# A 65-year-old female patient presents to the emergency department with chest pain. Which assessment finding would be most characteristic of stable angina? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540256 > language: ko > subject: Adult Health ## 문제 A 65-year-old female patient presents to the emergency department with chest pain. Which assessment finding would be most characteristic of stable angina? ## 보기 1. Chest pain that occurs at rest and lasts for 30 minutes 2. Sharp, stabbing pain that worsens with deep inspiration 3. Crushing chest pain with nausea and diaphoresis lasting 45 minutes 4. Substernal chest pressure that occurs with exertion and is relieved by rest **✔ 정답** **정답: 4** ## 해설 Stable angina features predictable substernal chest pressure with exertion, relieved by rest or nitroglycerin within 5-15 min. Other options describe unstable angina, pericarditis/pleuritis, or myocardial infarction. ## 심화 해설 Understanding Stable Angina The correct answer is option 4: Substernal chest pressure that occurs with exertion and is relieved by rest. This presentation is the classic, textbook description of stable angina pectoris. To understand why, it is essential to differentiate it from acute coronary syndromes (ACS), such as unstable angina and myocardial infarction (MI). Pathophysiology and Clinical Rationale Stable angina arises from a fixed, chronic narrowing of a coronary artery due to an atherosclerotic plaque. This creates a predictable supply-demand mismatch. At rest, the narrowed artery can still deliver enough oxygenated blood to the myocardium. However, during exertion, emotional stress, or any activity that increases cardiac workload (increasing heart rate, contractility, and wall tension), myocardial oxygen demand rises sharply. The stenotic vessel cannot dilate sufficiently to increase blood flow, leading to transient, reversible myocardial ischemia. This ischemia manifests as the characteristic substernal pressure or tightness. When the exertion stops, oxygen demand falls back to a level the narrowed artery can supply, and the pain resolves, typically within minutes. This mechanism is fundamentally different from the other options, which describe acute and often more dangerous processes. Analysis of Incorrect Options 1. Chest pain that occurs at rest and lasts for 30 minutes: Pain occurring at rest signifies that myocardial oxygen demand is not elevated, which breaks the supply-demand model of stable angina. Rest pain, especially when prolonged, strongly suggests an acute coronary syndrome. It indicates an unstable plaque that may have ruptured, causing dynamic thrombosis and vasospasm, severely reducing flow even at baseline. This is a hallmark of unstable angina or a non-ST-elevation myocardial infarction (NSTEMI). The cited scoping review highlights that myocardial infarction can be the very first clinical manifestation of coronary artery disease (CAD), underscoring that a first-time event is not necessarily preceded by stable exertional symptoms [1]. 2. Sharp, stabbing pain that worsens with deep inspiration: This description is pleuritic in nature. It points toward inflammation of the pericardium (pericarditis) or the pleura, not myocardial ischemia. Ischemic cardiac pain is typically a diffuse, visceral sensation (pressure, squeezing, tightness), not a sharp, localized, somatic pain that is reproducible with movement or breathing. 3. Crushing chest pain with nausea and diaphoresis lasting 45 minutes: The prolonged duration (45 minutes), associated autonomic symptoms (nausea, diaphoresis), and the severe "crushing" quality are classic indicators of an acute ST-elevation myocardial infarction (STEMI). This duration signifies irreversible myocyte necrosis is occurring, not transient ischemia. The review by D'Angelo et al. establishes that such an MI can be the inaugural presentation of CAD, meaning the patient may have had no prior history of angina at all [1]. This finding reinforces why a nurse must immediately recognize this symptom cluster as a medical emergency, distinct from the predictable pattern of stable angina.References (research sources) - [1]Myocardial Infarction as the First Clinical Manifestation of Coronary Artery Disease: A Scoping Review.Research articleD'Angelo M, Psycharis A, Piazza N, De Luca G, Kedhi E. (2026) · DOI: 10.3390/jcm15072603 ## 임상 시나리오 Clinical Guide: Stable Angina AssessmentDifferentiating predictable chest pain from acute coronary syndromes The hallmark of stable angina is substernal pressure or tightness triggered by exertion or emotional stress and relieved by rest or nitroglycerin within 5-10 minutes. This occurs due to a fixed coronary stenosis from atherosclerosis, creating a predictable supply-demand mismatch. The pain is transient and reversible. CautionPain at rest, new-onset angina, or pain lasting over 20 minutes is unstable angina or MI until proven otherwise. Immediate 12-lead ECG and troponin evaluation are critical. ## 핵심 개념 - **Stable Angina** — Chest pain or pressure occurring predictably with exertion or stress and relieved by rest or nitroglycerin, caused by fixed coronary artery stenosis. - **Supply-Demand Mismatch** — The pathophysiological basis of stable angina where narrowed coronary arteries cannot increase blood flow to meet the increased myocardial oxygen demand during exertion. - **Unstable Angina** — Chest pain that occurs at rest, is new-onset, or is increasing in frequency/duration, indicating a ruptured plaque and higher risk for myocardial infarction. - **Pleuritic Chest Pain** — Sharp, stabbing pain that worsens with breathing or coughing, typically originating from inflammation of the pleura, not the myocardium. ## 같은 주제 문제 - [A 45-year-old client with a history of coronary artery disease is admitted to the emergenc…](https://mymerci.kr/pages/nclex_q.php?qn_id=540255) - [A nurse is caring for a 58-year-old male client who presents to the emergency department w…](https://mymerci.kr/pages/nclex_q.php?qn_id=540257) - [A nurse is caring for a client with stable angina who reports chest pain during mild exert…](https://mymerci.kr/pages/nclex_q.php?qn_id=540258) - [A nurse is caring for a 65-year-old female client with stable angina who reports substerna…](https://mymerci.kr/pages/nclex_q.php?qn_id=540259) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._