Download coronary artery disease

Dr. Zahoor Ali Shaikh
CORONARY ARTERY DISEASE
PRESETATION AND
INVESTIGATION
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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
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