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1. Angina is chest pain caused by a "supply-demand" mismatch between coronary perfusion and cardiac workload.

2. Can be stable or unstable. Obstructive atherosclerotic coronary artery lesions (supply problem) are the most common cause of stable angina. Plaque rupture with superimposed thrombosis is the most common trigger for ACS.

3. There are many causes of increased demand (tachycardia, fever, and thyrotoxicosis) and many causes of a decreased supply (hypotension, coronary vasospasm, anemia, and hypoxia).

4. Plaque rupture or erosion with superimposed thrombus is the most common underlying process triggering ACS.

5. Only 20% of patients actually have classic angina at the moment of ischemic ST changes. Silent ischemia is seen frequently in diabetic patients as well as those with prior ischemic events.

6. Short- and long-term risk (death and MI) in patients with ACS is much higher than in stable angina.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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