Techniques used to dx CAD
- history
- physical examination
- ECG
- non-invasive imaging
- coronary angiography
History of CAD
- chest pain
- dyspnea
- risk factors
Types of non-invasive imaging
- echocardiography
- nuclear medicine (perfusion imaging)
- ultrafast CT
Dx of CAD from ECG
- resting ECG: ST segment changes, T wave inversion, Q-waves
- exercise ECG (stress testing): dynamic ST segment changes
- sensitivity of ECG is low
- sensitivity/specificity in stress-testing is improved w/concurrent imaging of myocardial perfusion or echocardiography
Dx of CAD via CT or direct angiography
-Picture of the vessel lumen – but does not tell us about the vessel wall.
-Good for diagnosis of coronary obstruction
causing anginal symptoms; not as good for
predicting future events.
-Guides therapeutic intervention (angioplasty,
bypass surgery)
Use of fractional flow reserve to estimate severity of coronary lesion
-if ration of distal coronary/aortic pressure stenosis is significant
Major types of treatment of CAD
Risk factor modification (for prevention AND treatment of overt disease) – Diet, exercise, smoking cessation • Drugs to treat angina, blood pressure, lipids, platelets • Revascularization – Coronary angioplasty – Coronary artery bypass surgery
Classes of drugs useful in treatment of coronary heart disease
• Lipid-modifying: Statins • Anti-platelet: Aspirin, clopidogrel • Anti-anginal: Nitrates, beta blockers, calcium channel blockers • LV dysfunction: ACE inhibitors or angiotensin receptor blocker
Acute tx of unstable angina
• Hospitalization • Intravenous nitroglycerin • Beta blockers • Aspirin and other anti-platelet agents • Anticoagulation (heparin) • Usually early catheterization and coronary intervention
Major problems with balloon angioplasty
- acute occlusion
- restenosis
Tx of acute MI w/ST elevation
• Treatment may be initiated in the field
• Immediate aspirin, nitroglycerin, ± beta blocker
• Reperfusion therapy ASAP: Usually coronary
angioplasty, if unavailable thrombolytic therapy.
