Coronary Artery DiseaseAngina PectorisUnstable AnginaVariant 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; 1996. AHA, Heart and Stroke Facts: 1996 Statistical Supplement (1993 data).

Editorial The Lancet 349:1997;1263

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

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 CoronaryArtery Disease

• Asymptomatic• Silent Ischemia• Sudden Death

• Angina Pectoria• Unstable Angina• Acute Myocardial

Infarction

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

See Appendix A

Variant Angina

• Symptoms

• ECG

• Treatment

Indications ForCoronary Angiogram

• Diagnosis

• Refractory Pain

• Probable High Risk

• Acute Myocardial Infarction

See Appendix B

See Appendix C

See Appendix D