1. Coronary Heart Disease (CHD) László Tornóci Inst. Pathophysiology Semmelweis University

2. Significance CHD causes more deaths and disability than any other disease in the developed countries. CHD like stroke and occlusion of peripheral arteries is a consequence of atherosclerosis.

3. Natural history No symptoms Angina pectoris Acute myocardial infarction Chronic heart failure Sudden death Possible symptoms or results:

4. Angina pectoris Classic vs. Prinzmetal angina Stable vs. unstable angina Severe, dull pain in the chest of limited duration. Usually provoked by physical activity, cold, or a large meal. Pain is relieved by nitrates in the classic type.

5. Comparison of angina types Common Usually stress induced (effort angina) ECG: ST depression Responds to nitrates Caused by coronary occlusion Rare Usually occurs at rest (during sleep) ECG: ST elevation No response to nitrates Caused by coronary spasm Classic anginaPrinzmetal angina

6. Stable vs. unstable angina Good prognosis Caused by quiescent plaque Reproducable pain Poor prognosis Caused by ruptured plaque Pain unusually bad, occurs more frequently or unexpectedly

7. Acute Myocardial Infarction (AMI) Symptoms Natural history, prognosis ECG signs Complications STEMI vs. NSTEMI infarctions

8. Vulnerable plaque NEJM: 342:101 (2000)

9. Plaque rupture NEJM: 342:101 (2000)

10. Acute Coronary Syndrome (ACS) First angina-like pain ever Angina in CHD patients, if: –Pain is not relieved by nitrates and/or –Pain is unusually severe ACS may be: AMI unstable angina ACS is suspected:

11. ACS types

12. Pathophysiology UA, STEMI NSTEMI Stable angina

13. Diagnosis of AMI Clinical signs ECG signs (ST elevation, depression, pathological Q) Plasma conc. of cardiac troponin T or I

14. Prevention of CHD Quit smoking Avoid sedentary lifestyle Care of hypertension Care of DM Care of hyperlipidemias

15. Prevention of AMI in CHD patients Use of drugs (aspirin) Check progression of CHD Hospitalize unstable angina cases Surgery, angioplasty, stent if necessary All things mentioned in the previous slide

16. Therapy of AMI Minimize damage (PTCA, thrombolysis) Control arrhythmias, circulation Look for complications Fight cardiac shock if it develops Assessment of prognosis, rehabilitation Secondary prevention

17. PTCA Percutaneous Transluminal Coronary Angioplasty Currently the best way to minimize the damage caused by AMI Timing is very important, however