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Coronary Artery Disease Clinical Manifestations Some video’s have had to be removed from the presentation due to size regulations. If any would like the original (1gb) presentation please contact Rob Turnbull (ret23) Dr Sameer Kurmani BHF Clinical Research Fellow Department of Cardiovascular Sciences Email: [email protected] Cardiovascular Disease Coronary Heart Disease Statistics 2010. P Scarborough et al. BHF Health Promotion Research Group Department of Public Health, Oxford Underlying Pathology: Atherosclerosis Thrombosis Formation of clot in response to plaque rupture with activation of coagulation cascade and platelets Embolism Occlusion of a vessel by an embolus created proximally to the site of occlusion Ischaemia Reduction in oxygen delivery to target tissue as a result of altered blood flow Infarction Necrosis of tissue resulting from Ischaemia Aneurysm Abnormal dilation of vascular wall Heart Disease: Broad Classification Coronary Artery Disease Valvular Heart Disease Arrythmias Heart Failure Other Diseases Myopericarditis, Endocarditis, Congenital & Acquired Structural Heart Disease, Cardiac Tumours, Hypertension History of Presenting Complaint 68yr old man presents to the General Practitioner with a 3 month history of chest pain. He reports that while gardening or walking the dog, he gets a discomfort in the middle of his chest which feels really heavy. After stopping for a couple of minutes, this settles before he can carry on again. Past Medical History Hypercholesterolaemia Hypertension Drug History Simvastatin 40mg Amlodipine 10mg Management of Angina Good Control of Cardiovascular Risk Factors Smoking, Hypertension, Hypercholesterolaemia, Diabetes Mellitus Anti-Anginal Therapy Nitrates, β-blockers, Ca2+ channel antagonists, If channel inhibitors, Ranolazine Percutaneous Coronary Intervention Drug-Eluting Stents, Bare Metal Stents Coronary Artery Bypass Grafting Left Internal Mammary Artery, Right Internal Mammary Artery, Saphenous Vein Grafts History of Presenting Complaint 59yr old man presents to the Emergency Department with a 1 hour history of central ‘crushing’ chest pain following an argument with his wife. He describes it like an elephant sitting on his chest and he is short of breath and clammy with it. Past Medical History Smoker Hypercholesterolaemia Hypertension Drug History Simvastatin 40mg Amlodipine 10mg Stable Angina Chest pain brought on predictably by exertion/stress which is relieved by rest or GTN Acute Coronary Syndromes: UA, STEMI, NSTEMI Unstable Angina Anginal pain of unpredictable onset/duration that may be associated with ischaemic ECG changes but without evidence of myocardial necrosis Non ST-elevation Myocardial Infarction Anginal pain of unpredictable onset/duration that may be associated with ischaemic ECG changes with evidence of myocardial necrosis ST-elevation Myocardial Infarction Anginal pain of unpredictable onset/duration associated with ST-segment elevation with evidence of myocardial necrosis History of Presenting Complaint Following an ostensibly successful stent, the patient remained on the Coronary Care Unit where he developed progressive shortness of breath and frequent palpitations. The chest pains have largely settled. Complications of Myocardial Infarction Ischaemic Re-infarction, Stent thrombosis, Infarct Extension Mechanical Heart Failure, Papillary muscle rupture, Ventricular Septal Defect, Mitral valve dysfunction, Aneurysms, Cardiac Rupture Arrhythmic Atrial & Ventricular arrhythmias, AV nodal dysfunction Embolic Central Nervous System, Peripheral Vasculature Inflammatory Pericarditis, Dressler’s Syndrome Questions?