CORONARY ARTERY DISEASE Dr. Zahoor Ali Shaikh CORONARY ARTERY DISEASE

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.

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

CORONARY ARTERY DISEASE

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

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

INVESTIGATIONS Myocardial Perfusion Scan - Thallium stress test

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.

INVESTIGATIONS

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

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

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.

ACUTE CORONARY SYNDROME (ACS) ACS is term used for both 1. Unstable Angina 2. Myocardial infarction [MI] 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

ACUTE CORONARY SYNDROME (ACS) CLINICAL FEATURES Presentation – retrosternal pain occurs but breathlessness, vomiting, collapse are common features. Pain lasts for longer than 20 mins. Patient may describe tightness, heaviness or constriction. Sudden death from ventricular fibrillation or asystole within 1 hour can occur.

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

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

MANAGEMENT OF ACS Admit the patient Morphine IV for pain Aspirin Nitrate Beta-blocker Calcium channel blocker Reperfusion therapy Percutaneous Coronary Intervention (PCI) Coronary artery bypass graft (CABG)

PCI

COMPLICATIONS OF ACUTE CORONARY SYNDROME

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