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

5. 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; 1996. AHA, Heart and Stroke Facts: 1996 Statistical Supplement (1993 data).

8. Editorial The Lancet 349:1997;1263

9. Murray et al, The Lancet 349:1997;1498-1504

13. Increased Wealth Decreases Mortality Increases Age Decreases Fertility

14. Also… Increases Smoking Decreases Physical Activity Changes Diet

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

16. Coronary Artery Disease Incidence

18. Causes of Chest Pain Cardiac Gastrointestinal Musculoskeletal Vascular Pulmonary

19. Vascular Aortic Dissection Pulmonary Embolism Pulmonary Hypertension

20. Pulmonary Pneumonia Pneumothorax

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

22. ST-segment elevation Non-ST-segment elevation

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

24. Diagnosis of Myocardial Infarction Clinical Presentation Electrocardiogram Cardiac Markers

28. Angina Pectoris Stable Unstable Variant

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

31. Management of Angina Pectoris General Medical Interventions

35. Unstable Angina New or increasing Rest Post Infarction

37. Nitroglycerin Beta Blocking Agents Calcium Antagonists Aspirin

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

40. See Appendix A

42. Variant Angina Symptoms ECG Treatment

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

53. See Appendix B

54. See Appendix C

55. See Appendix D