 Let's continue on with some more cardiology. We will discuss angina today. Angina is specifically ischemic myocardium that is secondary to coronary artery narrowing or spasm. There is no myocyte necrosis associated with angina. Angina can be broken down into three different categories, stable, vasospastic, also known as prins metal angina, and unstable angina. It's important to be able to distinguish between these three types because they are treated differently. Stable angina is usually due to atherosclerosis. We often see greater than or equal to a 70% occlusion of the coronary arteries with stable angina. Symptoms associated with stable angina include exertional chest pain that is in a classic distribution. So we have the chest pain in the middle of the chest and it can radiate out into the arms and up into the neck. On EKG we will see often an ST segment depression. You can think of stable angina as walking from your house to the mailbox and every single time you get three-fourths of the way to the mailbox then you start having these chest pains. It doesn't change day to day, it doesn't get shorter, it doesn't get longer, it's usually the exact same distance. The pain and the pressure is stable in its intensity and in its onset. Treatment for stable angina is going to be rest or nitroglycerin. Nitroglycerin helps open up those coronary arteries and vasodilate to allow more blood flow. Next we will discuss vasospastic angina. This is also known as Prince metals angina. Vasospastic angina occurs at rest. There is typically no exertion associated with the vasospastic angina. We will see a transient elevation in the ST segment on EKG. Risk factors with vasospastic angina include smoking. It is important to note that hypertension and hyperlipidemia do not increase one's risk of developing vasospastic angina. Treatment of vasospastic angina includes calcium channel blockers, nitrates, and smoking cessation. So due to having smoking as a risk factor if we can quit smoking we do decrease our risk of developing vasospastic angina. The final category of angina that we will discuss is unstable angina. Unstable angina is due to thrombosis. It is important to note that this thrombosis is an incomplete occlusion of the coronary arteries. Because it is an incomplete occlusion that it does allow blood flow and keeps the myocardium from infarcting. EKG changes can be present with an ST depression or it may not be. They are very unspecific. The clinical correlation with unstable angina is an increase in the frequency and or the intensity of the chest pain. This means that you can have chest pain at rest, but sometimes it takes a lot of exertion before we can get the chest pain. You do not have any cardiac biomarkers elevated with unstable angina. This distinguishes unstable angina from an instemi which we will discuss later. Unstable angina includes a cardiac catheterization. We need to go in and restore full blood flow to those cardiac arteries so that we don't have any further problems or progression to an infarction.