Coronary Artery Disease Angina Pectoris Unstable Angina Variant Angina Joseph D. Lynch, MD

Coronary Heart Disease (CHD) In the United States CHD is the single largest killer of men and women –13.5 million have history of MI and/or angina Each year 1.5 million people have MI –500,000 die of MI –250,000 dies within 1 hr By age 60, every 5th man and 17th woman develops CHD (1986 Framingham data) 1987 estimated direct and indirect costs of heart disease are $90.9 billion 56 million adults have elevated LDL-C and warrant 1ntervention (1994 NHANES data) –26 million qualify for drug therapy –5.3 million actually receive drug therapy AHA 1997 Heart and Stroke Statistical Update; AHA, Heart and Stroke Facts: 1996 Statistical Supplement (1993 data).

Editorial The Lancet 349:1997;1263

Murray et al, The Lancet 349:1997;

Increased Wealth Decreases Mortality Increases Age Decreases Fertility

Also… Increases Smoking Decreases Physical Activity Changes Diet

Cardiovascular Risk Factors Nonmodifiable Age Sex Family History Modifiable Hypertension Hyperlipidemia Cigarette Smoking Glucose intolerance (Hyperglycemia) Obesity Sedentary Lifestyle Psychological Stress

Coronary Artery Disease Incidence

Causes of Chest Pain Cardiac Gastrointestinal Musculoskeletal Vascular Pulmonary

Vascular Aortic Dissection Pulmonary Embolism Pulmonary Hypertension

Pulmonary Pneumonia Pneumothorax

Presentation of Coronary Artery Disease Asymptomatic Silent Ischemia Sudden Death Angina Pectoria Unstable Angina Acute Myocardial Infarction

ST-segment elevation Non-ST-segment elevation

Acute Coronary Syndromes Unstable angina Non-ST-segment elevation MI ST-segment elevation MI

Diagnosis of Myocardial Infarction Clinical Presentation Electrocardiogram Cardiac Markers

Angina Pectoris Stable Unstable Variant

Angina Pectoris Differential Diagnosis Physical Exam ECG X-Ray Stress Testing

Management of Angina Pectoris General Medical Interventions

Unstable Angina New or increasing Rest Post Infarction

Nitroglycerin Beta Blocking Agents Calcium Antagonists Aspirin

Unstable Angina Definition Aspirin Heparin II b III a inhibitors Stress test Echocardiogram

See Appendix A

Variant Angina Symptoms ECG Treatment

Indications For Coronary Angiogram Diagnosis Refractory Pain Probable High Risk Acute Myocardial Infarction

See Appendix B

See Appendix C

See Appendix D