Illustration depicting angina
3D rendering showing thick myocardium within the heart wall.
Diagram of discomfort caused by coronary artery disease. Pressure, fullness, squeezing or pain in the center of the chest. Can also feel discomfort in the neck, jaw, shoulders, back or arms.
The swirling musculature of the heart ensures effective pumping of blood.
Cardiac muscle
Illustration of a cardiac muscle cell.
Intercalated discs are part of the cardiac muscle cell sarcolemma and they contain gap junctions and desmosomes.
Dog cardiac muscle (400X)

Angina, also known as angina pectoris, is chest pain or pressure, a symptom of coronary heart disease, usually due to insufficient blood flow to the heart muscle (myocardium).

- Angina

These include ischemic conditions caused by a restricted blood supply to the muscle such as angina, and myocardial infarction.

- Cardiac muscle

8 related topics

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A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.

Myocardial infarction

A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.
Cross section showing anterior left ventricle wall infarction
Diagram showing the blood supply to the heart by the two major blood vessels, the left and right coronary arteries (labelled LCA and RCA). A myocardial infarction (2) has occurred with blockage of a branch of the left coronary artery (1).
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the right coronary artery. Elevation of the ST segment can be seen in leads II, III and aVF.
ECG : AMI with ST elevation in V2-4
Inserting a stent to widen the artery.

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.

The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw.

Illustration depicting atherosclerosis in a coronary artery

Coronary artery disease

Illustration depicting atherosclerosis in a coronary artery
Clogged artery
Micrograph of a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson's trichrome.
Illustration depicting coronary artery disease
Coronary angiogram of a man
Coronary angiogram of a woman
Deaths due to ischaemic heart disease per million persons in 2012

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart.

Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death.

The progression of atherosclerosis (narrowing exaggerated)

Atherosclerosis

Pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions.

Pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions.

The progression of atherosclerosis (narrowing exaggerated)
Atherosclerosis and lipoproteins
Micrograph of an artery that supplies the heart showing significant atherosclerosis and marked luminal narrowing. Tissue has been stained using Masson's trichrome.
Severe atherosclerosis of the aorta. Autopsy specimen.
Progression of atherosclerosis to late complications.
CT image of atherosclerosis of the abdominal aorta. Woman of 70 years old with hypertension and dyslipidemia.
Microphotography of arterial wall with calcified (violet color) atherosclerotic plaque (hematoxylin and eosin stain)
Doppler ultrasound of right internal carotid artery with calcified and non-calcified plaques showing less than 70% stenosis

Marked narrowing in the coronary arteries, which are responsible for bringing oxygenated blood to the heart, can produce symptoms such as chest pain of angina and shortness of breath, sweating, nausea, dizziness or light-headedness, breathlessness or palpitations.

One recent hypothesis suggests that, for unknown reasons, leukocytes, such as monocytes or basophils, begin to attack the endothelium of the artery lumen in cardiac muscle.

Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of cardiopulmonary bypass by placement of an aortic cannula (bottom of image). The perfusionist and heart-lung machine are on the upper right. The patient's head (not seen) is at the bottom.

Coronary artery bypass surgery

Surgical procedure to restore normal blood flow to an obstructed coronary artery.

Surgical procedure to restore normal blood flow to an obstructed coronary artery.

Early in a coronary artery bypass operation, during vein harvesting from the legs (left of image) and the establishment of cardiopulmonary bypass by placement of an aortic cannula (bottom of image). The perfusionist and heart-lung machine are on the upper right. The patient's head (not seen) is at the bottom.
René Gerónimo Favaloro was an Argentine cardiac surgeon and educator best known for his pioneering work on coronary artery bypass surgery using the great saphenous vein.
Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts – one to the right coronary artery system and one to the obtuse marginal system.
Illustration depicting single, double, triple, and quadruple bypass
Illustration of a typical coronary artery bypass surgery. A vein from the leg is removed and grafted to the coronary artery to bypass a blockage.
Coronary artery bypass surgery during mobilization (freeing) of the right coronary artery from its surrounding tissue, adipose tissue (yellow). The tube visible at the bottom is the aortic cannula (returns blood from the HLM). The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom.
Heart bypass patient showing almost invisible residual scarring. Left: days after operation. Middle: chest scar, two years later. Right: leg scar from harvested vein, two years later.
Illustration depicting coronary artery bypass surgery (double bypass)
Illustration of Single bypass
Illustration of Double bypass
Illustration of Triple bypass
Illustration of Quadruple bypass

A normal coronary artery transports blood to the heart muscle itself, not through the main circulatory system.

