Review Question - QID 106437

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Angina QID: 106437 (M2.CV.14.62)

QID 106437 (Type "106437" in App Search)

A 50-year-old woman with a history of hyperlipidemia and diabetes type 2 presents to your office complaining of "chest pain attacks." She says that these attacks tend to occur while walking up five flights of stairs to get to her apartment, and last for 15-20 minutes. She describes the pain as sharp and substernal. A baseline EKG is unremarkable. Suspecting the diagnosis, you perform an exercise stress EKG, and observe transient ST depressions in the anterolateral leads after significant exertion. Which of the following conditions has a pathogenesis most similar to this patient's condition?

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Prinzmetal's angina

26%

10/38

Lacunar stroke

16%

6/38

Abdominal aortic aneurysm

32%

12/38

Raynaud's phenomenon

16%

6/38

Pulmonary embolism

3/38

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This patient presents with typical, stable angina, which is almost always the result of atherosclerotic disease. Abdominal aortic aneurysm is also associated with atherosclerotic disease, making answer 3 correct.

Typical stable angina describes the chest pain and other symptoms that occur when there is transient myocardial ischemia. Myocardial ischemia, and therefore typical angina, occurs whenever myocardial oxygen demand exceeds oxygen supply and this pain remains constant over time. The most common cause of myocardial ischemia across the world is atherosclerotic obstruction of one or more coronary arteries (coronary artery disease). Abdominal aortic aneurysms are also highly associated with atherosclerosis.

As Achar et al. note, stable angina does not fall under the category of Acute Coronary Syndrome (ACS). ACS refers to specific thrombotic coronary artery diseases, namely unstable angina, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI).

As Golledge and Norman note, numerous studies have shown the association of coronary artery disease and peripheral atherosclerosis with abdominal aortic aneurysm. One theory is that aortic atherosclerosis leads to remodeling, thrombosis, and release of inflammatory cytokines that stimulate matrix degradation and adventitial inflammation, ultimately promoting aneurysmal development (see Illustration A).

Illustration A shows a figure depicting a theory on the relationship between atherosclerosis and abdominal aortic aneurysm.

Incorrect Answers:
Answer 1, 4: Prinzmetal's angina and Raynaud's phenomenon are the result of vasospasm.
Answer 2: Lacunar stroke is caused by hypertension.
Answer 5: Pulmonary embolism is caused by thrombosis and an embolic event.

ILLUSTRATIONS: