever site is precipitated by exertion, relieved by rest, and relieved by glyceryl trinitrate, the likelihood of angina is increased. In angina patients momentarily not feeling any chest pain, an electrocardiogram ECG is typically normal unless there have been other cardiac problems in the past. During periods of pain, depression, or elevation of the ST segment may be observed. Even constant monitoring of the blood pressure and the pulse rate can lead to some conclusions regarding angina.

The exercise test is also useful in looking for other markers of myocardial ischemia: blood pressure response or lack thereof, in particular, a drop in systolic blood pressure , dysrhythmia, and chronotropic response. Other alternatives to a standard exercise test include a thallium scintigram or sestamibi scintigram in patients unable to exercise enough for the treadmill tests, e. In patients in whom such noninvasive testing is diagnostic, a coronary angiogram is typically performed to identify the nature of the coronary lesion, and whether this would be a candidate for angioplasty , coronary artery bypass graft CABG , treatment only with medication, or other treatments.

In hospitalized patients with unstable angina or the newer term of "high-risk acute coronary syndromes" , those with resting ischaemic ECG changes or those with raised cardiac enzymes such as troponin may undergo coronary angiography directly. The most specific medicine to treat angina is antianginal where nitroglycerin is a potent vasodilator that decreases myocardial oxygen demand by decreasing the heart's workload.

Beta blockers and calcium channel blockers act to decrease the heart's workload , and thus its requirement for oxygen. Nitroglycerin should not be given if certain inhibitors such as sildenafil , tadalafil , or vardenafil have been taken within the previous 12 hours as the combination of the two could cause a serious drop in blood pressure. Treatments for angina are balloon angioplasty , in which the balloon is inserted at the end of a catheter and inflated to widen the arterial lumen.

Stents to maintain the arterial widening are often used at the same time. Coronary bypass surgery involves bypassing constricted arteries with venous grafts. This is much more invasive than angioplasty. The main goals of treatment in angina pectoris are relief of symptoms, slowing progression of the disease, and reduction of future events, especially heart attacks and death. Beta blockers e. ACE inhibitors are also vasodilators with both symptomatic and prognostic benefit. However, in patients without established cardiovascular disease, the increase in hemorrhagic stroke and gastrointestinal bleeding offsets any benefits and it is no longer advised unless the risk of myocardial infarction is very high.

Exercise is also a very good long-term treatment for the angina but only particular regimens — gentle and sustained exercise rather than intense short bursts , [39] probably working by complex mechanisms such as improving blood pressure and promoting coronary artery collateralisation. Though sometimes used by patients, evidence does not support the use of traditional Chinese herbal products THCP for angina. Identifying and treating risk factors for further coronary heart disease is a priority in patients with angina. This means testing for elevated cholesterol and other fats in the blood, diabetes and hypertension high blood pressure , and encouraging smoking cessation and weight optimization. The calcium channel blocker nifedipine prolongs cardiovascular event- and procedure-free survival in patients with coronary artery disease.

Women with myocardial ischemia often have either no or atypical symptoms, such as palpitations, anxiety, weakness, and fatigue. Additionally, many women with angina are found to have cardiac ischemia, yet no evidence of obstructive coronary artery disease on cardiac catheterization. Evidence is accumulating that nearly half of women with myocardial ischemia suffer from coronary microvascular disease, a condition often called microvascular angina MVA.

Small intramyocardial arterioles constrict in MVA causing ischemic pain that is less predictable than with typical epicardial coronary artery disease CAD. The pathophysiology is complex and still being elucidated, but there is strong evidence that endothelial dysfunction, decreased endogenous vasodilators, inflammation, changes in adipokines, and platelet activation are contributing factors. The diagnosis of MVA may require catheterization during which there is an assessment of the microcirculatory response to adenosine or acetylcholine and measurement of coronary and fractional flow reserve.

New techniques include positron emission tomography PET scanning, cardiac magnetic resonance imaging MRI , and transthoracic Doppler echocardiography. Managing MVA can be challenging, for example, women with this condition have less coronary microvascular dilation in response to nitrates than do those without MVA. Aggressive interventions to reduce modifiable risk factors are an important component of management, especially smoking cessation, exercise, and diabetes management.

The combination of non-nitrate vasodilators, such as calcium channel blockers and angiotensin-converting enzyme ACE inhibitors along with HMG-CoA reductase inhibitors statins , also is effective in many women, and new drugs, such as Ranolazine and Ivabradine, have shown promise in the treatment of MVA. Other approaches include spinal cord stimulators, adenosine receptor blockade, and psychiatric intervention. Hospital admission for people with the following symptoms is recommended, as they may have unstable angina: pain at rest which may occur at night , pain on minimal exertion, angina that seems to progress rapidly despite increasing medical treatment.

All people with suspected angina should be urgently referred to a chest pain evaluation service, for confirmation of the diagnosis and assessment of the severity of coronary heart disease. As of , angina due to ischemic heart disease affects approximately million people 1. In the United States, The prevalence of angina rises with increasing age, with a mean age of onset of Men with angina were found to have an increased risk of subsequent acute myocardial infarction and coronary heart disease related death than women.

Similar figures apply in the remainder of the Western world. All forms of coronary heart disease are much less-common in the Third World , as its risk factors are much more common in Western and Westernized countries; it could, therefore, be termed a disease of affluence. The condition was named "hritshoola" in ancient India and was described by Sushruta 6th century BC. From Wikipedia, the free encyclopedia. Redirected from Stable angina. Chest discomfort due to not enough blood flow to heart muscle. For other uses, see Angina disambiguation. Medical condition. See also: variant angina. Main article: Cardiac syndrome X. This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources.

Unsourced material may be challenged and removed. June Learn how and when to remove this template message. Medications Vasodilators Excessive thyroid hormone replacement Vasoconstrictors Polycythemia , which thickens the blood, slowing its flow through the heart muscle Hypothermia Hypervolemia Hypovolemia. Further information: Antianginal. This section needs expansion. You can help by adding to it. November Retrieved Heart Disease 1st ed.

April The New England Journal of Medicine. PMID The Journal of the American Osteopathic Association. European Heart Journal. Archived from the original on March 30, Retrieved April 28, National Heart Lung and Blood Institute. Chest pain with normal coronary angiograms: pathogenesis, diagnosis and management. Boston: Kluwer. ISBN Philadelphia; Elsevier, Archived from the original on Texas Heart Institute.

October Clinical Cardiology. PMC Journal of the American College of Cardiology. February Archives of Internal Medicine. Preventive Services Task Force recommendation statement". Annals of Internal Medicine.

Relationship of diabetes Essay On Mexican Stereotypes clinical outcomes: There was no difference in Unstable Angina Case Study or myocardial infarction between invasive vs. Pain may Unstable Angina Case Study accompanied by breathlessness, sweating, and nausea in some cases. Unstable Angina Case Study Read Edit View history.

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