Coronary Heart Disease

Coronary Heart Disease

Coronary Heart Disease

-Risk Factors for Heart Disease

-Non Modifiable Risk Factors

-Age

-Male Sex

-Family history of Premature Heart Disease

-High Elevated Lipoprotein A

-Elevated Fibrinogen Levels

-Decreased Fibrinolytic Activity
                        -Elevated homocysteine levels

-Risk Factors (Modifiable)

-Smoking

-Hyperlipidemia

-DM

-HTN

-Obesity and Inactivity

-Angina Pectoris 

-Discomfort in the chest related to myocardial ischemia

-Comes as a result of oxygen demand of myocardial tissue not meeting demand

-Can be from the jaw to the epigastrium

-May be associated with shortness of breath, diaphoresis, palpitations, or nausea

-If related to activity usually last less than 15 minutes

-Maybe improved with rest or nitroglycerin

-Stable Angina is when the pain is a chronic pattern and predictable with exertion

-The pain is alleviated with rest and does not occur at rest

-Unstable Angina

-Angina is consider unstable when it varies from baseline in terms of frequency, severity, duration of the episodes

-Occurs at rest

-Stable Angina

-Medical management involves risk factor modification

-Should be started on ASA therapy

-Nitrates, Beta Blockers, and calcium channel blockers can be used to help symptoms

-Should be on lipid lowering meds

-Beta Blockers inhibit catecholamine receptors and reduce myocardial oxygen demand

-Nitrates decrease systemic vascular resistance and help heart work more efficiently 

-Unstable Angina

-IV Nitroglycerin is used in the management of unstable angina

-Beta Blockers and Calcium Channel Blockers are used

-Oxygen, heparin/lovenox, ASA, and morphine are used

-Will need to be evaluated for re-vascularization

-Cardiac Catheterization Indications

-Unacceptable response to medical therapy

-Abnormal non invasive testing

-Angina in the setting of depressed LV function

-STEMI

-Chest pain with new onset LBBB

-Prinzmetal’s Angina

-Also called variant angina

-Caused by coronary artery spasm

-Presents similar to angina by discomfort described as a pain and episodes tend to occur at rest

-Treated with calcium channel blockers

-Acute MI

-ST elevation MI (STEMI)

-EKG shows ST elevation MI in Anterior Lateral Leads

-new ST elevation at the J Point at least 2 contiguous leads of >2 mm is diagnostic of with chest pain

-New LBBB with chest pain is a STEMI

-Treatment-ASA 325 mg PO, O2, Nitroglycerin, Morphine, Heparin, Beta Blockers.  Also glycoprotein IIb/IIIa inhibitors

-Patients need Reperfusion Therapy ASAP

-TPA should be reserved for when reperfusion therapy not readily 

-Non ST Elevation MI

-Non Q Wave MI usually do not have occlusion of the infarct related coronary artery

-Higher mortality

-Elevated Troponin without ST elevation on EKG.  Must also have Angina type chest pain

-Medical management involves ASA, Beta Blockers, nitrates, oxygen, and morphine

-Oral diltazem may decrease risk of reinfarction

-ACE inhibitors for those with decreased ejection fraction

-Identifying the Area Infarcted

-Inferior MI-ST Elevation seen in leads II, III and avF

-At least two contiguous leads

-Anteriolateral STEMI- ST elevation in anterior leads (V3, V4) and lateral leads (I, aVL, V5 and V6)

-ST elevation in at least 2 contiguous leads

-Septal Wall MI-ST elevation in septal leads (V1 and V2) 

-ST elevation in at lease two contiguous leads

-Posterior Wall STEMI-1 mm ST depression occurring in leads V1-V4

-These occur in at least 2 contiguous leads