Which of the following forms of ischemic hea disease manifests with slowly progressive hea failure, with or without other clinical manifestations of myocardial ischemia?
Atherosclerosis of coronary aeries is the underlying pathologic change in the great majority of cases of ischemic hea disease. Ischemic hea disease may manifest with several clinical syndromes depending on distribution and morphology of atherosclerotic changes and rate of progression. A slowly progressive increase in luminal stenosis in all major coronary vessels results in diffuse ischemia of the myocardium and dropout of scattered myocytes throughout the ventricular walls. Eventually, such a reduction in myocardial mass will lead to decreased contractility and hea failure. Patients with this chronic ischemic hea disease often come to clinical attention with signs and symptoms of congestive hea failure, sometimes without any history of chest pain or arrhythmias.Myocardial infarction may be clinically silent (ie, without pain), although it is usually associated with severe chest pain. If the infarct is extensive, cardiogenic shock ensues. All forms of angina can be easily ruled out as correct choices since angina indicates, by definition, paroxysmal chest pain due to reversible myocardial ischemia. Prinzmetal angina is an uncommon form of angina occurring at rest and caused by vasospasm. Stable angina refers to chest pain with a predictable pattern of onset, usually after physical effos, emotional excitement, or any cause of increased cardiac load. Ref: Antman E.M., Selwyn A.P., Loscalzo J. (2012). Chapter 243. Ischemic Hea Disease. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
Chronic ischemic hea disease
Myocardial infarction
Prinzmetal angina
Stable angina