ANGINA & CORONARY HEART DISEASE (CHD)

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ANGINA & CORONARY HEART DISEASE (CHD) by Mind Map: ANGINA & CORONARY HEART DISEASE (CHD)

1. DIAGNOSTIC TESTS

1.1. LAB TEST: CARDIAC BIOMARKERS (BLOOD)

1.1.1. High-sensitivity troponin

1.1.2. Creatinine kinase-MB

1.1.3. Myoglobin

1.1.4. BNP or NT-proBNP

1.2. NON-LABORATORY TEST

1.2.1. CT of the chest

1.2.2. Coronary Computed Tomography (CT) angiography

1.2.3. Magnetic resonance (MR) imaging

1.2.4. Catheter angiography

1.2.5. Stress test

1.2.6. Nuclear stress test

2. RISK FACTORS CORONARY HEART DISEASE (CHD)

2.1. CAN BE CHANGED

2.1.1. Altered blood cholesterol level

2.1.2. High blood pressure

2.1.3. Diabetes

2.1.4. Smoking

2.1.5. Overweight & obesity

2.1.6. Excessive alcohol & stress

2.2. CANNOT BE CHANGED

2.2.1. Age: Risk increases as you get older

2.2.2. Gender: before the age 60, men are at greater risk than women

2.2.3. Family history

3. CORONARY BYPASS

3.1. A procedures that restores normal blood flow to the heart by creating a “detour” (bypass) around the blocked artery/arteries with a healthy artery or vein.

3.2. WHEN TO CONSIDER CORONARY BYPASS SURGERY

3.2.1. Severe chest pain

3.2.2. The severity blockages in the large coronary (heart) arteries that supply a major part of the heart muscle with blood

3.2.3. Have more than one diseased coronary artery, and the heart's main pumping chamber

3.2.4. Your left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.

3.3. OTHER RELATED SURGERIES

3.3.1. ANGIOPLASTY

3.3.1.1. To increase blood flow through the blocked artery and reduces angina

3.3.2. ANGIOPLASTY (LASER)

3.3.2.1. To increase blood flow through the blocked artery by plaque removal

3.3.3. ATHERECTOMY

3.3.4. TRANSMYOCARDIAL REVASCULARIZATION

3.3.4.1. Relieve severe angina in very ill patients who aren't candidates for bypass surgery or angioplasty

3.3.5. MINIMALLY INVASIVE BYPASS SURGERY includes Port-Access Coronary Artery Bypass (PACAB) and Minimally Invasive Direct Coronary Artery Bypass Graft (MIDCAB)

3.3.5.1. Small incisions ("ports") are made in the chest, then, arteries or veins from the leg are attached to the heart to "bypass" the clogged coronary arteries.

3.3.5.2. In PACAB, multiple ports on multiple areas are made, and the heart is stopped, blood is pumped through an oxygenator or "heart-lung" machine.

3.3.5.3. In MIDCAB, small horizontal incision is made, heart is not completely stopped, so, heart-lung machine is avoided.

4. NORMAL ELECTROCARDIOGRAM (ECG)

4.1. A medical test that detect the cardiac abnormalities of the heart and records the electrical activity

4.2. ECG consists of P wave, PR interval, PR segment, QRS complex, ST segment and QT interval.

4.2.1. P wave: the depolarization of the left and right atrium and corresponds to atrial contraction

4.2.1.1. Normal P wave characteristics: smooth, positive and small wave. Normal P wave is upright in leads I, II and aVF and V1 and V6 & inverted in lead V1.

4.2.2. PR interval: starts onto the onset of the P-wave and ends at the end of the QRS complex.

4.2.2.1. Normal PR interval characteristics: between 0.12 sec to o.22 sec or 3-5 small square in duration

4.2.3. PR segment: flat line between the end of the P wave and the onset of the QRS complex

4.2.4. T wave: it represents ventricular repolarization

4.2.4.1. Normal T wave characteristics: Upright in all leads except aVR and V1. Positive deflection after QRS complex.

4.2.5. QRS complex: the depolarization or activation of the ventricle specifically the left ventricle

4.2.5.1. Normal interval of the QRS complex: it is between 0.08 and 0.10 sec.

4.2.6. ST segment: it represents the isoelectric period when the ventricles are in between depolarization and repolarization

