Most common form of
heart disease
Mostly due to atherosclerosis
It includes
1.Stable angina-Ischaemia due to fixed obstruction of coronary artery(Coronary
atheroma)
2.Unstable angina-
·
Ischaemia due to dynamic
obstruction of coronary artery(Thrombus/plaque rupture)
·
New onset or rapidly worsening angina (crescendo angina), angina
on minimal exertion or angina at rest without myocardial damage.
3.MI-
·
Infarction due to acute
coronary occlusion(Thrombus/plaque rupture)
·
Symptoms occur at rest and there is evidence of myocardial
necrosis(?)[Elevation in cardiac troponin or creatine kinase-MB isoenzyme]
4.Arrhythmia-Due to ischaemia/infarction
5.Heart failure-Due to ischaemia/infarction
6.Sudden cardiac death-Ischaemia causing ventricular arrhythmia ,asystole or massive MI
Stable
angina
Angina pectoris is symptom complex
caused by transient myocardial ischemia(It is syndrome not disease)
Symptoms
Central
chest pain, discomfort
Breathlessness
that is precipitated by exertion
Relieved by rest
Investigation
ECG-T wave flattening ,Inverted T wave , ST elevation/depression
Stress test/ETT(Trademill/bicycyle ergometre)-Downslopping ST
depression
Coronary arteriography under LA-CABG/PCI required or not
Treatment
Aspirin 75 mg/daily or clopidogrel 75mg/daily
Sublingual nitrates
Beta blockers-Metoprolol ,bisprolol
Ca antagonists-Nifedipin ,amlodipine
Invasive treatment-
- PCI-Passing
a fine guide wire across a coronary stenosis under radiographic control and
using it to position a balloon which is then inflated to dilate the stenosis
- CABG
Advice
- Do
not smoke
- Aim
for ideal body weight
- Take
regular exercise (exercise up to, but not beyond, the point of chest discomfort
is beneficial and may promote collateral vessels)
- Avoid
severe exercise
- Take
sublingual nitrate before undertaking exertion that may induce angina
Note:
Prinzmetal angina/variant angina-Coronary vasospasm with spontaneous and transient ST elevation.Here no detectable atheroma is found
Prinzmetal angina/variant angina-Coronary vasospasm with spontaneous and transient ST elevation.Here no detectable atheroma is found
Syndrome X-Typical angina on effort ,evidence of M.ischemia(Not infarction) on ETT but normal coronary artery in angiography
Warm up
angina-Symptoms of angina during walking
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