Coronary artery diseaseA- Stable angina

Abbas A. A. ShawkaMedical student ( 1st stage )

Introduction• Coronary artery disease (CAD) is the leading cause of

premature death in the developed world• Disease of the coronary arteries is almost always due to

atherosclerosis and its complications, particularly thrombosis.

• several risk factors have been identified:1- Age and sex2- Family history3- Hypertension4- Hypercholesterolaemia5- Diabetes mellitus6- Lifestyle factors

Coronary artery diseases ( CAD )

CAD include many diseases but we will focus on these three diseases : 1- stable angina 2- Unstable angina3- Myocardial infraction

• Definition Know the disease before diagnosing a patient with it. • Clinical features signs, symptoms, … etc that will lead us to the correct diagnosing • Investigating Making tests to the patient to determine more accurately the disease and severity of it , this perhaps will help us in the “ management “.• Management clinical decision that will help the patient to get rid of and/or reduce the disease(s)

For each disease you should know the following

Definition• Imbalance between myocardial oxygen

supply and demand causes transient myocardial ischaemia.

• Coronary atheroma is by far the most common cause of angina.

Stable angina

• Factors that Increased Oxygen Demand (cardiac work)

1- Heart rate.2- Blood pressure.3- Myocardial contractility.4- left ventricle hypertrophy.5- Valve disease ( aortic stenosis ).

Stable angina

• Factors decreased oxygen supply to heart1- Decreased Oxygen Supply ( Coronary Blood Flow)2- Duration of diastole3- Coronary perfusion pressure(aortic diastolic minus coronary sinus or right atrial diastolic pressure)3- Coronary Vasomotor tone4- Oxygenation a.Haemoglobin b. Oxygen saturation

Stable angina

Clinical features1- central chest pain, 2- discomfort 3- breathlessness that is precipitated by exertion or other forms of stress, and is promptly relieved by rest.

Stable angina

Investigations

1- Resting ECG.2- Exercise ECG.3- Myocardial perfusion scanning4- Stress echocardiography5- Coronary arteriography

Stable angina

Management1- Identification and control of risk factors2- Relief of symptoms3- Anti-anginal drugs: Five groups of drugs are used to prevent the symptoms of angina: “ Nitrates, β-blockers, Calcium antagonists, Potassium channel activators (nicorandil), If channel antagonists (ivabradine) “4- Percutaneous coronary intervention (PCI)5- Coronary artery bypass grafting (CABG):

Stable angina