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Cardiology - Coronary Artery Disease
Cardiology - Coronary Artery Disease
Cardiology - Coronary Artery Disease
Introduction
Stable ischemic heart disease, coronary artery disease, and atherosclerosis We carefully distinguish between “angina” and “chest pain”—cardiac
of coronary arteries are all synonyms. They represent the progressive angina is often not human chest pain, and each patient will have their
growth of an atheromatic plaque (atheroma, lipid-laden plaque, lipid core anginal equivalent (see page 2).
with a fibrocollagenous cap) that induces the progressive narrowing of an
artery’s lumen. Once past critical stenosis (~ 70% obstructed), symptoms
will appear during times of increased demand, the heart beating faster and
harder, angina with exertion. This is called demand ischemia: symptoms
are provoked by increased exertion though the degree of stenosis remains
unchanged. The ischemia provokes symptoms. A reduction in the
demand (resting) relieves the ischemia, and thus the angina. The patient
experiences these things without a myocardial infarction, presents to the
clinic, and will not have symptoms at the time of presentation.
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Clinical Sciences Cardiology Coronary Artery Disease
A patient may continue to have angina, most often in lesions that For patients without a history of infarction and with a normal ejection
are not amenable to procedural correction. Thus, after maximizing fraction, β-blocker may be discontinued if there are no other indications.
the β-blocker and ACE/ARB, if exertional angina persists, use anti-
anginals. If the blood pressure remains elevated, the hypertension
medications that also provide anginal relief are the dihydropyridine ANTI-ANGIALS
calcium-channel blockers, such as amlodipine and the nitrate Dihydropyridine calcium-
Amlodipine
isosorbide mononitrate. The other nitrate, nitroglycerin, can be channel blocker
used on an as-needed schedule. The last-ditch effort medication—for Nitrates scheduled Isosorbide mononitrate
palliation of refractory disease only—is ranolazine.
Nitrates prn Nitroglycerin
Ranolazine Ranolazine when refractive
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