Coronary Artery Disease Andrew C Rankin

2,101 views

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,101
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
174
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Coronary Artery Disease Andrew C Rankin

  1. 1. Coronary Artery Disease Andrew C Rankin Glasgow Royal Infirmary
  2. 2. Asymptomatic Coronary Artery Disease Myocardial Infarction Angina Unstable angina
  3. 3. Atherosclerosis Timeline Foam Cells Fatty Streak Intermediate Lesion Atheroma Fibrous Plaque Complicated Lesion/ Rupture Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104). From First Decade From Third Decade From Fourth Decade Endothelial Dysfunction
  4. 4. Risk Factors for Atherosclerotic Disease Hoeg JM. JAMA. 1997;277:1387–1390. <ul><li>Non-modifiable </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Sex </li></ul></ul><ul><li>Modifiable </li></ul><ul><ul><li>Cigarette smoking </li></ul></ul><ul><ul><li>Diabetes mellitus </li></ul></ul><ul><ul><li>Hyperlipidemia </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Physical inactivity </li></ul></ul>
  5. 5. Right Coronary Artery Posterior Descending Artery Left Main Coronary Artery Diagonal Artery Left Anterior Descending Artery Coronary arteries
  6. 6. Coronary Angiography Left coronary artery
  7. 7. Coronary Angiography Right coronary artery
  8. 8. Japan France Spain Portugal Mexico Italy Greece Luxembourg Netherlands Canada Australia Germany Austria USA Sweden Denmark Norway Poland UK Finland Romania Ireland Czech Republic Hungary Lithuania Russian Federation Latvia 0 200 400 600 800 200 400 1000 Death rates from CHD, (per 100,000) men and women aged 35-74, 1994, selected countries men women
  9. 9. P Q R S T wave
  10. 11. Mechanisms of Action of Anti-Anginal Drugs <ul><li>Improve Blood Supply </li></ul><ul><li>Coronary Vasodilatation </li></ul><ul><li>Reduce Cardiac Workload </li></ul><ul><li>Slow Heart Rate </li></ul><ul><li>Reduce Force of Contraction </li></ul><ul><li>Reduce Pre-load / After-load </li></ul>
  11. 12. Antianginals Adalat LA Adipine MR Adizem-XL Angiopine MR Angitil SR Beta-Adalat Beta-Prograne Betaloc Betim Blocadren Britiazim Cardene Cardilate MR Cedocard Coracten Cordilox Corgard Coro-Nitro Deponit Dilzem SR Elantan LA Emcor Glytrin Ikorel Imdur Inderal LA Isib 60XL Ismo Isoket Isordil Istin Lopresor MCR-50 Minitran Monit Mono-Cedocard Monocor Monomax Myocardol Nitro-Dur Nitrocine Nitrolingual Nitronal Percutol Probeta LA Sectral Securon SR Slow-Trasicor Slozem Sorbichew SorbidSA Sorbitrate Suscard Sustac Tenif Tenormin Tildiem LA Totamol Trandate Transiderm Trasicor Univer Visken Eucardic Isocard Nitromin Plendil Posicor Syscor MR Viazem XL Tensipine MR Drug Therapy for Angina
  12. 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 Isosorbide Mononitrate Nicorandil
  13. 14. PCI / PTCA = Angioplasty
  14. 15. Coronary stents
  15. 16. Acute Coronary Syndromes <ul><li>Acute Myocardial Infarction </li></ul><ul><li>Unstable angina </li></ul><ul><li>Rest pain </li></ul><ul><li>Crescendo angina </li></ul><ul><li>New onset angina </li></ul>
  16. 17. Role of Platelets in Thrombus Formation in Acute Ischemic Events MI Stroke Vascular Death Thrombotic Occlusion Atherosclerotic Vessel Lipid Core Plaque Rupture Platelet Adhesion, Activation, and Aggregation Thrombus Formation
  17. 18. ST depression
  18. 19. ST elevation
  19. 22. Complications of Acute MI LV RV Acute MI Expansion / Aneurysm RV Infarct Pericarditis Mechanical Mural Thrombus Arrhythmia Heart Failure Extension / Ischemia
  20. 23. ISIS-2. Lancet 1988;11:349–360
  21. 24. Acute coronary syndrome No ST elevation ST elevation Thrombolytic therapy PCI ?
  22. 25. Thrombolysis for ACS without ST elevation? <ul><li>It doesn’t work! </li></ul><ul><li>e.g. Fibrinolytic Therapy Trialist (1994) </li></ul><ul><li>3563 patients with suspected AMI </li></ul><ul><li>ST segment depression </li></ul><ul><li>Mortality 15.2% vs 13.8% </li></ul>
  23. 26. GUSTO IIb T-wave inversion ST  ST  P  0.001 ECG and outcome in ACS
  24. 27. Troponin level and mortality in ACS Mortality at 42 Days 831 174 148 134 50 67  % % % % % %
  25. 28. Myocardial infarction redefined <ul><li>WHO definition: (2 of 3) </li></ul><ul><li>Typical symptoms (chest pain) </li></ul><ul><li>Typical ECG changes (Q waves) </li></ul><ul><li>Enzyme rise </li></ul><ul><li>ESC/ACC redefinition 2000 </li></ul><ul><li>Troponin rise, with one of: </li></ul><ul><li>Chest pain </li></ul><ul><li>ECG changes (Q waves or ST segment) </li></ul><ul><li>PCI </li></ul>
  26. 30. Acute coronary syndrome Chest pain Presentation Working Diagnosis ECG Troponin Final diagnosis No ST elevation ST elevation Myocardial Infarction STEMI NSTEMI + + Unstable Angina -

×