Chronic Stable Angina Flashcards
group of conditions that includes nonobstructive and obstructive coronary artery disease with or without previous myocardial infarction, ischemic heart disease, chronic angina symptoms
chronic coronary disease (CCD)
caused by narrowing in major coronary arteries that supply blood to the heart that is mostly the result of atherosclerotic plaques, comes from an imbalance between myocardial oxygen supply and demand
ischemic heart disease (IHD)
chronic stable angina, unstable angina, myocardial infarctions (MI)
clinical manifestations of ischemic heart disease (IHD)
smoking, elevated LDL/total cholesterol, diabetes, hypertension, obesity, overconsumption of alcohol
modifiable risk factors of IHD
age (over 45 for men and over 55 for women), gender, family history
nonmodifiable risk factors of IHD
established atherosclerotic plaque in coronary arteries that gets in the way of coronary blood flow
stable IHD
atherosclerotic plaque rupture with subsequent clot formation
acute coronary syndrome (ACS)
comes from spasm/vasoconstriction of coronary artery without significant atherosclerosis
variant angina
class of angina - able to perform ordinary physical activity without any symptoms but prolonged exertion leads to symptoms
class I
class of angina - symptoms sort of limit ordinary physical activity, walking rapidly or for longer time/climbing more than one flight of stairs causes symptoms
class II
class of angina - symptoms more significantly limit ordinary physical activity, walking less than 2 blocks or one flight of stairs causes symptoms
class III
class of angina - angina may occur at rest, any physical activity causes symptoms
class IV
prevention of ACS and death, alleviating symptoms of angina, preventing recurrent angina, preventing disease progression, reducing complications, avoiding adverse treatment effects
goals for treating stable IHD
when medical therapy isn’t working, symptoms are unstable, there is extensive coronary atherosclerosis then this is indicated
percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery
lifestyle modifications (exercise, diet, weight loss, smoking cessation) and can include immediate-release nitrate like nitroglycerin –> then low dose aspirin or clopidogrel if aspirin in contraindicated/intolerance –> then potentially add ACE inhibitors or ARBs if patient has preexisting conditions –> triple therapy with beta blocker, calcium channel blocker, long-acting nitrate or ranolazine
general treatment recommendations for IHD
low dose aspirin for at least 12 months or longer
patients with CCD and no indication for anticoagulation
dual platelet therapy (DAPT) or drug eluting stent (DES) for 6 months and then single antiplatelet therapy (SAPT) thereafter
patients with PCI
drug eluting stent (DES) and dual antiplatelet therapy (DAPT) for 1-3 months, then a P2Y12 inhibitor for 9 months, then single antiplatelet therapy (SAPT) thereafter
patients with PCI and high bleeding risk
direct oral anticoagulant (DOAC)/clopidogrel/aspirin for about a month, then DOAC and clopidogrel for 6 months, then DOAC alone therafter
patients with PCI and indication for anticoagulation
what if aspirin is contraindicated or intolerable?
clopidogrel
why is dual antiplatelet therapy (DAPT) required after stent placement?
stents are prone to producing blood clots until they become covered in endothelial cells like a normal coronary artery so DAPT is required until then
when do we use prolonged/extended duration DAPT?
patients who have not experienced bleeding complications on DAPT or not at high risk of bleeding
when do we use shorter duration DAPT?
patients with significant bleeding complications or high risk of bleeding
hemoglobin, white blood cells, age, creatinine clearance, prior bleed (yes or no)
PRECISE-DAPT calculator factors
