TAILIEUCHUNG - Chapter 013. Chest Discomfort

Causes of Chest Discomfort Myocardial Ischemia and Injury Myocardial ischemia occurs when the oxygen supply to the heart is not sufficient to meet metabolic needs. This mismatch can result from a decrease in oxygen supply, a rise in demand, or both. The most common underlying cause of myocardial ischemia is obstruction of coronary arteries by atherosclerosis; in the presence of such obstruction, | Chapter 013. Chest Discomfort Table 13-1 Differential Diagnoses of Patients Admitted to Hospital with Acute Chest Discomfort Ruled Not Myocardial Infarction Diagnosis Percent Gastroesophageal disease 42 Gastroesophageal reflux Esophageal motility disorders Peptic ulcer Gallstones Ischemic heart disease 31 Chest wall syndromes 28 Pericarditis 4 Pleuritis pneumonia 2 Pulmonary embolism 2 Lung cancer Aortic aneurysm 1 Aortic stenosis 1 Herpes zoster 1 In order of frequency. Source P Fruergaard et al Eur Heart J 17 1028 1996. Causes of Chest Discomfort Myocardial Ischemia and Injury Myocardial ischemia occurs when the oxygen supply to the heart is not sufficient to meet metabolic needs. This mismatch can result from a decrease in oxygen supply a rise in demand or both. The most common underlying cause of myocardial ischemia is obstruction of coronary arteries by atherosclerosis in the presence of such obstruction transient ischemic episodes are usually precipitated by an increase in oxygen demand as a result of physical exertion. However ischemia can also result from psychological stress fever or large meals or from compromised oxygen delivery due to anemia hypoxia or hypotension. Ventricular hypertrophy due to valvular heart disease hypertrophic cardiomyopathy or hypertension can predispose the myocardium to ischemia because of impaired penetration of blood flow from epicardial coronary arteries to the .

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