Coronary artery disease - Revision history

Aidan: /* Management */

2021-02-23T16:23:44Z

Management

← Older revision		Revision as of 16:23, 23 February 2021
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	== Background ==		==Background==

	=== Risk Factors ===		===Risk Factors===

	* Modifiable: tobacco use, [[dyslipidemia]], [[diabetes mellitus]], [[hypertension]], [[chronic kidney disease]], physical inactivity, diet, [[obesity]], [[metabolic syndrome]], [[depression]]		*Modifiable: tobacco use, [[dyslipidemia]], [[diabetes mellitus]], [[hypertension]], [[chronic kidney disease]], physical inactivity, diet, [[obesity]], [[metabolic syndrome]], [[depression]]
	* Non-modifiable: age, sex, family history of premature cardiovascular disease, ethnic origin		*Non-modifiable: age, sex, family history of premature cardiovascular disease, ethnic origin

	==Investigations==		==Investigations==
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	*Medical management		*Medical management
			**Secondary prevention
	**Prevention
	***Antiplatelet		***Antiplatelet
	****ASA, with a PPI if history of GI bleeding		****ASA, with a PPI if history of GI bleeding
	****If ASA allergy: clopidogrel		****If ASA allergy, use [[clopidogrel]]
	***BP control		***BP control, preferentially with ACE inhibitor or ARB
			***If heart failure, ACE inhibitor or ARB
	***[[Statin]] ~~for~~ cholesterol		***[[Statin]] regardless of cholesterol
	**Anti-anginal medications		**Anti-anginal medications
	***[[Beta blockers]]		***[[Beta blockers]], which is the only one with possible mortality benefit
	***[[Calcium channel blockers]]		***[[Calcium channel blockers]]
	***[[Nitrates]]		***[[Nitrates]]
	**[[ACEi]] if heart failure
	*Cardiac rehab		*Cardiac rehab
	*Procedures		*Procedures
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	*Exercise and education		*Exercise and education

	== Further Reading ==		==Further Reading==

	* Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. ''Can J Cardiol''. 2014;30(8):837-849. doi: https://doi.org/10.1016/j.cjca.2014.05.013		*Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. ''Can J Cardiol''. 2014;30(8):837-849. doi: https://doi.org/10.1016/j.cjca.2014.05.013

	[[Category:Cardiology]]		[[Category:Cardiology]]

Aidan at 14:51, 23 February 2021

2021-02-23T14:51:27Z

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-== Investigations ==
+== Background ==
 <pre class="mermaid">graph LR;
@@ Line 17: / Line 24: @@
 normal_ecg --no--&gt; exercise_either[exercise mibi or echo]
 </pre>
-== Management ==
+==Management==
-== ABCDE ==
+== Further Reading ==
 [[Category:Cardiology]]

Maintenance script: Imported from text file

2020-07-04T01:17:29Z

Imported from text file

New page

== Investigations ==

* Fasting lipids and HbA1c, to assess cardiovascular risk and guide risk reduction treatment
* Stress test: exercise or persantine/dobutamine; ECG or echo or nuclear (mibi); see below
** Nuclear perfusion scan (mibi) or stress echo, for risk stratification and identification of reversible perfusion defects
* Angiography, for direct coronary visualization and diagnosis, and possible angioplasty
** Done for high risk features on stress testing

=== Choice of stress test ===

<pre class="mermaid">graph LR;
LBBB_etc[LBBB or V-paced] --yes--> mibi[persantine mibi]
LBBB_etc --no--> exercise[can exercise?]
exercise --yes--> normal_ecg[ECG normal]
exercise --no--> either[persantine mibi or dobutamine echo]
normal_ecg --yes--> exercise_ecg[exercise ECG]
normal_ecg --no--> exercise_either[exercise mibi or echo]
</pre>
== Management ==

* Medical management
** Prevention
*** Antiplatelet
**** ASA
**** Add PPi if GI bleed
**** If ASA allergy: clopidogrel
*** BP control
*** Statin for cholesterol
** Anti-anginal
*** Beta blockers
*** Calcium channel blockers
*** Nitrates
** ACEi if heart failure
* Cardiac rehab
* Procedures
** Angioplasty (percutaneous intervention [PCI])
*** Requires dual antiplatelet therapy (DAPT) for up to 1 year (for drug-eluting stents)
** Coronary artery bypass surgery (CABG)
*** Better for multivessel disease, diabetics

== ABCDE ==

* Antiplatelets and ACEi/ARB
* Beta blockers and BP
* Cholesterol, cigarettes, and cease hormone-replacement therapy
* Diet and diabetes
* Exercise and education

[[Category:Cardiology]]