1 dr. zahoor ali shaikh. 2 coronary artery disease (cad) cad is most common form of heart disease...
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CORONARY ARTERY DISEASEPRESETATION AND INVESTIGATION
Dr. Zahoor Ali Shaikh
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CORONARY ARTERY DISEASE (CAD)
CAD is most common form of heart disease and causes premature death.
In UK, 1 in 3 men and 1 in 4 women die from coronary heart disease.
Approximately 1.3 million people have angina every year.
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CORONARY ARTERY DISEASE
Stable Angina It is due to transient myocardial
ischemia and occurs when there is increased demand of oxygen by heart.
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CORONARY ARTERY DISEASE
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STABLE ANGINA
RISK FACTOR FOR STABLE ANGINA Hypertension Diabetes Mellitus Aortic valve disease
- Angina is precipitated by - Anemia - Throtoxicosis
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INVESTIGATIONS
ECG Exercise ECG – Exercise tolerance
test (ETT). We monitor ECG, BP, and general
condition of patient.
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INVESTIGATIONS
Myocardial Perfusion Scan - Thallium stress test
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INVESTIGATIONS
Coronary Arteriography - Usually performed with a view to
percutaneus coronary intervention (PCI) or coronary artery bypass graft (CABG)
NOTE – PCI is done under local anesthesia in cardiac cath lab.
- CABG surgery is done using left internal mammary artery or Saphenous vein.
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INVESTIGATIONS
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MANAGEMENT OF ANGINA PECTORIS
Assessment of patient Look for risk factors Advise to the patient
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MANAGEMENT OF ANGINA PECTORIS
Antiplatelet therapy – aspirin Antianginal drugs -Nitrate -Beta blocker -Calcium antagonist
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ASPIRIN
Inhibits platelet aggregation Inhibits synthesis of prostaglandin
Thromboxone A2 and promotes reperfusion and reduces likelihood of thrombosis
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NITRORGLYCERINE (NTG)
Action It is venous and arteriolar dilator,
therefore, decreases venous return and preload
Decreases intraventricular volume and ventricular wall tension, therefore, decreases myocardial oxygen demand
Sublingual NTG – peak action 4-8 minute, action last for 10-30 minute
Side effect - headache
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BETA BLOCKER
Beta blocker are very good for angina associated with effort
Beta blocker decrease heart rate, blood pressure, and contractility of heart
Therefore, decrease oxygen demand
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CALCIUM CHANNEL BLOCKER
Action Cause coronary dilatation and
increase coronary flow Decrease myocardial contractility
therefore decrease oxygen demand
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CORONARY ARTERY SPASM
It is called variant angina or Vasospastic or prinzmetal angina.
Angina pain is due to spasm of coronary artery.
ECG may show transient ST-elevation Treatment is with calcium blocker,
nitrates.
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ACUTE CORONARY SYNDROME (ACS)
ACS is term used for 1. Unstable Angina 2. Myocardial infarction [MI] – NSTEMI 3. Myocardial infarction [MI] – STEMI Unstable Angina occurs at rest or minimal
exertion in absence of myocardial damage. MI symptoms occur at rest and there is evidence
of myocardial damage, demonstrated by increased level of cardiac Troponin or creatinine kinase-MB.
IMPORTANT – Troponin is more specific
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UNSTABLE ANGINA
There is partial/intermittent occlusion of coronary artery
Chest pain occurs at rest and lasts for more than 20 minutes
ECG – ST depression, T wave changes (T inversion)
Cardiac enzyme – Troponin T & I are normal Because No myocardial damage has occurred
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NSTEMI
Chest pain occurs at rest and lasts for more than 20 minutes
ECG – ST depression, T wave changes (T inversion)
Cardiac enzyme – Troponin T & I are increased Because myocardial damage has occurred
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STEMI
Severe Chest pain occurs at rest and lasts for 30 minutes to 1 hour
ECG – ST elevation, T wave changes later Q wave appear Cardiac enzyme –Troponin T & I are
increased and CK-MB increased
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STEMI (cont)
In STEMI, there is severe damage to the myocardium due to occlusion of blood flow in the coronary artery that causes death of myocardial tissue
Sudden death from ventricular fibrillation or asystole within 1 hour can occur.
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Patient with chest pain
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ACUTE CORONARY SYNDROME (ACS)
Diagnosis Evaluation of ECG Measurement of biochemical markers of
cardiac damage e.g. Troponin I and T, creatine kinase
Cardiac Troponin T and I are most sensitive and specific marker of myocardial cell damage
NOTE – Cardiac Biochemical markers are raised in MI. There is no rise in cardiac markers in angina.
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ACUTE CORONARY SYNDROME (ACS)
Other blood test - WBC count - ESR - C-reactive protein - X-ray chest - Echo cardiography
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MANAGEMENT
Admit the patient Morphine IV for pain Aspirin Nitrate Beta-blocker Calcium channel blocker Reperfusion therapy Percutaneous Coronary Intervention
(PCI)
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PCI
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COMPLICATIONS OF ACUTE CORONARY SYNDROME
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THANK YOU