DOCSLIB.ORG

Incidence Ofcoronary Artery Disease in Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Incidence Ofcoronary Artery Disease in Patients Br Heart J: first published as 10.1136/hrt.44.6.630 on 1 December 1980. Downloaded from Br Heart J 1980: 44: 630-7 Incidence of coronary artery disease in patients with valvular heart disease G W MORRISON,* R D THOMAS,t S F M GRIMMER, P N SILVERTON4$ D R SMITH From the Department of Cardiology, The General Infirmary, Leeds SUMMARY The case notes, cardiac catheterisation data, and coronary arteriograms of 239 patients investigated for valvular heart disease during a five year period were reviewed. Angina was present in 13 of 95 patients with isolated mitral valve disease, 43 of 90 patients with isolated aortic valve disease, and 18 of54 patients with combined mitral and aortic valve disease. Significant coronary artery disease was present in 85 per cent of patients with mitral valve disease and angina, but in only 33 per cent of patients with aortic valve disease and angina. Patients with no chest pain still had a high incidence of coronary artery disease, significant coronary obstruction being present in 22 per cent with mitral valve disease, 22 per cent with aortic valve disease, and 11 per cent with combined mitral and aortic valve disease. Several possible clinical markers of coronary artery disease were examined but none was found to be of practical help. There was, however, a significant inverse relation between severity of coronary artery disease and severity of valve disease in patients with aortic valve disease. copyright. Asymptomatic coronary artery disease is not uncommon in patients with valvular heart disease and if it is policy to perform coronary artery bypass grafting in such patients, routine coronary arteriography must be part of the preoperative investigation. per- Angina occurs commonly in valvular heart dis- tion, and coronary artery bypass grafting is http://heart.bmj.com/ ease'-" but does not necessarily signify the presence formed for significant lesions whenever feasible, of coronary artery disease,'-3 8 This is particularly even when angina is absent. We have performed a true in patients with aortic valve disease'-8; retrospective study of these patients in order to it also applies in those with mitral valve disease. answer three main questions. First, what is the In addition, there are some patients without incidence of significant coronary artery disease in angina who still have significant coronary obstruc- patients with valve disease with and without angina? tion.3 8-10 In patients being considered for valve Second, are there any clinical features predictive of it is that the presence such disease? Third, how often are such lesions surgery generally accepted on September 27, 2021 by guest. Protected of angina is an indication for coronary arteriography amenable to surgical correction? as part of the preoperative investigations.' 8 l-13 Much less is known of the need for routine coronary Methods arteriography in patients without angina. Patients with coronary artery disease do less well after We reviewed the case notes of all adult patients who surgery,"1 13-17 and this has led to increasing underwent coronary arteriography as part of the interest in the possibility of treating coronary preoperative cardiac catheterisation for valvular artery disease at the time of valve surgery. During heart disease during the period 1 January 1975 to the past five years it has been our policy to perform 31 December 1979. Patients with valvular heart routine coronary arteriography on patients aged 45 disease resulting directly from ischaemic heart years or more as part of the preoperative investiga- disease (for example papillary muscle dysfunction) were excluded. A note was made of each patient's *Present address: St. James's University Hospital, Leeds LS9 7TF age, sex, and smoking history. The clinical history tPresent address: Royal United Hospital, Bath BAl 3NT. was examined for evidence of angina pectoris. *Present address: Department of Cardiovascular Studies, The University, Leeds LS2 9JT. Episodes of typical anterior chest pain, with or with- Received for publication 22 May 1980 out radiation, precipitated by exertion and relieved 630 Br Heart J: first published as 10.1136/hrt.44.6.630 on 1 December 1980. Downloaded from Incidence of coronary artery disease 631 by rest or an oral nitrate, were regarded as "typical least one other experienced operator. In the case of angina". In addition, there were some patients who borderline lesions, or a disparity in reporting, a had chest pain with some, but not all, of these third opinion was obtained. All reporting was done features, and these were classified as "atypical chest without clinical knowledge of the patient. The pain". Patients without pain were classified as "no severity of coronary artery stenosis was assessed chest pain". A record was made of any past cardiac as the maximum percentage reduction in luminal ischaemic events and past or current