Coronary heart disease

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

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