20180410 stable coronary artery disease treatment
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Treatment: stable coronary artery disease_201804_亞東紀念醫院
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20180410 stable coronary artery disease treatment
- 1. Stable Coronary Artery Disease 20180410 Intern 陳佳菁 TREATMENT
- 2. Am Fam Physician. 2018;97(6):376-384. Michael M. Braun, DO, and William A. Stevens, MD Madigan Army Medical Center, Joint Base Lewis-McCord, Washington Craig H. Barstow, MD, Womack Army Medical Center, Fort Bragg, North Carolina
- 3. Ischemia PlaqueHx of MI Reversible Supply/ Demand Mismatch
- 4. 1 2 CAD Asymptomatic Sx controlled by Medications or Revascularization STABLE ?
- 8. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Reduce Risk Modify Lifestyle Manage Comorbid Condition Overall & CVD-related Mortality
- 12. Lifestyle Cholesterol BP Diabetes 30-60 min. Moderate-Intensity Aerobic Activity 5-7 days / weeks
- 13. Lifestyle Cholesterol BP Diabetes ALL PATIENTS ! ! ! Pharmacotherapy / Programs
- 14. Lifestyle Cholesterol BP Diabetes Annual Influenza Vaccination
- 15. Lifestyle Cholesterol BP Diabetes CV events, Revascularization, Stroke: 20% Statin
- 16. Lifestyle Cholesterol BP Diabetes Statin < 75 yr ≥ 75 yr HIGH Intensity MODERATE Intensity American College of Cardiology / American Heart Association, 2013 cholesterol treatment guideline
- 17. Lifestyle Cholesterol BP Diabetes American College of Cardiology / American Heart Association 2013 cholesterol treatment guideline
- 18. Lifestyle Cholesterol BP Diabetes - Bile acid sequestrants - Niacin - Ezetimibe - Fibrates Non-statin Monotherapy
- 19. Lifestyle Cholesterol BP Diabetes Combination to Statin: NO benefit Non-statin
- 20. Lifestyle Cholesterol BP Diabetes Injectable Monoclonal Ab LDL PCSK9 INB
- 21. Lifestyle Cholesterol BP Diabetes Evolocumab, Alirocumab Risks of MI, Revascularization PCSK9 INB
- 22. Lifestyle Cholesterol BP Diabetes PCSK9 INBNon-statin High-risk Patients
- 23. Lifestyle Cholesterol BP Diabetes Eighth Joint National Committee guidelines 2012 ACC/AHA/ European Society of Cardiology practice guideline 2017 guideline on high BP from the ACC/ AHA 150/90mmHg 140/90mmHg 140/80mmHg 130/80mmHg
- 24. Lifestyle Cholesterol BP Diabetes SBP (mmHg) 120 140 All-cause Mortality Heart Failure Risk Hypotension Acute Kidney Injury Electrolyte Abnormality Additional Medication
- 25. Lifestyle Cholesterol BP Diabetes Initial Therapy Race Diabetes ACEi ARB CCB Thiazide CCB ACEi ARB
- 26. Lifestyle Cholesterol BP Diabetes < 65 yr ≥ 65 yr A1C < 7% A1C 7-8% Metformin Liraglutide Semaglutide Empagliflozin
- 28. 75 to 162 = 325 mg/day 81 mg/day Low Cost, Known Benefit
- 29. Clopidogrel - Alternative Irreversibly Inhibit Platlet Aggregation
- 30. All-cause Mortality Risk of Bleeding Dual Antiplatlet Therapy
- 32. Ticagrelor, Prasugrel More Potent Only in ACS - PCI
- 33. ICH ! ! ! CV Mortality, MI, CVA
- 37. When Beta Blocker Do not Control Symptoms
- 38. If Monotherapy is Ineffective or Intolerated
- 40. Recent MI, Abnormal left ventricular function No MI Improve Survival Reduce MI Recurrence 3 Years Reduced CV Rates Increased CVA Risk Effective Antianginals Recommend: Initial Therapy Cardioselective: β1 Receptors Heart Failure: Metoprolol succinate, Carvedilol Beta Blockers
- 41. CCB Intolerant to Beta Blockers Angina uncontrolled with Beta Blockers Abnormal LV Function Reflex tachycardia, Exacerbating ischemia Increasing harm risk Amlodipine Extended-release Nifedipine Non-DHP Verapamil, Diltiazem DHP Amlodipine, Nifedipine 時機 禁⽤用 短效 長效
- 42. Nitrate Quick onset, Immediate relief短效 長效 BB, CCBs 發作次數 運動耐受 短效 NTG 需求 Alternative Adjunctive
- 43. Ranolazine Inhibit late inward Na+ Angina, Bradycardia, Low BP Alternative to: Beta Blockers / CCB Hepatic Impairment 時機 禁⽤用 QT Prolong注意 Ventricular Diastolic Tension Myocardial Oxygen Demand 作⽤用
- 49. SUMMARY
- 50. Ischemia PlaqueHx of MI Reversible Supply/ Demand Mismatch
- 51. 1 2 CAD Asymptomatic Sx controlled by Medications or Revascularization STABLE ?
- 53. 1 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Lifestyle Modification 運動 戒菸 減重
- 54. 1 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Comorbidity Treatment ⾎血壓 ⾎血脂 ⾎血糖
- 55. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Statin Non-statin Monotherapy1
- 56. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities 2 Clopidogrel Aspirin
- 57. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities 3 Beta Blocker CCB Nitrates Ranolazine Medication
- 58. 3 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Re- Vascularization PCI CABG 內 外
- 60. 謝 謝！