angina presentation
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Transcript of angina presentation
Angina
Angina
1
Angina1
What is anginaChest pain caused by transient myocardial ischemia due to an imbalance between Myocardial oxygen supply
Myocardial oxygen demand
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Classes
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Classes (cont.)Stable angina:
Most common type of angina
Common in smokers, hypertensive patients
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Classes (cont.)Unstable angina:Less common than stable angina
can occur at any time, duringstrenuous exerciseRest
Urgent condition and can progress to heart attack
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Classes (cont.)Prinzmetal Angina
vasospasm occursNarrowing of the coronariesNo buildup of fatty deposits in the artery walls
Experienced at night, which can be disruptive to sleep
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Pathophysiology7Coronaries narrow by plaque lead to stable angina
Clot formationlead to unstable angina
Video
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Causes 8
videoWhat Causes Angina -presentation.wmv
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Symptoms
The common symptoms:
Chest pain
Squeezing of the chest
Uncomfortable pressure
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Angina itself is a symptomHeavy pressure squeezing9
Symptoms (cont.)
Chest pain that may spread to :Left shouldersNeck ArmsJaws
The pain is milder when leaning forward
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Risk FactorsMajor non-modifiable
Age over 40
Gender ( > )
Family history
Major modifiable
Dyslipidaemia
Hypertension
Smoking
DM(insulin resistance)
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Risk Factors (cont.)Major non-modifiable
Age over 40
Gender ( > )
Family history
Major modifiable
Obesity
Sedentary lifestyle
Atherogenic diet
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Risk Factors (cont.)Minor Controllable
Lack of exercise
Personality
Extreme temperatures
Emotional Stress
Alcohol Abuse
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Risk Factors (cont.) 3 CAD risk factors (cholesterol, DM , smoking , HTN).
Prior CAD (cath stenosis 50%).
2 anginal events----- 24 hours.
ST segment deviation.
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DiagnosisECG ------ non-invasive (85% accurate).
Exercise stress test with ECG .
Holter monitoring (24 hrs ambulatory ECG).
Cardiac catheterization
Diagnostic
Therapeutic
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Diagnosis (cont.)ECGUseful to confirm angina pain and other abnormal features.
Must be coupled with some sort of stress test
ECG levels during a 24 hour period (used with nocturnal angina)
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Diagnosis (cont.)ECG17
Diagnosis (cont.)Angiography Insertion of a catheter to coronaries
Dye is injected
Detect blocks
Accurate
Effective
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Do not recommendations
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Exclude people from treatment based on their age.
Do not recommendations (cont.)
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Investigate/treat symptoms differently in men and women in different ethnic groups.
Do not recommendations (cont.)
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Offer vitamin or fish oil supplements
Do not recommendations (cont.)22
Offer TENS, EECP or acupuncture
TENS Transcutaneous electrical nerve stimulationEECP Enhanced External counter pulsation
Do not recommendations (cont.)23
Routinely offer drugs for 2ry prevention of CVD to people with suspected cardiac syndrome X
Cardiac syndrome Xis angina (chest pain) with signs associated with decreased blood flow to heart tissue but with normal coronary arteries
Management 24
Risk factor modification25
Limit alcohol
No high saturated fat/high cholesterol foods
Maintain normal blood lipid levels
Maintain blood pressure within normal range
Risk factor modification (cont.)Regular exercise
Optimal weight
Maintain blood glucose within normal range
No tobacco
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Pharmacological Management Pharmacological Management include:
Beta blockers
calcium channel blockers
Nitrates
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Pharmacological Management (cont.) Pharmacological Management include:
Antiplatelets
Other agents
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Beta blockers
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Beta blockers (cont.)
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Beta blockers (cont.) Pharmacological effects:
myocardial oxygen consumption by:
heart rate
blood pressure
myocardial contractility
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Calcium channel blockers 32
Calcium channel blockers (cont.)Pharmacological effects: Reduce trans membrane flux of calcium via calcium channels:
Negative chronotropicNegative inotropicSmooth Muscle relaxation
Therefore myocardial oxygen Consumption & Enhance coronary perfusion. 33
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Nitrates
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Nitrates (cont.)Pharmacological effects:Relax all types of smooth muscles vascular or non vascular.
Relax both arteries and veins but more effective on veins.
Increase cGMP that decrease platelet aggregation.
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Antiplatelets
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Antiplatelets (cont.)Pharmacological activity:
Prevent thrombus formation by inhibiting platelet aggregation by:
Inhibits prostaglandin synthesis by cyclooxygenase
Inhibitor of ADP-induced pathway for platelet aggregation
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Anti-ischemic agentsRanolazine
Inhibits fatty acid oxidation Inhibits late sodium current into myocardial cells
Prolongs QT interval
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Anti-ischemic agents (cont.)Ranolazine
Indicated for chronic angina unresponsive to other antianginal treatments.
Does not reduce blood pressure or heart rate
Therefore myocardial oxygen Consumption and maintain perfusion
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Surgery & Revascularization Surgical options includes:CABG
Veins fromSaphenous vein (leg)
Arteries fromInternal mammary artery (chest)
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Surgery & Revascularisation (cont.) Surgical options inlcludes:PCI
Use balloon
Use stent
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PCI Percutaneous coronary intervention
ComplicationsAngina condition can progress to myocardial infarction MI
MI includes permanant necrosis in the tissue of myocardium
Patient non responsive to NTG
Dont give more than 3 NTG sublingual pills
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Complications (cont.)Emergency situation
Quick management required: Systolic BP must be maintained above 100 mm Hg and, optimally, below 140 mm Hg.
OXYGEN
MORPHINE (IV)
BETA-BLOCKERS & NITRATES (IV)
THROMBOLYTICS
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0 hrs0% damage24 hrs100% damage
ConclusionAngina is chest pain caused by transient myocardial ischemia due to lack of adequate oxygen supply44
Conclusion (cont.)45
Conclusion (cont.)Angina occurs due to narrowing of the coronary arteries by:
Spasm
Plaque
formation 46
Conclusion (cont.)Angina caused by:
Smoking Sedentary life
Unhealthy foods
Alcohol abuse
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Conclusion (cont.)Angina is presented mainly as:
Chest pain that may spread to :Left shoulders
Neck
Arms
Jaws
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Conclusion (cont.)Angina can be diagnosed by:
ECG (stress)
Coronary angiography49
Conclusion (cont.)
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DONT Offer TENS, EECP or acupuncture
Conclusion (cont.)
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Offer vitamin or fish oil supplements
Conclusion (cont.)
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DONT Routinely offer drugs for 2ry prevention to patient with suspected cardiac syndrome X
Conclusion (cont.)
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Conclusion (cont.)Pharmacological Management include:
Beta blockers
calcium channel blockers
Nitrates
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Conclusion (cont.)Pharmacological Management include:
Antiplatelets
Other agents (e.g. Ranolazine )
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Conclusion (cont.)Risk factor modification is the most important No smoking
Limit alcohol
No high saturated fat/high cholesterol foods
Maintain normal blood lipid levels
Maintain blood pressure within normal range
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