Figure 2-21
Angiograms before and two years after anterior descending coronary artery blockage and subsequent angioplasty and stent implantment.

A 46 year-old male was engaged in a weekly interval training run when he gradually became aware of a diffuse substernal pain that radiated across his chest to his left shoulder and part way down his arm. Having been athletic most of his adult life, he dismissed the pain as a minor infirmity that would go away if he continued his daily running as well as swimming and occasionally bicycling. The pain, however was recurrent with each workout but subsided during rest. He continued his workouts but became concerned about the discomfort. He consulted his physician and was advised to undergo a stress test conducted by a cardiologist. Tests revealed moderately elevated serum cholesterol level and an abnormal ECG. A subsequent angiogram revealed a block in the anterior descending coronary artery. (Figure 2-21 A, Arrow) The block was dilated and secured with a stent. The patient was placed on a cholesterol reducing drug and advised to participate in the hospital rehabilitation program attended by patients with similar coronary artery disease. At the same time, improved diet, continued moderate but regular exercise, abstinence from tobacco and reduction of stress were undertaken. The followup angiogram taken two years later revealed a clear artery and no further coronary artery blockage. (Figure 2-21 B, Arrow).

QUESTIONS

1. What is the name of the recurring chest pain experienced by the patient upon exertion?
2. How could the high cholesterol levels aggravate the patients condition?
3. Describe the arterial supply to the heart and how these vessels may have been affected by the high cholesterol levels.
4. Why did the patient initially only experience pain during exercise?
5. What did the anticoagulant and vasodilator drugs do?
6. How do you account for the fact this man survived the ordeal when so many instances of the same problems are fatal?