NON INVASIVE MODALITY FOR

DIAGNOSIS OF CORONARY
ARTERY DISEASE
 CORONARY ARTERY DISEASE

CAD IHD Angina pectoris

ALL PATIENTS WITH ATHEROSCLEROSIS
SYMPTOM OF ISCHEMIA

INBALANCE SUPPLY AND DEMAND OXYGEN IN MYOCARDIAL

 ANGINA ?

Angina is pain or discomfort in the

chest that happens when some part
of the heart does not receive
enough oxygen from the blood
The Grip of Angina
O xygen Supply O xygen Dem and
- Blood Flow - Heart rate
-O 2 Carrying -Contractility
Capacity -W all stress
ISCHEMIC SYNDROMES
Angina pectoris

Stenotic coronary artery

 CharaCter
of
anginal Pain
Typical angina (definite)
l Substernal chest discomfort with a characteristic
quality and duration that is
l provoked by exertion or emotional stress and
l relieved by rest or nitroglycerin

Atypical angina (probable)

meets 2 of the above characteristics

Noncardiac chest pain

meets <=1 of the typical angina characteristics
Diamond GA. J Am Coll Cardiol 1983
assessing Chest Pain
tyPes of anginal Pain
 CCS Classification

l I : Angina occurring with strenous but not

ordinary physical activity
l II : Slight limitation of ordinary physical activity
l III : Marked limitation of ordinary physical
activity
l IV : Inability to carry on any physical activity
without discomfort, symptoms may be
present at rest.
 Atherosclerosis:
a multi factorial disease
 Characteristics of the
stable atherosclerotic plaque
Fibrous cap
(VSMCs and matrix) Intimal VSMCs
Endothelial (repair phenotype)
cells

Lipid core

Adventitia

Medial VSMCs
(contractile phenotype)
The vulnerable atherosclerotic plaque

Lipid core

Adventitia
.
 Atherosclerosis Timeline
Complicated
Foam Fatty Intermediate Fibrous Lesion/
Cells Streak Lesion Atheroma Plaque Rupture

Endothelial Dysfunction
From First From Third From Fourth
Decade Decade Decade

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 10A):23S-27S.

CRE027/Jul07-Jul08/TEP | RTD Master Slide 2nd Semester
PhysiCal eaMination
eleCtroCarDiograM
 R R

P T P T

Q Q
S S

ST- segment depression Negative T waves

eXerCise test
 ISCHEMIC SYNDROMES
Angina pectoris

Normal Exercise
condition
condition relative
obstruction.
sUMMary