drug treatment. diameter, seen in any one of at least three different The electrocardiogram was examined for rhythm, projections, as compared with the diameter of the evidence of cardiac ischaemia, and previous myo- vessel proximal to the obstruction. The severity of cardial infarction. Heart size was assessed by the each lesion was graded on a simple scale from 0 to 4 radiological cardiothoracic ratio. as follows: 0 =no obstruction; 1=1 to 49 per cent; The data obtained at cardiac catheterisation were 2=50 to 69 per cent; 3=70 to 99 per cent; 4=total reviewed. Pulmonary hypertension was indicated by occlusion. Obstructions of grade 2 or more were a pulmonary artery mean pressure greater than said to be "significant". The maximum narrowings 20 mmHg. Left ventricular end-diastolic pressure on five major vessels' branches were assessed. The was measured directly. Mitral valve gradients were left main stem; left anterior descending; circumflex; measured indirectly between pulmonary artery obtuse marginal (large lateral) branch of the mean wedge pressure and left ventricular end- circumflex; and right coronary arteries were diastolic pressure. Aortic valve gradients were chosen because of their surgical importance in measured by withdrawal from left ventricle to coronary artery bypass grafting. Major vessel aorta. Pressures were measured at rest using disease was assessed as zero, single, double, or Statham (P23 Gp) strain gauges recording on an triple, and the overall severity of coronary artery ultraviolet light recorder. The zero reference point disease was estimated by summing the grades of was 10 cm above the level of the catheter table. The stenosis in the five vessel branches listed above. This severity of valve obstruction was graded on a total was called the coronary score. copyright. simple scale, from 0 to 4, according to the gradient Finally the decision made at the time of investiga- at rest. For mitral stenosis: 0 =no gradient; 1 =1 to tion regarding surgery was recorded and the opera- 4 mmHg; 2 =5 to 10 mmHg; 3 = 11 to 19 mmHg; tion notes examined to obtain details of the pro- 4=more than 20 mmHg. For aortic stenosis: cedure performed. 0=no gradient; 1=1 to 34mmHg; 2=35 to 49 The significance of differences between groups mmHg; 3=50 to 74mmHg; 4=more than 75 was tested using Student's t test for unpaired data mmHg. Haemodynamically "significant" valve or x2 as appropriate. The significance of correla- http://heart.bmj.com/ obstruction was arbitrarily defined as grade 3 or 4. tions was tested by linear regression analysis. The severity of mitral or aortic valve regurgitation was assessed from the left ventricular or aortic root Results cine angiogram and graded on a simple scale from 0 to 4 according to the criteria of Yang et al.'8 During the study period, 239 patients with valvular Haemodynamically "significant" regurgitation was heart disease underwent routine coronary arterio- said to be present with a grade of 3 or 4. The overall graphy as part of their preoperative cardiac cathe- severity ofvalvular disease was assessed by summing terisation. Isolated mitral valve disease was present on September 27, 2021 by guest. Protected all the grades of stenosis and regurgitation, this then in 95 (40%) with isolated stenosis in 35 and isolated being called the valve score. On the basis of the data regurgitation in 10, the remaining 50 having mixed obtained from cardiac catheterisation and angio- lesions. Isolated aortic valve disease was present in graphy the patients were assigned to one of three 90 (38%) with isolated stenosis in 37, isolated groups, depending upon the presence of "signi- regurgitation in 28, and mixed lesions in 25. There ficant" disease as defined above: isolated mitral were 54 (23%) patients with combined mitral and valve disease; isolated aortic valve disease; combined aortic valve disease. A few patients also had tricuspid mitral and aortic valve disease. valve disease but the severity of this was not as- Left ventricular function was assessed from the sessed. The average age of the patients was 51 0 + ejection fraction, calculated from the left ventricular 8-7 years (±SD), with no differences between the volumes obtained from single plane right anterior valve groups. There were 117 men and 122 women. oblique ventriculography.19 Coronary arteriography Typical angina was present in 74 (31%) patients, was performed by the Judkins or Sones technique. atypical chest pain in 34 (14%), and no chest pain Both coronary arteries were injected in at least three in 131 (55%). Coronary arteriography was therefore projections using magnified images. The arterio- performed as a routine screening procedure in more grams were analysed by a cardiac radiologist and at than half the patients. Br Heart J: first published as 10.1136/hrt.44.6.630 on 1 December 1980. Downloaded from 632 Morrison, Thomas, Grimmer, Silverton, Smith Table 1 Relation between angina and coronary artery disease in 239 patients being investigated for valvular heart disease No.
