Coronary Heart Disease (CHD)

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Coronary Heart Disease (CHD)

• László Tornóci
• Inst. Pathophysiology
• Semmelweis University

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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.
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Natural history
Possible symptoms or results

• No symptoms
• Angina pectoris
• Acute myocardial infarction
• Chronic heart failure
• Sudden death

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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

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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

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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

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Acute Myocardial Infarction (AMI)

• Symptoms
• Natural history, prognosis
• ECG signs
• Complications
• STEMI vs. NSTEMI infarctions

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Vulnerable plaque
NEJM 342101 (2000)
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Plaque rupture
NEJM 342101 (2000)
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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

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ACS types
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Pathophysiology
Stable angina
NSTEMI
UA, STEMI
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Diagnosis of AMI

• Clinical signs
• ECG signs (ST elevation, depression, pathological
  Q)
• Plasma conc. of cardiac troponin T or I

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Prevention of CHD

• Quit smoking
• Avoid sedentary lifestyle
• Care of hypertension
• Care of DM
• Care of hyperlipidemias

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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

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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

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