Page 1
Coronary Artery DiseaseAngina PectorisUnstable AnginaVariant Angina
Joseph D. Lynch, MD
Page 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).
Page 8
Editorial The Lancet 349:1997;1263
Page 9
Murray et al, The Lancet 349:1997;1498-1504
Page 13
Increased Wealth
• Decreases Mortality
• Increases Age
• Decreases Fertility
Page 14
Also…
• Increases Smoking
• Decreases Physical Activity
• Changes Diet
Page 15
Cardiovascular Risk Factors
Nonmodifiable • Age• Sex• Family History
Modifiable
• Hypertension
• Hyperlipidemia
• Cigarette Smoking
• Glucose intolerance
(Hyperglycemia)
• Obesity
• Sedentary Lifestyle
• Psychological Stress
Page 16
Coronary Artery Disease Incidence
Page 18
Causes of Chest Pain
• Cardiac
• Gastrointestinal
• Musculoskeletal
• Vascular
• Pulmonary
Page 19
Vascular
• Aortic Dissection
• Pulmonary Embolism
• Pulmonary Hypertension
Page 20
Pulmonary
• Pneumonia
• Pneumothorax
Page 21
Presentation of CoronaryArtery Disease
• Asymptomatic• Silent Ischemia• Sudden Death
• Angina Pectoria• Unstable Angina• Acute Myocardial
Infarction
Page 22
Acute Myocardial Infarction
• ST-segment elevation
• Non-ST-segment elevation
Page 23
Acute Coronary Syndromes
• Unstable angina
• Non-ST-segment elevation MI
• ST-segment elevation MI
Page 24
Diagnosis of Myocardial Infarction
• Clinical Presentation
• Electrocardiogram
• Cardiac Markers
Page 28
Angina Pectoris
• Stable
• Unstable
• Variant
Page 30
Angina Pectoris
• Differential Diagnosis
• Physical Exam
• ECG
• X-Ray
• Stress Testing
Page 31
Management of Angina Pectoris
• General
• Medical
• Interventions
Page 35
Unstable Angina
• New or increasing
• Rest
• Post Infarction
Page 37
• Nitroglycerin
• Beta Blocking Agents
• Calcium Antagonists
• Aspirin
Page 39
Unstable Angina
• Definition
• Aspirin
• Heparin
• II b III a inhibitors
• Stress test
• Echocardiogram
Page 42
Variant Angina
• Symptoms
• ECG
• Treatment
Page 48
Indications ForCoronary Angiogram
• Diagnosis
• Refractory Pain
• Probable High Risk
• Acute Myocardial Infarction