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Coronary Artery Diseases

Prof. dr. Harris Hasan SpPD,SpJP(K),FIHA


Departemen Kardiologi & Kedokteran Vaskular
FK USU RSUP H.Adam Malik

Risk factors CAD


Non modified : Age ( M > 40 y; F
menopause)

Sex ( M > F )
Family history

(genetic)
Modified (Major) :

Smoking
Diabetes
Hypertension

Stable Angina
Pectoris
Definition : Chest discomfort
or pain caused by myocardial
ischaemia or coronary
stenosis is due to atheroma
plaque in coronary artery.
It makes imbalance
myocardial oxygen demand
and supply.

Typical angina.
Feature

discomfort , pain, burns,


heaviness, sharp, pressure.
Location : Central chest (substernal),
precordial, epigastric.
Duration : 1 5 minutes.
Radiation : Back, neck, jaw, left arm.
Elicited :
physical activity, emotional
stress.
Relieved : rest, nitrate sublingual.

Complications :
-Prolong

chest pain (angina)


or neurogenic shock.
- Heart failure , acute
pulmonary edema,
cardiogenic shock.
-- Arrhytmia or suddent death.
-- Rupture (chordae, septal).

The ten commandments of the management


of stable angina
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Identify and treat precipitating factors


Initiate diet and lifestyle changes, to control risk factors, improve
diet, and encourage physical activity
Initiate anti-anginal therapy, tailored to the patient symptoms,
starting usually with -blockers
Ensure prescription of proper effective evidence-based
pharmacological secondary prevention (the fab four quartet)
Prescribe and explain the use of sublingual nitroglycerin
Re-evaluate the patient at regular intervals for ischaemia
Consider revascularization in patients who have severe symptoms
or evidence of severe ischaemia
Consider the symptomatic and prognostic benefits or physical
training
Educate the patient for long-term compliance
Instruct on the steps to take in an emergency