Load more

Recommended publications
  • J Wave and Cardiac Death in Inferior Wall Myocardial Infarction
    ORIGINAL ARTICLES Arrhythmia 2015;16(2):67-77 J Wave and Cardiac Death in Inferior Wall Myocardial Infarction Myung-Jin Cha, MD; Seil Oh, MD, ABSTRACT PhD, FHRS Background and Objectives: The clinical significance of J wave Department of Internal Medicine, Seoul National University presentation in acute myocardial infarction (AMI) patients remains Hospital, Seoul, Korea unclear. We hypothesized that J wave appearance in the inferior leads and/or reversed-J (rJ) wave in leads V1-V3 is associated with poor prognosis in inferior-wall AMI patients. Subject and Methods: We enrolled 302 consecutive patients with inferior-wall AMI who were treated with percutaneous coronary in- tervention (PCI). Patients were categorized into 2 groups based on electrocardiograms before and after PCI: the J group (J waves in in- ferior leads and/or rJ waves in leads V1-V3) and the non-J group (no J wave in any of the 12 leads). We compared patients with high am- plitude (>2 mV) J or rJ waves (big-J group) with the non-J group. The cardiac and all-cause mortality at 6 months and post-PCI ventricular arrhythmic events ≤48 hours after PCI were analyzed. Results: A total of 29 patients (including 19 cardiac death) had died. Although all-cause mortality was significantly higher in the post-PCI J group than in the non-J group (p=0.001, HR=5.38), there was no difference between the groups in cardiac mortality. When compar- ing the post-PCI big-J group with the non-J group, a significant dif- ference was found in all-cause mortality (n=29, p=0.032, HR=5.4) and cardiac mortality (n=19, p=0.011, HR=32.7).
    [Show full text]
  • Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease
    Europace (2017) 0, 1–21 EHRA CONSENSUS DOCUMENT doi:10.1093/europace/eux240 Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulacion Cardıaca y Electrofisiologıa (SOLEACE) Gregory Y. H. Lip1*, Jean Philippe Collet2, Raffaele de Caterina3, Laurent Fauchier4, Deirdre A. Lane5, Torben B. Larsen6, Francisco Marin7, Joao Morais8, Calambur Narasimhan9, Brian Olshansky10, Luc Pierard11, Tatjana Potpara12, Nizal Sarrafzadegan13, Karen Sliwa14, Gonzalo Varela15, Gemma Vilahur16, Thomas Weiss17, Giuseppe Boriani18 and Bianca Rocca19 Document Reviewers: Bulent Gorenek20 (Reviewer Coordinator), Irina Savelieva21, Christian Sticherling22, Gulmira Kudaiberdieva23, Tze-Fan Chao24, Francesco Violi25, Mohan Nair26, Leandro Zimerman27, Jonathan Piccini28, Robert Storey29, Sigrun Halvorsen30, Diana Gorog31, Andrea Rubboli32, Ashley Chin33 and Robert Scott-Millar34 * Corresponding author. Tel/fax: þ44 121 5075503. E-mail address: [email protected] Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author 2017. For permissions, please email: [email protected]. 2 G.Y.H. Lip 1Institute of Cardiovascular Sciences, University of Birmingham and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (Chair, representing EHRA); 2Sorbonne Universite´ Paris 6, ACTION Study Group, Institut De Cardiologie, Groupe Hoˆpital Pitie´-Salpetrie`re (APHP), INSERM UMRS 1166, Paris, France; 3Institute of Cardiology, ‘G.
