Coronary Artery DiseasesProf. dr. Harris Hasan SpPD,SpJP(K),FIHADepartemen Kardiologi & Kedokteran VaskularFK USU RSUP H.Adam Malik

Risk factors CADNon modified : Age ( M > 40 y; F menopause) Sex ( M > F )Family history (genetic)Modified (Major) : SmokingDiabetesHypertensionHypercholesterol

Stable Angina PectorisDefinition : Chest discomfort or pain caused by myocardial ischaemia or coronary stenosis is due to atheroma plaque in coronary artery.It makes imbalance myocardial oxygen demand and supply.

Typical angina.Feature :discomfort , pain, burns,heaviness, sharp, pressure.Location :Central chest (substernal), precordial, epigastric.Duration :1 5 minutes.Radiation :Back, neck, jaw, left arm.Elicited : physical activity, emotional stress.Relieved :rest, nitrate sublingual.

Complications :Prolong chest pain (angina) or neurogenic shock. Heart failure , acute pulmonary edema, cardiogenic shock.- Arrhytmia or suddent death. - Rupture (chordae, septal).

Identify and treat precipitating factorsInitiate diet and lifestyle changes, to control risk factors, improve diet, and encourage physical activityInitiate anti-anginal therapy, tailored to the patient symptoms, starting usually with b-blockersEnsure prescription of proper effective evidence-based pharmacological secondary prevention (the fab four quartet)Prescribe and explain the use of sublingual nitroglycerinRe-evaluate the patient at regular intervals for ischaemiaConsider revascularization in patients who have severe symptoms or evidence of severe ischaemiaConsider the symptomatic and prognostic benefits or physical trainingEducate the patient for long-term complianceInstruct on the steps to take in an emergencyThe ten commandments of the management of stable angina

*CABG = coronary artery bypass graft; CV = cardiovascular; PCI = percutaneous coronary intervention*apo = apolipoprotein; hsCRP = high sensitivity C-reactive protein; lp(a) = lipoprotein a*BBB = bundle-branch block; CAD = coronary artery disease; LV = left ventricular*CT = computed tomography** Monotherapy, for relief of symptoms, and ischaemia.** Monotherapy, for relief of symptoms, and ischaemia.AV = atrioventricular; CCB = calcium channel blocker; HR = heart rate; MI = myocardial infarction; RCT = randomized controlled trial *High-risk candidates for revascularization on prognostic grounds alone should be identified and referred appropriatelyEvidence for prognosis refers to evidence of reduction CV death or CV death MI. Evidence for symptoms include reduction in need for revascularization and hospitalization for chest pain* Relative contraindications to beta-blockade include asthma, symptomatic peripheral vascular disease and first-degree heart block** Avoid short acting dihydropyridine formulations when not combined with beta-blockerACE = angiotensin-converting enzyme; CVD = cardiovascular disease; MI = myocardial infarction