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Old 12-22-2013
medicalbiology's Avatar
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Heart Chest Pain that is relieved by movement!

Pt. presented with history of sub-sternal pain that radiate to his left shoulder occurs at rest and pain improves when he gets up and move around also improve after taking nitroglycerin..
Likely cause of finding?
1) coronary artery spasm
2) coronary artery thrombosis
3) coronary artery embolism
4) coronary artery vasculitis
5) coronary artery atherosclerosis

Please explain also..
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Old 12-22-2013
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Cannot be a coronary Art spasm as it occurs at laying/standing up/ moving .... also should rule out vasculits as nitroglycerin resolves symptoms ....it has to be coronary Artery atherosclerosis/thrombosis .... Atherosclerosis is the initial process through which thrombus develops which is responsible for the almost occlusion of the Artery thus producing symptoms ..... laying down will increase VR = increased workload = hence increase in oxygen consumption= Angina .... standing up would cause gravitational forces to act and thus decrease some VR and hence pain resolves .....

I may be wrong though but this explanation seems right
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Old 12-22-2013
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I would say 1. coront. art. spasm

reasons:
-crushing pain @ rest
- pain is substernal radiates to LEFT side
-relived when patient moves around
-imroves AFTER nitroglycerin

Unlike angina that is caused by hardening of the coronary arteries, chest pain and shortness of breath due to coronary artery spasm are often not present when you walk or exercise.
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Old 12-23-2013
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According to kaplan qbank itz no.1...
I never heard that prinzmetal can be relieved by taking nitroglycerin or by movemnt..
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Old 12-23-2013
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interesting question... I'm looking forward to the answer and explanation as I'm confused too btw spasm and atherosclerosis.
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