    [Show full text]
  • Unstable Angina with Tachycardia: Clinical and Therapeutic Implications
    Unstable angina with tachycardia: Clinical and therapeutic implications We prospectively evaluated 19 patients with prolonged chest pain not evolving to myocardiai infarction and accompanied with reversible ST-T changes and tachycardia (heart rate >lOO beats/min) in order to correlate heart rate reduction with ischemic electrocardiographic (ECG) changes. Fourteen patients (74%) received previous long-term combined treatment with nifedipine and nitrates. Continuous ECG monitoring was carried out until heart rate reduction and at least one of the following occurred: (1) relief of pain or (2) resolution of ischemic ECG changes. The study protocol consisted of carotid massage in three patients (IS%), intravenous propranolol in seven patients (37%), slow intravenous amiodarone infusion in two patients (lo%), and intravenous verapamil in four patients (21%) with atrial fibrillation. In three patients (16%) we observed a spontaneous heart rate reduction on admission. Patients responded with heart rate reduction from a mean of 126 + 10.4 beats/min to 64 k 7.5 beats/min (p < 0.005) and an ST segment shift of 4.3 k 2.13 mm to 0.89 k 0.74 mm (p < 0.005) within a mean interval of 13.2 + 12.7 minutes. Fifteen (79%) had complete response and the other four (21%) had partial relief of pain. A significant direct correlation was observed for heart rate reduction and ST segment deviation (depression or elevation) (f = 0.7527 and 0.8739, respectively). These patients represent a unique subgroup of unstable angina, in which the mechanism responsible for ischemia is excessive increase in heart rate. Conventional vasodilator therapy may be deleterious, and heart rate reduction Is mandatory.
    [Show full text]
  • The J Wave of the ECG. Concepts Compiled by Dr
    The J wave of the ECG. Concepts Compiled by Dr. Andrés R. Pérez Riera The J wave is a positive deflection in the ECG normal (present in 2%–14% of healthy individuals and is more prevalent in young males, particularly if athletic and African descent. Additionally, ERP is a common finding in young teen athletes (the prevalence in the athletic population rises to 20-90%.).1 In this population ERP in both inferior and lateral leads is more common (18.2%) than isolated inferior (9.1%) or lateral (8.2%) ERP. Young age might be a contributing factor in causing a more diffuse repolarization abnormality. 2 or pathological that occurs approximately (There is an overlap of ≈10 msec. 3) after the junction between the end of the QRS complex and the beginning of the ST segment, also known as the J point (junction point), QRS end, J-junction, ST0 [zero millisecond] or ST beginning to occur after the notch/slur or J wave 4. It is described as J deflection as slurring/lambda 5 or notching of the terminal portion of QRS complex. Currently, J waves, is defined as an elevation of the QRS-ST junction ≥1 mm either as QRS slurring or notching in at least 2 contiguous leads. Additionally, when it becomes more accentuated, it may appear as a small, R wave (R′) or ST segment elevation. The term J deflection or J-wave has been used to designate the formation of the wave produced when there is a large, prominent deviation of the J point from the baseline with two shapes: notching/spike-and- slurring/lambda 5 or dome 6 variety.