4.2.6.1. Normal interval of the ST segment: it is between 0.05 to 0.15 sec.

4.3. ECG IN ANGINA PECTORIS PATIENT

4.3.1. T wave inversion: T wave are usually upright during pain

4.3.2. ST segment depression/elevation: greater depression of the ST segment below the baseline

5. What is Stable Angina?

5.1. A type of chest pain caused by reduced blood flow to the heart. It is describes as feeling of tightness, heaviness, squeezing or pain in the heart

5.2. Often triggered by physical activity such as walking, climbing stairs and exercising.

6. What is Coronary Heart Disease (CHD)?

6.1. CHD or coronary artery disease occurs when a coronary artery clogs and narrows because of a buildup of plaque.

6.2. The buildup of the plaque reduced blood flow to the heart.

6.3. When the heart muscle is not getting enough oxygen, it causes a condition called ischemia.

7. CLASSIC SYMPTOMS

7.1. ANGINA

7.1.1. Pain and discomfort starts behind the breastbone to arms or back

7.1.2. Discomfort that feels like gas or indigestion

7.1.3. Pain during physical exertion or mental stress

7.1.4. Pain that is relieved by medicines and rest

7.1.5. Pattern of symptoms that has not changed in the last 2 months

7.1.6. Symptoms that go away within 5 minutes

7.1.7. SYMPTOMS OF ANGINA IN WOMEN

7.1.7.1. Instead of chest pain, or in addition to it, women may feel pain sensation in the neck, jaw, throat, abdomen or back

7.2. CORONARY HEART DISEASE (CHD)

7.2.1. Angina

7.2.2. Shortness of breath especially with activity

7.2.3. Nausea or feeling of indigestion

7.2.4. Cold sweats

7.2.5. Dizziness

7.2.6. Neck pain

8. PREMATURE CORONARY HEART DISEASE (CHD)

8.1. An early heart attack, before age 55 for man and before age 65 for woman

8.2. RISK FACTORS

8.2.1. Family history of premature CHD

8.2.2. Dyslipidemia

8.2.3. Hypertension

8.2.4. Diabetes mellitus

8.2.5. Cigarette smoking

8.2.6. High Lp(a) level = High risk of heart attack and stroke

8.2.6.1. Lipoprotein(a): a low-density lipoprotein variant containing a protein called apolipoprotein(a)

8.2.6.2. Normal values: less than 30 milligrams per deciliter (mg/dL)

8.2.6.3. This is believed to be due to the Apo(a) protein, which may reduce the body's ability to break down clots

9. MECHANISM OF ACTION OF DRUGS

9.1. ATORVASTATIN

9.1.1. A competitive inhibitor of the enzyme HMG-CoA reductase, which catalyzes the conversion of HMG-CoA to mevalonate.

9.1.2. Decrease the hepatic cholesterol concentrations which will stimulate the hepatic LDL receptor thus increasing hepatic uptake of LDL.

9.2. PROPRANOLOL

9.2.1. A nonselective β-adrenergic receptor antagonist.

9.2.2. Blocking the beta receptors on the nerves of the sympathetic system thus, decreasing the heart rate and contractility.

9.2.3. It also downregulates the renin-angiotensin-aldosterone system which reduces the renin secretion from the kidney.

9.3. ISOSORBIDE MONONITRATE

9.3.1. It increases cGMP in smooth muscle, cause formation of Nitric Oxide (NO) and reduce preload (venous vasodilator)

10. OTHER DRUG IN TREATING ANGINA

10.1. BETA BLOCKER

10.2. CALCIUM CHANNEL BLOCKER

10.3. ASPIRIN

10.4. RANOLAZINE (RANEXA)

10.5. ACE INHIBITOR

10.6. ANGIOTENSIN RECEPTOR BLOCKER

11. NON-PHARMACOLOGICAL INTERVENTION

11.1. WEIGHT LOSS AND EXERCISE (brisk walking, swimming and cycling)

11.2. SMOKING CESSATION

11.2.1. Pharmacological assistance considered; nicotine replacement therapy or bupropion when not contraindicated

11.3. HEALTHY DIET

11.4. cycling