CABG is performed to relieve angina that is poorly managed by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.

Heart failure

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body; its signs and symptoms result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood or its ejecting of it during each heart beat.

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body; its signs and symptoms result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood or its ejecting of it during each heart beat.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
Signs and symptoms of severe heart failure
Severe peripheral pitting edema
Kerley B lines in acute cardiac decompensation. The short, horizontal lines can be found everywhere in the right lung.
Model of a normal heart (left); and a weakened heart, with over-stretched muscle and dilation of left ventricle (right); both during diastole
Chest radiograph of a lung with distinct Kerley B lines, as well as an enlarged heart (as shown by an increased cardiothoracic ratio, cephalization of pulmonary veins, and minor pleural effusion as seen for example in the right horizontal fissure. Yet, no obvious lung edema is seen. Overall, this indicates intermediate severity (stage II) heart failure.
Siderophages (one indicated by white arrow) and pulmonary congestion, indicating left congestive heart failure
Ultrasound showing severe systolic heart failure
Congestive heart failure with small bilateral effusions
Kerley B lines

Chest pain, including angina, does not typically occur due to heart failure.

Heart failure may be the result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle).

Vascular ischemia of the toes with characteristic cyanosis

Ischemia

Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Vascular ischemia of the toes with characteristic cyanosis
Native records of contractile activity of the left ventricle of isolated rat heart perfused under Langendorff technique. Curve A - contractile function of the heart is greatly depressed after ischemia-reperfusion. Curve B - a set of short ischemic episodes (ischemic preconditioning) before prolonged ischemia provides functional recovery of contractile activity of the heart at reperfusion.

Cardiac ischemia may be asymptomatic or may cause chest pain, known as angina pectoris.

It occurs when the heart muscle, or myocardium, receives insufficient blood flow.

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Troponin

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Troponin activation. Troponin C (red) binds Ca2+, which stabilizes the activated state, where troponin I (yellow) is no longer bound to actin. Troponin T (blue) anchors the complex on tropomyosin.

Troponin, or the troponin complex, is a complex of three regulatory proteins (troponin C, troponin I, and troponin T) that are integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle.

They are measured in the blood to differentiate between unstable angina and myocardial infarction (heart attack) in people with chest pain or acute coronary syndrome.

Hypertrophic cardiomyopathy

Condition in which the heart becomes thickened without an obvious cause.

Condition in which the heart becomes thickened without an obvious cause.

An ECG showing HOCM
Pressure tracings demonstrating the Brockenbrough–Braunwald–Morrow sign AO = Descending aorta; LV = Left ventricle; ECG = Electrocardiogram. After the third QRS complex, the ventricle has more time to fill. Since there is more time to fill, the left ventricle will have more volume at the end of diastole (increased preload). Due to the Frank–Starling law of the heart, the contraction of the left ventricle (and pressure generated by the left ventricle) will be greater on the subsequent beat (beat #4 in this picture). Because of the dynamic nature of the outflow obstruction in HCM, the obstruction increases more than the left ventricular pressure increase. This causes a fall in the aortic pressure as the left ventricular pressure rises (seen as the yellow shaded area in the picture).
Echocardiography of hypertrophic-obstructive cardiomyopathy (HOCM) in a cat.
Saddle thrombus in the feline aorta. 1 opened Aorta with thrombus, 2 A. iliaca externa, 3 common trunk for both Aa. iliacae internae, 4 A. circumflexa ilium profunda, 5 A. mesenterica caudalis, 6 Colon descendens.

It is often due to mutations in certain genes involved with making heart muscle proteins.

The symptoms of HCM include shortness of breath due to stiffening and decreased blood filling of the ventricles, exertional chest pain (sometimes known as angina) due to reduced blood flow to the coronary arteries, uncomfortable awareness of the heart beat (palpitations), as well as disruption of the electrical system running through the abnormal heart muscle, lightheadedness, weakness, fainting and sudden cardiac death.