Download Angina Pectoris

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Quantium Medical Cardiac Output wikipedia , lookup

Cardiovascular disease wikipedia , lookup

Electrocardiography wikipedia , lookup

Jatene procedure wikipedia , lookup

Drug-eluting stent wikipedia , lookup

History of invasive and interventional cardiology wikipedia , lookup

Antihypertensive drug wikipedia , lookup

Management of acute coronary syndrome wikipedia , lookup

Coronary artery disease wikipedia , lookup

Transcript
Chronic stable angina
Dr Taban
Internist & cardiologist
MAGNITUDE OF THE
PROBLEM
Lifetime risk of CAD after 40Y:
• Men = 49%
• Women =32%
52% cardiac death
One of six all death
Stable Angina .
The commonest cause is ADVANCED
ATHEROSCELEROSIS
Not new onset
Not at rest chest pain
Not new exacerbated
3
Chest pain caused by transient
myocardial ischemia due to an
imbalance between myocardial
oxygen supply and demand.
4
Clinical Manifestations
Myocardial Blood Flow
Myocardial O2 Demands
Differential Diagnosis of Chest Pain
Transient Myocardial
ischemia
Fixed threshold angina
Severe Chest pain
Variable threshold angina
• FIXED-THRESHOLD= Angina Caused by
Increased Myocardial O2 Requirements
• VARIABLE-THRESHOLD = Angina Caused by
Transiently Decreased O2 Supply
• MIXED ANGINA.
Differential Diagnosis of Chest
Pain
Physical Examination
Pathophysiology
Noninvasive Testing
• Biochemical Tests :
Aop-ProB, LPa, LDL(smal dense), LP-PL A, homocystein
Inflammation: hsCRP, BNP, Soluble CD4,
Risk factors: FBS, HBA1c &…
• Resting Electrocardiogram
• Noninvasive Stress Testing
Resting Electrocardiogram
50% between attacks : ECG is entirely
Other : old problems
50% durig pain = NL-ECG
NORMAL
Noninvasive Stress Testing
Anginal pain is often associated with Depression
of ST segment
Exercise ECG showing typical severe down sloping ST
segment :
Standing
1 min.
3 min.
7 min.
9 min.
13
• Computed Tomography (MSCT):
90%=sensitivity 50% = specificity
• Cardiac Magnetic Resonance Imaging
Catheterization, Angiography, and
Coronary Arteriography
• SVD = 2VD = 3VD = 25%.
• LML = 5 – 10%.
• NL-CAG = 15%.
diffuse disease than MI
Natural History of Angina
Pectoris and Risk Stratification
Management of Stable Angina
(1)
identification and treatment of associated diseases that can
precipitate or worsen angina;
(2) reduction of coronary risk factors;
(3) application of general and nonpharmacological
methods, with particular attention to adjustments in life style;
(4) pharmacological management;
(5) revascularization by percutaneous catheter-based techniques
or by coronary bypass surgery
General measures
Treat Hypertension ,
Hypercholestrolimia
and Diabetes
Stop smoking
AVOID
Severe
exertion
Reduce weight
Heavy meal
Emotions
Cold Weather
•Graduated exercise may open new collaterals
20
Treatment of an acute attack of angina
Sublingual nitroglycerin (0.5 mg ) or isosorbide
dinitrate (5 mg ) or
Oral spray nitroglycerin (0.4 mg/metered dose),
isosorbide dinitrate(1.25 mg/metered dose)
Persistence of pain
Relief within 1-3 min.
Repeat nitroglycerin at 5 min.
interval (3 tab. max.)
Relief
HOSPITALIZATION
not relieved
Infarction
What are the antianginal drugs?
Organic nitrates.
- adrenoceptor blockers.
Calcium channel blockers.
?
?
?
?
Anti-platelet
• ASPIRIN
• CLOPIDOGREL
Rx for Risk factors
• HTN
• DM
• HLP
- statins
• ACE-Inh:
Management of Variant Angina
Nitrates and/or Ca- Channel
blockers
For the acute attack & prophylaxis
Beta-Blocker?
ASA?
For patients not responding to adequate medical
therapy:
•Percutaneous Transluminal coronary
Angioplasty (PTCA)
•Coronary artery bypass grafting (CABG)
28
You can download this slid in :