Presentation is loading. Please wait.

Presentation is loading. Please wait.

Coronary Artery Disease

Similar presentations

Presentation on theme: "Coronary Artery Disease"— Presentation transcript:

1 Coronary Artery Disease
Andrew C Rankin Glasgow Royal Infirmary

2 Coronary Artery Disease
Angina Myocardial Infarction Asymptomatic Unstable angina

3 Atherosclerosis Timeline
Complicated Lesion/ Rupture Foam Cells Fatty Streak Intermediate Lesion Atheroma Fibrous Plaque Endothelial Dysfunction From First Decade From Third Decade From Fourth Decade Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).

4 Risk Factors for Atherosclerotic Disease
Non-modifiable Age Family history Sex Modifiable Cigarette smoking Diabetes mellitus Hyperlipidemia Hypertension Obesity Physical inactivity Hoeg JM. JAMA. 1997;277:1387–1390.

5 Coronary arteries Left Main Coronary Artery Right Coronary Artery
Diagonal Artery Left Anterior Descending Artery Posterior Descending Artery

6 Coronary Angiography Left coronary artery

7 Coronary Angiography Right coronary artery

8 Death rates from CHD, (per 100,000) men and women aged 35-74, 1994, selected countries
Latvia Russian Federation Lithuania Hungary Czech Republic Ireland Romania Finland UK Poland Norway Denmark Sweden USA Austria Germany Australia Canada Netherlands Luxembourg Greece Italy Mexico men Portugal women Spain France Japan 1000 800 600 400 200 200 400

9 P Q R S T wave


11 Mechanisms of Action of Anti-Anginal Drugs
Reduce Cardiac Workload Slow Heart Rate Reduce Force of Contraction Reduce Pre-load / After-load Improve Blood Supply Coronary Vasodilatation

12 Drug Therapy for Angina
Antianginals Adalat LA Coracten Isocard Nitromin Syscor MR Adipine MR Cordilox Isoket Nitronal Tenif Adizem-XL Corgard Isordil Percutol Tenormin Plendil Angiopine MR Coro-Nitro Istin Tensipine MR Deponit Posicor Angitil SR Lopresor Tildiem LA Dilzem SR Probeta LA Beta-Adalat MCR-50 Totamol Elantan LA Sectral Minitran Beta-Prograne Trandate Emcor Securon SR Monit Betaloc Transiderm Eucardic Slow-Trasicor Mono-Cedocard Betim Trasicor Glytrin Slozem Monocor Blocadren Sorbichew Univer Ikorel Monomax Britiazim SorbidSA Viazem XL Imdur Myocardol Cardene Sorbitrate Visken Inderal LA Nitro-Dur Suscard Cardilate MR Isib 60XL Nitrocine Sustac Cedocard Ismo Nitrolingual

13 Drug Therapy for Angina
Beta-blockers Calcium Nitrates K+ Channel Antagonists Activator Acebutolol Atenolol Bisoprolol Carvedilol Labetolol Metoprolol Nadolol Oxprenolol Pindolol Propranolol Timolol I Verapamil II Amlodipine Felodipine Nicardipine Nifedipine Nisoldipine II Diltiazem GTN Isosorbide Dinitrate Mononitrate Nicorandil

14 PCI / PTCA = Angioplasty

15 Coronary stents

16 Acute Coronary Syndromes
Acute Myocardial Infarction Unstable angina Rest pain Crescendo angina New onset angina

17 Role of Platelets in Thrombus Formation in Acute Ischemic Events
Atherosclerotic Vessel Lipid Core Plaque Rupture Platelet Adhesion, Activation, and Aggregation Thrombus Formation Thrombotic Occlusion MI Stroke Vascular Death

18 ST depression

19 ST elevation



22 Complications of Acute MI
Extension / Ischemia Arrhythmia Pericarditis Expansion / Aneurysm Acute MI RV Infarct RV LV Heart Failure Mechanical Mural Thrombus

23 ISIS-2.Lancet 1988;11:349–360

24 ? Acute coronary syndrome No ST elevation ST elevation
Thrombolytic therapy PCI

25 Thrombolysis for ACS without ST elevation?
It doesn’t work! e.g. Fibrinolytic Therapy Trialist (1994) 3563 patients with suspected AMI ST segment depression Mortality 15.2% vs 13.8%

26 ECG and outcome in ACS ST ¯ P  0.001 ST ­ T-wave inversion GUSTO IIb

27 Troponin level and mortality in ACS
Mortality at 42 Days 831 174 148 134 50 67 %

28 Myocardial infarction redefined
WHO definition: (2 of 3) Typical symptoms (chest pain) Typical ECG changes (Q waves) Enzyme rise ESC/ACC redefinition 2000 Troponin rise, with one of: Chest pain ECG changes (Q waves or ST segment) PCI


30 Acute coronary syndrome
Presentation Working Diagnosis Chest pain Acute coronary syndrome No ST elevation ST elevation ECG Troponin Final diagnosis Myocardial Infarction STEMI NSTEMI + Unstable Angina -


Download ppt "Coronary Artery Disease"

Similar presentations

Ads by Google