    [Show full text]
  • Percutaneous Mitral Valve Therapies: State of the Art in 2020 LA ACP Annual Meeting
    Percutaneous Mitral Valve Therapies: State of the Art in 2020 LA ACP Annual Meeting Steven R Bailey MD MSCAI, FACC, FAHA,FACP Professor and Chair, Department of Medicine Malcolm Feist Chair of Interventional Cardiology LSU Health Shreveport Professor Emeritus, UH Health San Antonio [email protected] SRB March 2020 Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company • Grant/Research Support • None • Consulting Fees/Honoraria • BSCI, Abbot DSMB • Intellectual Property Rights • UTHSCSA • Other Financial Benefit • CCI Editor In Chief SRB March 2020 The 30,000 Ft View Maria SRB March 2020 SRB March 2020 Mitral Stenosis • The most common etiology of MS is rheumatic fever, with a latency of approximately 10 to 20 years after the initial streptococcal infection. Symptoms usually appear in adulthood • Other etiologies are rare but include: congenital MS radiation exposure atrial myxoma mucopolysaccharidoses • MS secondary to calcific annular disease is increasingly seen in elderly patients, and in patients with advanced chronic kidney disease. SRB March 2020 Mitral Stenosis • Mitral stenosis most commonly results from rheumatic heart disease fusion of the valve leaflet cusps at the commissures thickening and shortening of the chordae calcium deposition within the valve leaflets • Characteristic “fish-mouth” or “hockey stick” appearance on the echocardiogram (depending on view) SRB March 2020 Mitral Stenosis: Natural History • The severity of symptoms depends primarily on the degree of stenosis. • Symptoms often go unrecognized by patient and physician until significant shortness of breath, hemoptysis, or atrial fibrillation develops.
    [Show full text]
  • How to Define Valvular Atrial Fibrillation?
    Archives of Cardiovascular Disease (2015) 108, 530—539 Available online at ScienceDirect www.sciencedirect.com REVIEW How to define valvular atrial fibrillation? Comment définir la fibrillation atriale valvulaire ? ∗ Laurent Fauchier , Raphael Philippart, Nicolas Clementy, Thierry Bourguignon, Denis Angoulvant, Fabrice Ivanes, Dominique Babuty, Anne Bernard Service de cardiologie, faculté de médecine, université Franc¸ois-Rabelais, CHU Trousseau, Tours, France Received 3 June 2015; accepted 8 June 2015 Available online 14 July 2015 KEYWORDS Summary Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials compar- Atrial fibrillation; ing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in Valve disease; AF were performed among patients with so-called ‘‘non-valvular’’ AF. The distinction between Stroke ‘‘valvular’’ and ‘‘non-valvular’’ AF remains a matter of debate. Currently, ‘‘valvular AF’’ refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regur- gitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of ‘‘non-valvular’’ AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran.
    [Show full text]
  • Echo in Asymptomatic Mitral and Aortic Regurgitation
    2017 ASE Florida | Orlando, FL October 9, 2017 | 10:40 – 11:00 PM | 20 min | Grand Harbor Ballroom South Echo in Asymptomatic Mitral and Aortic Regurgitation Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology | Echo Lab Associate Professor of Medicine Disclosures Speakers Bureau (Philips, Medtronic) Advisory Board (Siemens) Regurgitation Axioms ▪Typically, regurgitation is NOT symptomatic unless severe ▪The opposite is not true: Severe regurgitation may be asymptomatic ▪ Chronic regurgitation leads to chamber dilatation on either side of the regurgitant valve Regurgitation Discovery ▪ Regurgitation as a anatomic entity was recognized in the 17th century ▪ Regurgitation was first clinically diagnosed by auscultation in the 19th century, well before the advent of echocardiography First Use of Regurgitation Term in English 1683 W. Charleton Three Anat. Lect. i. 18 Those [valves] that are placed in the inlet and outlet of the left Ventricle, to obviate the regurgitation of the bloud into the arteria venosa, and out of the aorta into the left Ventricle. Walter Charleton (1619 – 1707) English Physician Heart Murmur OXFORD ENGLISH DICTIONARY DEFINITION ▪ Any of various auscultatory sounds ▪ Adventitious sounds of cardiac or vascular origin [that is, separate from standard heart sounds: S1, S2, S3, S4] ▪ Sometimes of no significance ▪ But sometimes caused by valvular lesions of the heart or other diseases of the Στῆθος : Stēthos = chest circulatory system René Laënnec Stethoscope (1781 – 1826) (‘Chest examiner’) French Physician Hollow wooden cylinder Inventor of stethoscope in 1816 Laënnec Performing Auscultation Painted by Robert Alan Thom (1915 – 1979), American illustrator Commissioned by Parke, Davis & Co. 1816 1832 René Laënnec, James Hope French physician British physician Invents MONAURAL stethoscope separates MS from MR murmur 1852 1862 George Cammann Austin Flint Sr.
