CHRONIC CORONARY SYNDROME Flashcards
Coronary artery disease or Coronary Heart Disease
Inadequate supply of blood to the myocardium due to obstruction of the epicardial coronary arteries
Forms of coronary artery disease
Stable or Chronic
Acute disease or Unstable
Modifiable risk factors of atherosclerotic CVD
Diabetes mellitus
Obesity
Microalbuminuria
Atherogenic dyslipidaemia
Hyperglycemia
Hypertension
Stress
Physical inactivity
Smoking/Alcohol
Diet and nutritional deficiencies
Types of acute coronary syndromes
Unstable angina
Non-ST-segment elevation MI
ST-segment elevation MI
Non-modifiable risk factors
Age
Gender(male)
Heredity
Ethnicity
Inflammation
Family history of CV disease
Psychosocial risk factors
Employment status
Educational factors
Physical and social environment
Income level
Behavioural risk
Psychological factors
Tradition ASCVD risks
Diabetes
Hypertension
Dyslipidemia
Smoking
Physical inactivity
Obesity
Unhealthy diet
Determinants of myocardial blood demand
Heart rate
Myocardial wall stress
Systolic blood pressure
Myocardial contractility
Determinants of myocardial blood supply
Coronary artery diameter and tone
Collateral blood flow
Perfusion presure
Heart rate ( duration of diastole)
Classification of angina
- Constricting discomfort in the front of the chest or in the neck, jaw, shoulder, or arm
- Precipitated by physical exertion
- Relied by rest or nitrates within 5 minutes
Typical angina meets all three
Atypical angina meets two
Non-anginal chest pain meets only one or none
Investigations for CCS
Rest ECG
Stress/Exercise ECG
Echocardiogram (rest and stress)
CT coronary angiogram
Cardiac MRI
Cardiac scintigraphy
Invasive coronary angiogram
Lifestyle modifications
Smoking cessation
Healthy diet
Physical activity
Healthy weight
Cardiac scintigraphy
Examines blood flow to the myocardium at rest and during exercise
Ranolazine
improves exercise tolerance by interacting with sodium channels
Medications for CCS
Aspiring
Statins
Nitrtaes
Beta blockers
Calcium channel blockers
Ranolazine
Ivabradine
Trimetazidine
NICORANDIL
ACEIs/ARBs
Nicorandil
K activator
Nitrate component- vasodilation
Trimetazidine
Blocks fatty acid beta oxidation by inhibiting the enzyme long-chain-3-ketoacyl-CoA thiolase
Standard therapy for angina and CAD
- BB or CCB
- BB + DHP-CCB
- Add 2nd line drug
- Add nicorandil, ranolazine or trimetazidine
Angina and CAD with high heart rate (>80bpm)
- BB or Non-DHP-CCB
- BB + CCB
- BB + Ivabradine
- Add nicorandil, ranolazine or trimetazidine
Angina and CAD with low heart rate (<50bpm)
- DHP-CCB
- Switch to LAN
- DHP-CCB + LAN
- Add nicorandil, ranolazine or trimetazidine
Angina and CAD with LV dysfunction or Heart failure
- BB
- BB + LAN or BB + Ivabradine
- Add another 2nd line drug
- Add nicorandil, ranolazine or trimetazidine
Angina and CAD with Low blood pressure
- Low dose BB or Low dose CCB
- Switch to Ivabradine, Ranolazine or Trimetazidine
- Combine two 2nd line drugs
- ADD nicorandil, ranolazine or trimetazidine
Interventions for CCS
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Surgery for CCS
Coronary artery bypass grafting (CABG