Coronary Heart Disease (CHD) - PowerPoint PPT Presentation

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Coronary Heart Disease (CHD)

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Significance Natural history No symptoms Angina pectoris Acute myocardial infarction Chronic heart failure Sudden ... ST elevation No response to nitrates ... – PowerPoint PPT presentation

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Title: Coronary Heart Disease (CHD)


1
Coronary Heart Disease (CHD)
  • László Tornóci
  • Inst. Pathophysiology
  • Semmelweis University

2
Significance
CHD causes more deaths and disability than any
other disease in the developed countries.
CHD like stroke and occlusion of peripheral
arteries is a consequence of atherosclerosis.
3
Natural history
Possible symptoms or results
  • No symptoms
  • Angina pectoris
  • Acute myocardial infarction
  • Chronic heart failure
  • Sudden death

4
Angina pectoris
Severe, dull pain in the chest of limited
duration. Usually provoked by physical activity,
cold, or a large meal. Pain is relieved by
nitrates in the classic type.
  • Classic vs. Prinzmetal angina
  • Stable vs. unstable angina

5
Comparison of angina types
Classic angina
Prinzmetal angina
  • Common
  • Usually stress induced (effort angina)
  • ECG ST depression
  • Responds to nitrates
  • Caused by coronary occlusion
  • Rare
  • Usually occurs at rest (during sleep)
  • ECG ST elevation
  • No response to nitrates
  • Caused by coronary spasm

6
Stable vs. unstable angina
  • Good prognosis
  • Caused by quiescent plaque
  • Reproducable pain
  • Poor prognosis
  • Caused by ruptured plaque
  • Pain unusually bad, occurs more frequently or
    unexpectedly

7
Acute Myocardial Infarction (AMI)
  • Symptoms
  • Natural history, prognosis
  • ECG signs
  • Complications
  • STEMI vs. NSTEMI infarctions

8
Vulnerable plaque
NEJM 342101 (2000)
9
Plaque rupture
NEJM 342101 (2000)
10
Acute Coronary Syndrome (ACS)
ACS may be
  • AMI
  • unstable angina

ACS is suspected
  • First angina-like pain ever
  • Angina in CHD patients, if
  • Pain is not relieved by nitrates and/or
  • Pain is unusually severe

11
ACS types
12
Pathophysiology
Stable angina
NSTEMI
UA, STEMI
13
Diagnosis of AMI
  • Clinical signs
  • ECG signs (ST elevation, depression, pathological
    Q)
  • Plasma conc. of cardiac troponin T or I

14
Prevention of CHD
  • Quit smoking
  • Avoid sedentary lifestyle
  • Care of hypertension
  • Care of DM
  • Care of hyperlipidemias

15
Prevention of AMI in CHD patients
All things mentioned in the previous slide
  • Use of drugs (aspirin)
  • Check progression of CHD
  • Hospitalize unstable angina cases
  • Surgery, angioplasty, stent if necessary

16
Therapy of AMI
  • Minimize damage (PTCA, thrombolysis)
  • Control arrhythmias, circulation
  • Look for complications
  • Fight cardiac shock if it develops
  • Assessment of prognosis, rehabilitation
  • Secondary prevention

17
PTCA
Percutaneous Transluminal Coronary Angioplasty
Currently the best way to minimize the damage
caused by AMI
Timing is very important, however
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