缺血性心脏病教学PPT.ppt

Rapid worsening angina (Crescendo) Severe angina at rest New-onset angina Post-infarction angina Without evidence of Infarction (ECG / Enzyme) Clinical Manifestation Symptom: Unstable Angina Clinical Manifestation Risk stratification in Angina High risk Low risk Unstable angina Predictable exertional angina Post-infarct angina Poor effort tolerance Good effort tolerance Ischaemia at low workload (ETT) Ischaemia only at high workload (ETT) Left main or three-vessel disease Single-vessel or minor two-vessel disease Poor LV function Good LV function N.B. Patients may fall between these categories. Management Angina Pectoris Risk factors control Symptoms Control Life expectancy improvement ADVICE TO PATIENTS WITH ANGINA Do not smoke Aim at ideal body weight Take regular exercise (Exercise up to, but not beyond, the point of chest pain is beneficial and may promote collateral vessels.) Avoid severe unaccustomed exertion, and vigorous exercise after a heavy meal or in very cold weather Take sublingual nitrate before undertaking exertion that may induce angina Management Angina Pectoris Anti - anginal Drug Nitrates ?-blocker CCB anti-platelet Aspirin 75-100mg Lipid-lowing – Statin ACEI Management Angina Pectoris baseline Plaque area 6mm2 Statins for 6months Plaque area 6.4mm2 Shinya Okazaki, et al. Circulation. 2004;110:1061-1068 Regression of Plaque by Statins Invasive Treatment Revascularization PTCA / CABG Management Angina Pectoris Management --PCI A triple coronary artery bypass graft operation Management coronary artery bypass grafting