1. CORONARY ARTERY DISEASE
Dr. Zahoor Ali Shaikh
CORONARY ARTERY DISEASE

3. CORONARY ARTERY DISEASE (CAD)
CAD is most common form of heart disease and causes premature death.
In UK, 1 in 3 men and 1 in 4 women die from coronary heart disease.
Approximately 1.3 million people have angina every year.

5. CORONARY ARTERY DISEASE
Stable Angina
It is due to transient myocardial ischemia and occurs when there is increased demand of oxygen by heart.

7. CORONARY ARTERY DISEASE

8. STABLE ANGINA RISK FACTOR FOR STABLE ANGINA Hypertension
Diabetes Mellitus
Aortic valve disease
Angina is precipitated by
- Anemia
- Throtoxicosis

10. INVESTIGATIONS ECG Exercise ECG – Exercise tolerance test (ETT).
We monitor ECG, BP, and general condition of patient.

12. INVESTIGATIONS
Myocardial Perfusion Scan
- Thallium stress test

13. INVESTIGATIONS Coronary Arteriography
- Usually performed with a view to percutaneus coronary intervention (PCI) or coronary artery bypass graft (CABG)
NOTE – PCI is done under local anesthesia in cardiac cath lab.
- CABG surgery is done using left internal mammary artery or Saphenous vein.

14. INVESTIGATIONS

16. MANAGEMENT OF ANGINA PECTORIS
Assessment of patient
Look for risk factors
Advise to the patient

17. MANAGEMENT OF ANGINA PECTORIS
Antiplatelet therapy – aspirin
Antianginal drugs
-Nitrate
-Beta blocker
-Calcium antagonist

18. CORONARY ARTERY SPASM
It is called variant angina or Vasospastic or prinzmetal angina.
Angina pain is due to spasm of coronary artery.
ECG may show transient ST-elevation
Treatment is with calcium blocker, nitrates.

19. ACUTE CORONARY SYNDROME (ACS)
ACS is term used for both
1. Unstable Angina
2. Myocardial infarction [MI]
Unstable Angina occurs at rest or minimal exertion in absence of myocardial damage.
MI symptoms occur at rest and there is evidence of myocardial damage, demonstrated by increased level of cardiac Troponin or creatinine kinase-MB.
IMPORTANT – Troponin is more specific

21. ACUTE CORONARY SYNDROME (ACS)
CLINICAL FEATURES
Presentation – retrosternal pain occurs but breathlessness, vomiting, collapse are common features.
Pain lasts for longer than 20 mins.
Patient may describe tightness, heaviness or constriction.
Sudden death from ventricular fibrillation or asystole within 1 hour can occur.

23. ACUTE CORONARY SYNDROME (ACS)
Diagnosis
Evaluation of ECG
Measurement of biochemical markers of cardiac damage e.g. Troponin I and T, creatine kinase
Cardiac Troponin T and I are most sensitive and specific marker of myocardial cell damage

25. ACUTE CORONARY SYNDROME (ACS)
Other blood test
- WBC count
- ESR
- C-reactive protein
- X-ray chest
- Echo cardiography

26. MANAGEMENT OF ACS Admit the patient Morphine IV for pain Aspirin
Nitrate
Beta-blocker
Calcium channel blocker
Reperfusion therapy
Percutaneous Coronary Intervention (PCI)
Coronary artery bypass graft (CABG)

27. PCI

30. COMPLICATIONS OF ACUTE CORONARY SYNDROME

31. THANK YOU