    [Show full text]
  • The Management of Acute Coronary Syndromes in Patients Presenting
    CONCISE GUIDANCE Clinical Medicine 2021 Vol 21, No 2: e206–11 The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician Authors: Ramesh NadarajahA and Chris GaleB There have been significant advances in the diagnosis and international decline in mortality rates.2,3 In September 2020, management of non-ST-segment elevation myocardial the European Society of Cardiology (ESC) published updated infarction over recent years, which has been reflected in an Clinical Practice Guidelines for the management of ACS in patients international decline in mortality rates. This article provides an presenting without persistent ST-segment elevation,4 5 years after overview of the 2020 European Society of Cardiology Clinical the last iteration. ABSTRACT Practice Guidelines for the topic, concentrating on areas relevant The guidelines stipulate a number of updated recommendations to the general or emergency physician. The recommendations (supplementary material S1). The strength of a recommendation and underlying evidence basis are analysed in three key and level of evidence used to justify it are weighted and graded areas: diagnosis (the recommendation to use high sensitivity according to predefined scales (Table 1). This focused review troponin and how to apply it), pathways (the recommendation provides learning points derived from the guidelines in areas to facilitate early invasive coronary angiography to improve relevant to general and emergency physicians, including diagnosis outcomes and shorten hospital stays) and treatment (a (recommendation to use high sensitivity troponin), pathways paradigm shift in the use of early intensive platelet inhibition).
    [Show full text]
  • Risk Stratification in Acute Coronary Syndrome: Focus on Unstable Angina/Non-ST Segment Elevation Myocardial Infarction R Bugiardini
    729 EDITORIAL Heart: first published as 10.1136/hrt.2004.034546 on 14 June 2004. Downloaded from Risk stratification in acute coronary syndrome: focus on unstable angina/non-ST segment elevation myocardial infarction R Bugiardini ............................................................................................................................... Heart 2004;90:729–731. doi: 10.1136/hrt.2004.034546 Although there have been advances in the management of fashion. Experts in a variety of fields make decisions using a more intuitive process of unstable angina/non-ST segment elevation myocardial recognising patterns and applying their own infarction syndromes, the rate of cardiovascular mortality rules. In varying proportions, pathophysiologic after discharge is still unacceptably high. With many reasoning, personal clinical experience, and recent published research each play a role in therapeutic options available, the clinician is challenged to the development of our own clinical rules. This identify the safest and most effective treatment for long term approach may produce incorrect use of tools of survival of each individual patient risk stratifications and inappropriate use of treatment strategies and procedures. However, ........................................................................... errors are more often due to ‘‘failure’’ of the system, not of the doctors. Most errors occur at the transfer of care, and particularly at the transfer from the outpatient to the inpatient ‘‘Simple, but not too simple’’—Albert Einstein sites. There are a number of programs now focusing on errors and strategies to reduce errors welve million individuals in the USA and (GAP, CRUSADE QI, JACHO).5–7 All of these 143 million worldwide have coronary artery programs focus on education of physicians, Tdisease. Two million US patients are better interaction between health care organisa- admitted annually to cardiac care units with tions and physicians, and appropriate use of care acute coronary syndromes (ACS).
