Transcript
Coronary artery disease (CAD) is a
condition in which plaque builds up
inside the coronary arteries.
Plaque is made up of fat, cholesterol,
calcium, and other substances found i
n
the blood, and narrows the arteries an
d
reduces blood flow to the cardiac mu
scle.
Atheroschlerosis also increases the risk of bl
ood clotting. CAD can lead to angina, myoc
ardial infarction and even death
Angina
Angina–also sometimes called angina pectoris. It means
that the heart is not getting enough blood and as a
result, not enough oxygen. This decrease of oxygen being
delivered to the muscle of the heart happens if one or
more coronary arteries are narrowed or blocked, a
condition called atherosclerosis.
Definition
is a clinical syndrome
characterized by discomfort in the
chest, jaw, shoulder, back, or
arms, typically elicited by exertion
or emotional stress and relieved
by rest or nitroglycerin
Angina can be:Stable
occurs when the heart has to work harder than
normal, during exercise.
Once you stop exercising, or take medication
(usually nitroglycerin) the pain goes away.
Unstable caused
by unstable plaque,
occurs at rest,
unpredictable, pain can
increase for no obvious
reason
Less common kinds of angina include: • variant angina • microvascular angina • atypical angina
Variant angina ,the spasm is most likely to occur near a
buildup of fatty plaque in an artery.
Microvascular angina —sometimes referred to as Syndrome X
—occurs when tiny vessels in the heart become narrow and
stop functioning properly
Atypical angina often doesn’t cause pain, but you may feel a
vague discomfort in your chest. Women are more likely than
men to have feelings of vague chest discomfort
Stable angina pectorisProvoked by physical exertion,
especially in cold weather, after meals and commonly aggravated by anger or excitement
The pain fades quickly with rest
Myocardial ischemia is caused by an imbalance between myocardial oxygen supply and myocardial oxygen consumption
Risk factors for angina
High blood pressure Diabetes Mellitus Unhealthy cholesterol levels Smoking Lack of exercise Obesity
Risk factors for angina
Too much salt in your diet Excessive use of alcohol Family history of CAD or strokeBeing male Being a postmenopausal woman Age - the risk increases for men
over the age of 45 and for women over the age of 55
Clinical symptoms
Patient history is a˝golden standard˝
Retrosternal pain??may also be silentDyspneaNauseaArrhythmiaRestlessness
InvestigationsLaboratory tests (leukocytes, hemoglobin,
thyroid hormones, troponin I and T, CKMB (creatine kinase myocardial band)to exclude myocardial injury.
Resting ECGExcercise ECG (stress test)EchocardiographyCoronary angiography
Nitrates are available in a number of different forms. Headache
is a possible side effect.
Beta-blockers are a to treat several kinds of heart disease. They
work by lowering blood pressure, and slowing heart rate which
means your heart class of medicines used doesn’t have to work
as hard.
Calcium channel blockers or calcium antagonists also work
by lowering blood pressure and slowing heart rate, and are
often used if you cannot take a beta-blocker. They may be
useful to treat coronary artery spasm.
Antiplatelet medications are blood thinners that
work by preventing blood clots from forming and
blocking arteries. The most commonly used
antiplatelet medication is aspirin, which works by
preventing platelets from sticking to blood vessel
walls. An enteric-coated aspirin is generally
recommended because it is easier on the stomach.
If several arteries are severely blocked, coronary artery bypass surgery (also sometimes referred to as coronary artery bypass grafting or CABG)
Living well with anginaStop smoking.
Exercise regularly.
Watch your alcohol intake.
Watch what you eat. You should try to stop eating
unhealthy fats and sugars as much as you can, and
instead eat more fresh fruits and vegetables, grains
and grain products, lean poultry, beef or fish.
Limit your salt intake.
Watch your weight
Have your cholesterol levels checked
Control high blood pressure
ACUTE CORONARY SYNDROME
Acute coronary syndrome (ACS) is the umbrella term
for the clinical signs and symptoms of myocardial
ischemia: unstable angina, non–ST-segment elevation
myocardial infarction, and ST-segment elevation
myocardial infarction
In an MI, an area of the myocardium is
permanently destroyed, typically because
plaque rupture and subsequent thrombus
formation result in complete occlusion of
the artery.
Clinical ManifestationsChest pain that occurs suddenly and continues
despite rest and medication is the presenting
symptom in most patients with ACS
Patients may present with a combination of
symptoms, including chest pain, shortness of breath,
indigestion, nausea, and anxiety. They may have cool,
pale, and moist skin
Laboratory TestsCardiac enzymes and biomarkers are used to
diagnose an acute MI. Cardiac biomarkers, which
include myoglobin and troponin, can be analyzed
rapidly, expediting an accurate diagnosis. These tests
are based on the release of cellular contents into the
circulation when myocardial cells die.
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