Chronic Stable Angina (CSA) Concept Map: An Overview
This map focuses on Chronic Stable Angina (CSA). This map links the etiology and pathophysiology of Coronary Artery Disease (CAD) and pharmacological treatment of chronic stable angina (CSA). This map also contains a smaller mind map for the diagnosis of angina pectoris.
The map starts from the right upper corner with a classification for cardiovascular diseases stating that there are four categories of cardiovascular diseases which are:
- Coronary Artery Disease (CAD) /Ischemic Heart Disease (IHD)
- Cerebrovascular Disease
- Peripheral Artery Disease (PAD)
- Aortic atherosclerosis and thoracic, or abdominal aortic aneurysm
Angina pectoris is one of the manifestations of Coronary Artery Disease (CAD).
Definition of CSA
Angina pectoris is a clinical syndrome of chest pain due to transient myocardial ischemia (without infarction) caused by an imbalance between myocardial blood supply and oxygen demand. Angina is a common presenting symptom among patients with coronary artery disease which is caused by atherosclerosis that leads to a reduction in myocardial blood flow and inadequate perfusion of the myocardium.
Risk Factors
Major risk factors for atherosclerosis and CAD
- Family history of CAD: < 45 years in first-degree male relatives and < 60 years in female relatives.
- Advanced age.
- Cigarette smoking.
- Diabetes Mellitus.
- Hypercholesterolemia (high LDL level, low HDL level).
- Hypertension.
- Obesity.
- Physical inactivity.
- Alcohol consumption.
- Stress
Etiology & Pathophysiology of Angina
Ischemic heart disease is caused by an imbalance between myocardial supply and myocardial demand leading to myocardial ischemia. A detailed explanation of Chronic Heart Disease (CHD) pathophysiology and the causes of decrease in coronary blood flow and the oxygen-carrying capacity of blood; in addition to causes of the increase in the oxygen demand (left ventricular hypertrophy secondary to hypertension) is stated in the map.
Diagnosis of Angina Pectoris
Symptoms of angina pectoris
Angina pectoris is characterized by:
- discomfort, heaviness, burning or a pressure-like feeling over the sternum or near it, which may radiate to the jaw, shoulder, back, or arm and which typically lasts 0.5-30 min.
- chest tightness and SOB
These symptoms are the typical symptoms of chronic stable angina. Exceptions are present in cases of silent ischemia, unstable angina, variant / Prinzmetal angina as shown in the map.
Family History
Check out the image above.
Physical Examination
Check out the image above.
Laboratory Tests
Check out the image above.
Diagnostic Tests
The map includes a mind map for the following diagnostic tests including their mechanisms for diagnosis, indications, sensitivity, and specificity:
- Electrocardiogram (ECG)
- Exercise Tolerance (Stress) Testing (ETT)
- Cardiac Imaging: Radionuclide angiocardiography – Positron Emission Tomography (PET) – Ultra-rapid Computerized Tomography – Cardiovascular Magnetic Resonance Imaging (MRI).
- Echocardiography
- Cardiac Catheterization and Coronary Angiography
- Coronary Computed Tomography Angiography (CTA)
Classification of Angina
According to Modified Canadian Cardiovascular Society Grading for Angina Severity:
- Class I
- “Ordinary physical activity does not cause…angina,” such as walking or climbing stairs
- Angina occurs with strenuous, rapid, or prolonged exertion at work or recreation.
- Class II
- “Slight limitation of ordinary activity.”
- Angina occurs on walking or climbing stairs rapidly; walking uphill; walking or stair climbing after meals; in cold, in wind, or under emotional stress; or only during the few hours after awakening.
- Angina occurs on walking > 2 blocks on the level and climbing > 1 flight of ordinary stairs at a normal pace and under normal conditions.
- Class III
- “Marked limitations of ordinary physical activity.”
- Angina occurs on walking 1–2 blocks on the level and climbing 1 flight of stairs under normal conditions and at a normal pace.
- Class IV
- “Inability to carry on any physical activity without discomfort—anginal symptoms may be present at rest.”
Treatment of Chronic Stable Angina (CSA)
Management plan should include:
- Patient education regarding the importance of medication adherence, cardiovascular risk reduction strategies, daily physical activity recommendations, and self-monitoring to recognize worsening symptoms and take appropriate action.
- Risk factors modifications including: Lipid management, management of hypertension and diabetes mellitus, weight management, and smoking cessation.
- Therapy to relieve symptoms in patients with stable IHD. This includes: Beta-adrenergic blockers – Calcium-channel blockers – Nitrates – Ranolazine.
- Therapy to prevent myocardial infarction and death in patients with stable IHD. Including antiplatelet agents (aspirin and /or clopidogrel).
Details about each drug/drug class are stated in the map, including: mechanisms of action, therapeutic effects, indications, adverse effects, contraindications, and drug interactions.
Nonpharmacological treatment
“Revascularization, either with PCI (eg, angioplasty, stenting) or CABG should be considered if angina persists despite drug therapy and worsens quality of life or if anatomic lesions (noted during angiography) put a patient at high risk of mortality.”
Order the map
You can order the Chronic Stable Angina concept map in any of the following forms according to your preference. Our maps are comprehensive in a way that can benefit both students and clinicians.
This map is available in two forms;
1. Printable version.
2. Whole map version.
Check them out below to know the difference, so that you can choose what is suitable for you. And please feel free to leave your feedback, comments, or questions in the comments section below.
