cad+and+acs
DESCRIPTION
TRANSCRIPT
CAD & ACS
CORONARY ARTERY DISEASE
Coronary artery disease is a chronic disease caused by the gradual deposition of fats in the coronary arteries (atherosclerosis).
Narrowed artery reduces oxygen supply to the myocardium.
Ischemia (reduced blood & O2 supply) often causes chest pain or discomfort known as angina pectoris or Myocardial Infarction due to complete blockage.
CAD is also called as IHD & CHD.
CAD
Atherosclerosis :
Deposition of lipids under the intima of arteries. Chronic process that develops in following stages over 30-40 years Fatty streak Fibrous plaque Rupture
ATHEROSCLEROSIS: HARMFUL CONSEQUENCES
Atherosclerosis causes decrease in lumen of arteries and thus decreases blood supply
Artery involved
Organ Condition
Symptoms
Events
Coronary Heart CAD Angina MI
Cerebral carotid
Brain CVD TIA Stroke
Peripheral Peripheral tissue
(sk muscle)
PVD/PAD Intermittent claudication
Gangrene
SYMPTOMS OF CAD
Chest pain (angina) : Patient may feel pressure or tightness in chest, as if someone is standing on chest.
Shortness of breath.
ANGINA PECTORIS
Principle symptom of CAD (IHD, CHD) Sudden, severe & temporary chest pain caused by an
inadequate supply of oxygen to the myocardium due to narrowing of the coronary artery
Pain may radiate to left arm or shoulder, back, neck or jaw
The symptoms usually last for few minutes and pain subsides on rest.
No permanent damage occurs Angina may be is precipitated by exercise, cold,
stress, heavy meal
TYPES OF ANGINA
Chronic Stable angina (CSA)
Unstable angina (UA)
Other names Exertional / classical Preinfarct Angina
Occurrence Usually precipitated by physical activity
Occurs even at rest
Predictability Predictable Unpredictable
Frequency, severity & duration of pain
Less More
Cause Stable plaque (atherosclerosis)
Unstable plaque (atherothrombosis)
Relieving factors Rest or sublingual nitrates
Requires hospitalization
Variant / Vasospastic
Caused by spasm of the coronary arteries
May occur at rest, may not be precipitated by emotion or stress.
MYOCARDIAL INFARCTION
Myocardium : heart muscleInfarction : death of the tissue (necrosis)MI is death of the myocardial tissue due to complete blockade of coronary artery
ISCHEMIA & MYOCARDIAL INFARCTION
Ischemia Myocardial infarction
Partial block of artery Complete block of artery
Temporary decrease in O2 supply
Permanent damage (necrosis)
ST Segment depression Usually ST Segment elevation
ANGINA PECTORIS
Determinants of the myocardial O2
requirement :
Heart rate Myocardial contractility Afterload Preload
ACUTE CORONARY SYNDROME
It is an umbrella term used to describe symptoms and signs occuring because of acute atherothrombosis in coronary artery
It is an emergency condition and patient has to be hospitalized
CLASSIFICATION OF ACS
Unstable angina
NSTEMI STEMI
Typical chest pain Yes Yes Yes
Elevation of serum cardiac enzymes*
No Yes Yes
ST Segment elevation No No Yes
ACS includes 3 syndromes: UA, NSTEMI, STEMI
They are different manifestations of the same clinical syndrome depending upon the period of severity
* Troponin T & CKMB
Investigations in ACS & CAD
ECG
Recording of electrical activity of the heart via electrodes attached to the skin
Net sum of depolarisation and repolarisation potentials of all myocardial cells
P-QRS-T pattern P - atrial depolarisation QRS - ventricular
depolarisation T - ventricular repolarisation
ECG ABNORMALITIES IN ISCHEMIA & MI
ECG (Electrocardiogram)
Stress test (Treadmill Test/TMT/CST)
Patients are asked to walk on a treadmill during an ECG. This is the test to unmask CAD when resting ECG is normal
INVESTIGATION OF CAD
A diagnostic procedure
Cardiac catheterization done
‘Catheter’ refers to a long narrow
rubber tube inserted through
artery of leg & advanced upto
the opening of coronary artery in
aorta
A small amount of contrast
material (dye) is injected through
the catheter into coronary
arteries
INVESTIGATION OF CAD
Coronary angiography
The movement of the dye is recorded as an angiogram and viewed on a television monitor.
Images are then captured
using X-rays.
Disease is described in terms of
Extent & location of block : e.g. 90% block in proximal RCA
Number of arteries involved: Single-vessel, double-vessel or triple-vessel disease
INVESTIGATION OF CAD
Coronary angiography
TREATMENT OF ANGINA (CAD)
Life style modification Regular physical exercise Stop smoking Stop alcohol Dietary controls : weight control
Restrict saturated fats
Pharmacological Organic nitrates : Nitroglycerine, ISMN CCBs : Diltiazem, Verapamil Beta Blockers : Metoprolol, nebivolol K+ Channel opener : Nicorandil
Interventional PTCA CABG
ORGANIC NITRATES
Dilates veins & large arteries
Dilation of veins lead to reduction of the preload
Dilation of the arteries leads to reduction of the afterload
Coronary artery dilation
BETA BLOCKERS
Reduces Myocardial Oxygen Demand
↓ Heart Rate
↓ Force of contraction
Increases Coronary filling
↑ Diastolic time
CCBs
Block Calcium channelsPrevent entry of Ca++ ions
Myocardial Cell Vascular smooth muscle
Decreased force of Coronary Artery Peripheral contraction arteriole
Coronary blood flow PVR
NICORANDIL
Nitrate-like action K+ channel opener ATP
Dilates epicardial Coronary arteries
Venodilatation Dilates peripheral arterioles
Dilates coronaryResistance vessels
DecreasedPreload
Decreased afterload
↑ coronary blood flow
↓ Myocardial O2
requirement
↓ Myocardial O2
requirement
↑ coronary blood flow
Nicorandil dual action
PTCA WITH STENTING(Percutaneous Transluminal Coronary
Angioplasty)
Also known as Balloon angioplasty Angioplasty PCI (percutaneous
coronary intervention)
Done in Cardiac Catheterization Laboratory (Cath Lab) by an interventional cardiologist
PTCA WITH STENTING
Opening of the artery after stenting
The arrow on the angiogram shows block in the artery.
CABG(Coronary Artery Bypass Graft Surgery)
(Done by CVTS in Cardiac OT)
Thank You