POPULAR CARDIOLOGISTS IN SAHAKARANAGAR
Cardiomyopathies and valvular heart disease
Regardless of the status of the coronary arterial tree, both primary and secondary heart
muscle disease can produce anginal pain through the imbalance of the oxygen demand and
supply. Hypertrophic cardiomyopathy is a relatively common cause of angina in
the presence of normal coronary arteries. Aortic stenosis is the most common valvular cause
of exertional chest tightness, which is probably due to myocardial ischaemia Exertional
chest pain, which may be due to right ventricular angina, is a feature of pulmonary
There is some confusion regarding the ‘metabolic’ and ‘cardiac’ varieties. The former is a
combination of insulin resistance, obesity, pro-inflammatory state and so on, leading to raised
cardiovascular risk in the sufferers. The latter is, or should be, a form of stable effort angina
that can be ascribed to coronary microvascular malfunction.23 The epicardial coronary tree is
normal and the diagnosis is rather difficult to make except by exclusion.
Acute coronary syndromes
The terminology used to describe acute coronary syndromes (ACSs) continues to evolve as
clinicians attempt to adjust to the accumulating evidence of the usefulness of modern cardiac
markers and the treatment implications of different results. The most recent terminology is
designed to help with treatment decisions based on the earliest clinical information from the
patient. This comes from the history and the ECG.
When the patient’s symptoms suggest an acute coronary syndrome, the first decisions about
diagnosis and treatment are based on the ECG. If there is ST elevation present in a pattern to
suggest myocardial infarction, the diagnosis is of ‘ST elevation myocardial infarction’ (STEMI).
If there is no ST elevation, the initial diagnosis is of ‘non-ST elevation acute coronary syndrome’
(NSTEACS).24 This elegant phrase has replaced ‘non-ST elevation myocardial infarction’ (non-
STEMI). The reason is that the diagnosis of infarction cannot be made in the absence of ST
elevation until cardiac marker estimations are available. The decisions about treatment, however,
need to be made immediately and are based on symptoms and ECG changes.