A 51-year-old male presents with recurrent chest pain on exertion and is diagnosed with angina pectoris. The pain occurs when:
a. cardiac output has fallen below normal levels.
b. the myocardial oxygen supply has fallen below demand.
c. myocardial stretch has exceeded the upper limits.
d. the vagus nerve is stimulated.
ANS: B
Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen con-tent of coronary blood is insufficient to meet the metabolic demands of myocardial cells. A de-crease in cardiac output would lead to general systemic symptoms, not just chest pain, which is due to a decrease in myocardial oxygenation. Myocardial stretch does not affect angina symp-toms. When the vagus nerve is stimulated, a change in rate occurs; it does not precipitate chest pain.
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