1 / 41

Coronary Artery Disease and Acute Coronary Syndrome

Coronary Artery Disease and Acute Coronary Syndrome. Description. Coronary Artery Disease (CAD) A type of blood vessel disorder that is included in the general category of atherosclerosis. Description. Atherosclerosis Can occur in any artery in the body Atheromas (fatty deposits)

didina
Télécharger la présentation

Coronary Artery Disease and Acute Coronary Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Coronary Artery Disease and Acute Coronary Syndrome

  2. Description • Coronary Artery Disease (CAD) • A type of blood vessel disorder that is included in the general category of atherosclerosis

  3. Description • Atherosclerosis • Can occur in any artery in the body • Atheromas (fatty deposits) • Preference for the coronary arteries

  4. Description • Atherosclerosis • Terms to describe the disease process: • Arteriosclerotic heart disease (ASHD) • Cardiovascular heart disease (CHD) • Ischemic heart disease (IHD) • CAD

  5. Description • Cardiovascular diseases are the major cause of death in the US and Canada • Heart attacks are still the leading cause of all cardiovascular disease deaths and deaths in general

  6. Etiology and Pathophysiology • Atherosclerosis is the major cause of CAD • Characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery

  7. Etiology and Pathophysiology • Endothelial lining altered as a result of chemical injuries • Hyperlipidemia • Hypertension

  8. Etiology and Pathophysiology • Bacteria and/or viruses may have role in damaging endothelium by causing local inflammation • C-reactive protein (CRP) • Nonspecific marker of inflammation • Increased in many patients with CAD • Chronic exposure to CRP triggers the rupture of plaques

  9. Etiology and Pathophysiology • Endothelial alteration  • Platelets are activated • Growth factor stimulates smooth muscle proliferation • Cell proliferation entraps lipids, which calcify over time and form an irritant to the endothelium on which platelets adhere and aggregate

  10. Etiology and Pathophysiology • Endothelial alteration  • Thrombin is generated • Fibrin formation and thrombi occur

  11. Response to Endothelial Injury Fig. 33-3

  12. Stages of Development in Atherosclerosis Fig. 33-4

  13. Etiology and PathophysiologyCollateral Circulation • Analogous to “detours” around atherosclerotic plaques • Occur normally in coronary circulation • But collaterals increase in the presence of chronic ischemia • When occlusion occurs slowly over a long period, there is a greater chance of adequate collateral circulation developing

  14. Collateral Circulation Fig. 33-5

  15. Risk Factors for Coronary Artery Disease • Risk factors can be divided: • Unmodifiable risk factors • Modifiable risk factors

  16. Risk Factors for Coronary Artery Disease • Unmodifiable risk factors: • Age • Gender • Ethnicity • Genetic predisposition

  17. Risk Factors for Coronary Artery Disease • Modifiable risk factors: • Elevated serum lipids • Hypertension • Smoking • Obesity • Physical inactivity • Diabetes mellitus • Stressful lifestyle

  18. Risk Factors for Coronary Artery Disease • Health Promotion • Identification of high-risk persons • Management of high-risk persons • Risk factor modification • Physical fitness • Health education in schools • Nutrition (weight control, ↓ fat, ↓ chol intake) • Cholesterol-lowering medications

  19. Types of Angina • Results when the lack of oxygen supply is temporary and reversible • Types of Angina • Stable Angina • Prinzmetal Angina • Unstable Angina

  20. Stable Angina Pectoris • Chest pain occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms • Can be controlled with medications on an outpatient basis • Pain usually lasts 3 to 5 minutes • Subsides when the precipitating factor is relieved • Pain at rest is unusual

  21. Silent Ischemia

  22. Prinzmetal’s Angina • Occurs at rest usually d/t spasm of major coronary artery • Spasm may occur in the absence of CAD

  23. Unstable Angina • Angina that is: • New in onset • Occurs at rest • Has a worsening pattern • Unpredictable • Considered to be an acute coronary syndrome • Associated with deterioration of a once stable atherosclerotic plaque

  24. Clinical Manifestations Angina • Chest pain or discomfort (d/t ischemia) • A strange feeling, pressure, or ache in the chest • Constrictive, squeezing, heaving, choking, or suffocating sensation • Indigestion, burning

  25. However • Up to 80% of patients with myocardial ischemia are asymptomatic • Associated with diabetes mellitus and hypertension

  26. Location of Chest Pain Fig. 33-12

  27. Diagnostic StudiesAngina • ECG • Coronary angiography • Cardiac markers (CK MB, Troponin) • Treadmill exercise testing (stress test) • Serum lipid levels • C-reactive protein (CRP) • Nuclear imaging

  28. Collaborative CareAngina • Treatment for stable angina: •  oxygen demand and/or  oxygen supply • Nitrate therapy • Stent placement

  29. Collaborative CareAngina • Treatment for stable angina: • Percutaneous coronary intervention • Atherectomy • Laser angioplasty • Myocardial revascularization (CABG)

  30. Collaborative CareAngina • Drug Therapy • Antiplatelet aggregation therapy • Aspirin: drug of choice (for MI prevention) • First line of treatment for angina

  31. Collaborative CareAngina • Drug Therapy • Nitrates • 1st line therapy for treatment of acute anginal symptoms • Dilation of vessels

  32. Collaborative CareAngina • Drug Therapy • -Adrenergic blockers • Calcium channel blockers

  33. Collaborative CareAngina • Percutaneous coronary intervention • Surgical intervention alternative • Performed with local anesthesia • Ambulatory 24 hours after the procedure

  34. Collaborative CareAngina • Stent placement • Used to treat abrupt or threatened abrupt closure and restenosis following PCI

  35. Collaborative CareAngina • Atherectomy • The plaque is shaved off using a type of rotational blade • Decreases the incidence of abrupt closure as compared with PCI

  36. Collaborative CareAngina • Laser angioplasty • Performed with a catheter containing fibers that carry laser energy • Used to precisely dissolve the blockage

  37. Collaborative CareAngina • Myocardial revascularization (CABG) • Primary surgical treatment for CAD • Patient with CAD who has failed medical management or has advanced disease is considered a candidate

  38. Clinical Manifestations Myocardial Infarction • Pain • Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration • The hallmark of an MI

  39. Clinical Manifestations • Acute Coronary Syndrome (ACS) • Develops when the oxygen supply is prolonged and not immediately reversible

  40. Clinical Manifestations • ACS encompasses: • Unstable angina • Myocardial infarction (MI)

  41. Relationships Among CAD, Stable Angina, and MI Fig. 33-8

More Related