Chronic Stable Angina (CSA) Concept Map | Definition | Pathophysiology | Etiology | Risk Factors | Diagnosis | Treatment

Chronic CAD & Chronic Stable Angina (CSA) Concept Map
Chronic CAD & Chronic Stable Angina (CSA) Concept Map
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Chronic Stable Angina (CSA) Concept Map: An Overview

This map focuses on Chronic Stable Angina (CSA).  This map links between 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 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:
  1. Coronary Artery Disease (CAD) /Ischemic Heart Disease (IHD)
  2. Cerebrovascular Disease
  3. Peripheral Artery Disease (PAD)
  4. Aortic atherosclerosis and thoracic, or abdominal aortic aneurysm
Angina pectoris is one of the manifestations of Coronary Artery Disease (CAD).
Categories of Cardiovascular Diseases map
Categories of Cardiovascular Diseases
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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 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

Chronic Heart Disease (CHD) pathophysiology and etiology
Part of CHD pathophysiology and etiology
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Ischemic heart disease is caused by an imbalance between myocardial supply and myocardial demand leading to myocardial ischemia.
A detailed explanation on 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 increase in the oxygen demand (left ventricular hypertrophy secondary to hypertension) is stated in the map.

Diagnosis of Angina Pectoris

Angina Pectoris Diagnosis Mind Map
Part of Angina Pectoris Diagnosis
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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 (Details are stated in the map)

Physical Examination (Details are stated in the map)

Laboratory Tests (Details are stated in the map)

      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)

Treatment of Chronic Stable Angina (CSA)
Part of Treatment of Chronic Stable Angina (CSA)
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Management plan should include:

  1. 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.
  2.  Risk factors modifications including: Lipid management, management of hypertension and diabetes mellitus, weight management, and smoking cessation.
  3.  Therapy to relieve symptoms in patients with stable IHD.  This includes: Beta-adrenergic blockers - Calcium-channel blockers – Nitrates – Ranolazine.
  4.  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."

We hope you find Chronic Stable Angina (CSA) Concept Map helpful.  If you have any inquiries or suggestions please don't hesitate to contact us or comment below. This map is available in the following formats:

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The map is split into pages to be printed on nine A4 papers. After printing them, you have to tape the edges together to make a folded poster.

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Chronic Stable Angina (CSA) concept map is written by: Hagar M. Abdel AA'l, B Pharm.
Reviewed and edited by Maha Atef, B Pharm.
Last updated on:  17 August 2013
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