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CORONARY ARTERY DISEASE PRESETATION AND INVESTIGATION

Dr. Zahoor Ali Shaikh. CORONARY ARTERY DISEASE PRESETATION AND INVESTIGATION. 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.

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CORONARY ARTERY DISEASE PRESETATION AND INVESTIGATION

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  1. Dr. Zahoor Ali Shaikh CORONARY ARTERY DISEASEPRESETATION AND INVESTIGATION

  2. 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.

  3. CORONARY ARTERY DISEASE Stable Angina • It is due to transient myocardial ischemia and occurs when there is increased demand of oxygen by heart.

  4. CORONARY ARTERY DISEASE

  5. STABLE ANGINA RISK FACTOR FOR STABLE ANGINA • Hypertension • Diabetes Mellitus • Aortic valve disease • Angina is precipitated by - Anemia - Throtoxicosis

  6. INVESTIGATIONS • ECG • Exercise ECG – Exercise tolerance test(ETT). We monitor ECG, BP, and general condition of patient.

  7. INVESTIGATIONS Myocardial Perfusion Scan - Thallium stress test

  8. 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.

  9. INVESTIGATIONS

  10. MANAGEMENT OF ANGINA PECTORIS Assessment of patient Look for risk factors Advise to the patient

  11. MANAGEMENT OF ANGINA PECTORIS • Antiplatelet therapy – aspirin • Antianginal drugs -Nitrate -Beta blocker -Calcium antagonist

  12. ASPIRIN • Inhibits platelet aggregation • Inhibits synthesis of prostaglandin Thromboxone A2 and promotes reperfusion and reduces likelihood of thrombosis

  13. 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

  14. 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

  15. CALCIUM CHANNEL BLOCKER Action • Cause coronary dilatation and increase coronary flow • Decrease myocardial contractility therefore decrease oxygen demand

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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.

  22. Patient with chest pain

  23. ACUTE CORONARY SYNDROME (ACS) Diagnosis • Evaluation of ECG • Measurement of biochemical markersof cardiac damagee.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.

  24. ACUTE CORONARY SYNDROME (ACS) • Other blood test - WBC count - ESR - C-reactive protein - X-ray chest - Echo cardiography

  25. MANAGEMENT • Admit the patient • Morphine IV for pain • Aspirin • Nitrate • Beta-blocker • Calcium channel blocker • Reperfusion therapy • Percutaneous Coronary Intervention (PCI)

  26. PCI

  27. COMPLICATIONS OF ACUTE CORONARY SYNDROME

  28. THANK YOU

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