    [Show full text]
  • Angina: Contemporary Diagnosis and Management Thomas Joseph Ford ‍ ‍ ,1,2,3 Colin Berry ‍ ‍ 1
    Education in Heart CHRONIC ISCHAEMIC HEART DISEASE Heart: first published as 10.1136/heartjnl-2018-314661 on 12 February 2020. Downloaded from Angina: contemporary diagnosis and management Thomas Joseph Ford ,1,2,3 Colin Berry 1 1BHF Cardiovascular Research INTRODUCTION Learning objectives Centre, University of Glasgow Ischaemic heart disease (IHD) remains the leading College of Medical Veterinary global cause of death and lost life years in adults, and Life Sciences, Glasgow, UK ► Around one half of angina patients have no 2 notably in younger (<55 years) women.1 Angina Department of Cardiology, obstructive coronary disease; many of these Gosford Hospital, Gosford, New pectoris (derived from the Latin verb ‘angere’ to patients have microvascular and/or vasospastic South Wales, Australia strangle) is chest discomfort of cardiac origin. It is a 3 angina. Faculty of Health and Medicine, common clinical manifestation of IHD with an esti- The University of Newcastle, ► Tests of coronary artery function empower mated prevalence of 3%–4% in UK adults. There Newcastle, NSW, Australia clinicians to make a correct diagnosis (rule- in/ are over 250 000 invasive coronary angiograms rule- out), complementing coronary angiography. Correspondence to performed each year with over 20 000 new cases of ► Physician and patient education, lifestyle, Dr Thomas Joseph Ford, BHF angina. The healthcare resource utilisation is appre- medications and revascularisation are key Cardiovascular Research Centre, ciable with over 110 000 inpatient episodes each aspects of management. University of Glasgow College year leading to substantial associated morbidity.2 In of Medical Veterinary and Life Sciences, Glasgow G128QQ, UK; 1809, Allen Burns (Lecturer in Anatomy, Univer- tom.
    [Show full text]
  • Coronary Artery Disease Management
    HealthPartners Inspire® Special Needs Basic Care Clinical Care Planning and Resource Guide CORONARY ARTERY DISEASE MANAGEMENT The following Evidence Base Guideline was used in developing this clinical care guide: National Institute of Health (NIH); American Heart Association (AHA) Documented Health Condition: Coronary Artery Disease, Coronary Heart Disease, Heart Disease What is Coronary Artery Disease? Coronary artery disease (CAD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen‐rich blood to your heart muscle. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH‐er‐o‐skler‐O‐sis). The buildup of plaque occurs over many years. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen‐rich blood to the heart. If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries. Common Causes of Coronary Artery Disease? If the flow of oxygen‐rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur. Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. A heart attack occurs if the flow of oxygen‐rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die.
    [Show full text]
  • Ventricular Tachycardia Associated Syncope in a Patient of Variant
    Case Report http://dx.doi.org/10.4070/kcj.2016.46.1.102 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal Ventricular Tachycardia Associated Syncope in a Patient of Variant Angina without Chest Pain Soo Jin Kim, MD, Ji Young Juong, MD, and Tae-Ho Park, MD Department of Cardiology, Dong-A University Medical Center, Busan, Korea A 68-year-old man was admitted for a syncope workup. After routine evaluation, he was diagnosed with syncope of an unknown cause and was discharged from the hospital. He was readmitted due to dizziness. On repeated Holter monitoring, polymorphic ventricular tachycardia was detected during syncope. We performed intracoronary ergonovine provocation test; severe coronary spasm was induced at 70% stenosis of the proximal left anterior descending artery. The patient was treated with percutaneous coronary intervention. We present a rare case of syncope induced by ventricular arrhythmia in a patient with variant angina without chest pain. (Korean Circ J 2016;46(1):102-106) KEY WORDS: Prinzmetal’s variant angina; Coronary vasospasm; Tachycardia, ventricular. Introduction Case Variant angina commonly manifests as chest pain and transient A 68-year-old man visited our emergency room due to recurrent ST elevation by coronary spasm, and generally follows a benign syncope. He had experienced four episodes of syncope with clinical course.1) Rarely, syncope induced by ventricular arrhythmia dizziness and chest discomfort during the prior 2 months. The associated with transient myocardial ischemia can be developed episodes were evoked when he was preparing his boat for sailing by coronary spasm.2)3) If the cause of syncope is not correctly in early morning.
    [Show full text]