Angina

Question 1

Compare and contrast stable and unstable angina.

Answer 1

Unstable:
It has at least one of these three features:

it occurs at rest (or with minimal exertion), usually lasting more than 10 minutes
it is severe and of new onset (i.e., within the prior 4–6 weeks)
it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than before).

UA may occur unpredictably at rest, which may be a serious indicator of an impending heart attack. What differentiates stable angina from unstable angina (other than symptoms) is the pathophysiology of the atherosclerosis.

The pathophysiology of unstable angina is the reduction of coronary flow due to transient platelet aggregation on apparently normal endothelium, coronary artery spasms, or coronary thrombosis.[6][7] The process starts with atherosclerosis, progresses through inflammation to yield an active unstable plaque, which undergoes thrombosis and results in acute myocardial ischemia, which, if not reversed, results in cell necrosis (infarction).[7] Studies show that 64% of all unstable anginas occur between 22:00 and 08:00 when patients are at rest.[7][8]

In stable angina, the developing atheroma is protected with a fibrous cap. This cap may rupture in unstable angina, allowing blood clots to precipitate and further decrease the area of the coronary vessel’s lumen. This explains why, in many cases, unstable angina develops independently of activity.[7]

Question 2

Limiting your answer to the concept of somatic dysfunction, explain TWO ways in which osteopathic treatment might theoretically influence this patient’s angina symptoms

Answer 2

Inhibition of sympathetic nervous system - encouraging positive changes in blood pressure, heart rate, and peripheral vascular resistance associated which may lead to recurrent attacks
Decreased muscle tone .
Therefore increased bloodflow

Excercises - Gentle excercise along with encouragement and guidance can imporve symptoms.

Angina intensity that should be below his anginal threshold.
Angina management programs have been shown to decrease the episodes of chest pain by 70%, reduce nitrate use by 65% and improve exercise tolerance by 57%.

Question 3

What role do you think you could play as the patient’s osteopath in the management of their angina and what advice would you give? Justify your answer.

Answer 3

Excercise gently - to increase ischemic threshold.
improving blood pressure and promoting coronary artery collateralisation
Deliver techniques to down regulate sympathetic nervous system.
Relieve stress
Eat healthily to promote heart health. Food such as garlic- Allicin helps to keep the blood thin and flowing smoothly, as well as regulate blood pressure and maintain healthy cholesterol levels

This in turn can improve body weight - Study on fat:
pon analyzing the results, the researchers found that the overweight and obese participants were more prone to abnormal diastolic function than the normal weight individuals. Unsurprisingly, these individuals were also more likely to have other cardiovascular risks such as high blood pressure, diabetes, and a larger heart mass. However, when the researchers controlled for the effects of the other risks, the overweight and obese subject still had up to a 60% higher chance of having LV diastolic dysfunction. It also made a difference how much extra body fat the person carried. The risk of abnormal heart function went up 4% for each point increase in BMI measurement.

Question 4

Most commonly caused by coronary artery disease -

Answer 4

atherosclerosis in the coronary arteries results in a narrowing of the lumen and if blood supply does not meet the oxygen demands of the myocardium (e.g. exercise) then symptoms of angina can develop.

Question 5

CHRONIC STABLE ANGINA:

When a coronary artery becomes

Answer 5

becomes narrow beyond a critical value, the myocardium that is supplied by the artery will not receive adequate oxygen due to reduced blood flow. This level of blood flow may be sufficient to supply the myocardium at rest, however with exertion or emotional stress, oxygen demand increases causing ischaemia. Acute impairment of flow = ischaemia.

This can be referred to as demand ischaemia.

Question 6

UNSTABLE ANGINA:

In this instance, thrombosis formation

Answer 6

often due to cholesterol plaque rupture in a coronary artery), causes a reduced level of blood and oxygen supply to the myocardial tissue as above - however the amount of exertion needed to bring on the symptoms of angina are reduced and the pain can occur even at rest.

This can be referred to as supply ischaemia.