Coronary Artery Disease
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Acute coronary syndromes cause a variety of symptoms. Stimuli from the heart and other thoracic organs cause discomfort. This is described as pressure, burning, indigestion, aching, sharp pain, or stabbing pain. It is difficult to assess the amount of ischemia present only by symptoms, unless the infarction is very large. The symptoms often mimic those of angina. Complications of acute coronary syndromes may involve electrical dysfunction, myocardial dysfunction, or valvular dysfunction. Electrical defects include arrhythmias and conduction defects. Myocardial effects include heart failure, free wall rupture, interventricular septum rupture, pseudoaneurysm, ventricular aneurysm, cardiogenic shock, and formation of a mural thrombus. Valvular defects usually involve mitral regurgitation. Additional complications of acute coronary syndromes include recurring ischemia and pericarditis. If pericarditis occurs 2–10 weeks after an MI, it is called post-MI syndrome, also known as Dressler syndrome.
Cardiovascular system
David A Lisle in Imaging for Students, 2012
As outlined above, sudden rupture of an atherosclerotic plaque with subsequent arterial thrombosis and occlusion may lead to acute cardiac events, such as sudden death, myocardial infarction and acute unstable angina. The classic symptoms of acute angina are chest pain and tightness radiating to the left arm. Other causes of acute chest pain include aortic dissection, pulmonary embolism, gastro-oesophageal reflux, muscle spasm, and a variety of respiratory causes. Initial workup for a cardiac cause includes ECG and serum markers such as CK-MB and cardiac treponins. Initial imaging assessment in the acute situation consists of a CXR to look for evidence of cardiac failure and to diagnose a non-cardiac cause of chest pain, such as pneumonia or pneumothorax. Coronary angiography is indicated in patients with ECG changes or elevated serum markers. Interventional procedures aimed at restoring coronary blood flow, including coronary artery angioplasty and stent deployment, may also be performed acutely.
Clinical syndromes in acute coronary syndrome
K Sarat Chandra, AJ Swamy in Acute Coronary Syndromes, 2020
Diagnosis of angina, clinically at bedside, should take into consideration the following variables: Pre-test probability of disease (CAD): Based on prevalence of disease and presence of risk factors.Characteristics of ischaemic manifestations: Angina and its equivalent location, duration, intensity, precipitating factors, relieving factors and associated features. These ischaemic manifestations generally do not last for 10–15 minutes in stable coronary artery disease, but may last longer (greater than 20 minutes), are more frequent at lower threshold (of angina) in acute coronary syndromes.
Advances in small-molecule therapy for managing angina pectoris in the elderly
Published in Expert Opinion on Pharmacotherapy, 2019
Nida Waheed, Ahmad Mahmoud, Cecil A. Rambarat, Carl J. Pepine
Angina is a discomfort in the anterior chest, often perceived as painful, pressure-like, heaviness, tightness, and/or squeezing, originating from transient myocardial ischemia. The angina pattern may be either acute or chronic and the myocardial ischemia arises from an imbalance between myocardial oxygen supply and demand. The factors controlling these fundamental functions provide targets for therapy. Myocardial oxygen demand is affected by heart rate, myocardial contractility, systemic blood pressure, and left ventricular (LV) wall tension. Increases in myocardial oxygen demand must be provided by increases in myocardial blood flow since myocardial oxygen extraction is near maximal. Myocardial or coronary blood flow reserve is the ratio of near maximum coronary blood flow to resting flow and under normal circumstances can increase by four to six times the resting flow value to meet myocardial metabolic demands [12,13].
Machine learning for predicting cardiac events: what does the future hold?
Published in Expert Review of Cardiovascular Therapy, 2020
Brijesh Patel, Partho Sengupta
Patients with angina or its equivalent symptoms often undergo stress testing. In nuclear cardiology, ML has shown improved detection of myocardial ischemia [14]. It is possible to combine clinical variables and stress test data to predict cardiovascular outcomes. Betancur and colleagues studied 2,619 consecutive patients who underwent exercise or pharmacologic stress myocardial perfusion imaging (MPI) [15]. The goal was to study the combined value of MPI and clinical variables to predict 3-year MACE, including nonfatal myocardial infarction. As expected, the combined ML model predicted with better accuracy than the imaging ML model (AUC 0.81 vs. 0.78, respectively, p < 0.01). While there is value in incorporating MPI data, better predicting models are needed to identify short- and long-term MACE.
Off-pump Coronary Artery Bypass through Ministernotomy in Patients with Diabetes Mellitus
Published in Structural Heart, 2020
Khusan Khalikulov, Abrol Mansurov, Saidorifhon Murtazaev
Methods: We have performed 40 operations off-pump coronary artery bypass. All operations were performed through ministernotomy using myocardial stabilizer. The age of patients varies from 32 to 60 years old. All patients were male. Unstable angina was diagnosed in 15 (37.5%) patients, and the rest of 25 (62.5%) patients had different class of stable angina. Arterial hypertension was present in 38 patients, coronary insufficiency in 11 patients. 34 patients had myocardial infarction in the anamnesis. ECG data revealed ischemia in 25 patients. Echo: left ventricle ejection fraction under 40% in patients, under 50% in 22 patients and the rest of patients had 55%. Blood glucose level was varied from 8 to 15 mmol/L and average mean composed of 11.2 mmol/L. Angiography data revealed single-vessel disease in 25 cases and the other 15 patients had double-vessel disease.
Related Knowledge Centers
- Arrhythmia
- Chest Pain
- Coronary Artery Disease
- Vascular Occlusion
- Vasospasm
- Ischemia
- Cardiac Muscle
- Atherosclerosis
- Heart Failure
- Coronary Arteries