Angina is transient chest pain caused by myocardial ischemia.

This occurs when the demand for

oxygen exceeds the ability of the coronary arteries to supply it. Normally, the myocardium extracts
a large amount of oxygen from the coronary circulation to meet its continuous demand. And when
there is an increase in demand, flow from the coronary arteries needs to be increase. This usually
happens when were under emotional stress or physical exertion, such as exercise. However when
there is a blockage in a coronary artery, flow cannot be increased, and ischemia results. According
to Libby, the primary reason for insufficient blood flow is narrowing of coronary arteries by
atherosclerosis and for ischemia to occur, the artery is usually 75% or more obstructed (as cited in
Lewis et al., 2010.). Ischemia of the heart muscle causes reversible cellular injury where it can
produce pain or discomfort that is poorly localize and may radiate to the neck, jaw, shoulders and
inner aspect of the upper arms. The pain doesnt really last long and can be relieve by rest or
medication.
Myocardial infarction is different from angina in that the ischemia in MI causes irreversible
myocardial cell death. This usually cause by the rupture of the once stable plaque, exposing the
intima to blood and stimulates platelet aggregation and local vasoconstriction with thrombus
formation. What causes the plaque to become unstable is not well understood but systematic
inflammation is thought to play a role. This thrombus then totally occludes the artery and perfusion
of the myocardium distal to it is halted. As the cell is deprived of oxygen, ischemia develops, and
cellular injury occurs resulting to infarction or cell death. The process takes time and the cardiac
cell can withstand ischemic conditions for approximately 20 minutes before cellular death begins.

References:
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., OBrien, P. G., & Bucher, L. (2010). Medical-surgical
nursing in Canada: Assessment and management of clinical problems (2nd ed.). Toronto:
Elsevier

Canada.

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., Cheever, K. H., (2008). Brunner & Suddarth`s textbook of
medical-surgical nursing (11th ed). Philippines: Lippincott Williams & Wilkins