Coronary heart disease, or atherosclerotic coronary artery disease, is the commonest cause of cardiovascular disability and death in the United States. Men are more often affected than women by an overall ratio of 4:1, but before age 40 the ratio is 8:1, and after age 70 it is 1:1. In men, the peak incidence of clinical manifestations is at age 50-60; in women, at age 60-70.
Epidemiologic studies have identified a number of important risk factors for premature coronary artery disease. These include a positive family history (particularly when onset is before age 50), age, male gender, blood lipid abnormalities, diabetes mellitus, insulin resistance and the metabolic syndrome, hypertension, physical inactivity, cigarette smoking, elevated blood homocysteine levels, markers of inflammation such as C-reactive protein (CRP) and hyperfibrinogenemia, and hypoestrogenemia in women.
- Coronary Heart Disease: Introduction
- Risk Factors for Coronary Artery Disease
- Primary & Secondary Prevention of Coronary Heart Disease
- Pathophysiology of Chronic Ischemia & Acute Coronary Syndromes
- Myocardial Hibernation & Stunning
- Revascularization procedures for patients with Angina Pectoris
- Type of Procedure
- Summary of Results of Treatment
- Angina Pectoris
- General Considerations
- Clinical Findings
- Differential Diagnosis
- Evaluation of Patients with Angina Pectoris
- Coronary Vasospasm & Angina with Normal Coronary Arteriograms
- Angina Pectoris: Prognosis
- Angina Pectoris: Treatment
Acute coronary syndromes Acute coronary syndromes comprise the spectrum of unstable cardiac ischemia from unstable angina to acute myocardial infarction. Rather than the traditional nomenclature of unstable angina, non-Q wave and Q wave myocardial infarction, acute coronary syndromes are now classified based on the presenting electrocardiogram as either “ST elevation” or “non-ST elevation.” This allows for immediate classification and guides determination of whether patients should be considered for acute reperfusion therapy. The evolution of cardiac markers then allows determination of whether myocardial infarction has occurred. Acute coronary syndromes represent a dynamic state in which patients frequently shift from one category to another, as new ST elevation can develop after presentation and cardiac markers can become abnormal with recurrent ischemic episodes.
- Acute coronary syndromes
- Prognosis & Indications for Revascularization
Myocardial infarction results from prolonged myocardial ischemia, precipitated in most cases by an occlusive coronary thrombus at the site of a preexisting (though not necessarily severe) atherosclerotic plaque.
Arrhythmias Abnormalities of cardiac rhythm and conduction can be lethal (sudden cardiac death), symptomatic (syncope, near syncope, dizziness, or palpitations), or asymptomatic. They are dangerous to the extent that they reduce cardiac output, so that perfusion of the brain or myocardium is impaired, or tend to deteriorate into more serious arrhythmias with the same consequences. Stable supraventricular tachycardia is generally well tolerated in patients without underlying heart disease but may lead to myocardial ischemia or congestive heart failure in patients with coronary disease, valvular abnormalities, and systolic or diastolic myocardial dysfunction. Ventricular tachycardia, if prolonged (lasting more than 10-30 seconds), often results in hemodynamic compromise and is more likely to deteriorate into ventricular fibrillation.
- Disturbances of rate and rhythm
- Mechanisms of Arrhythmias
- Techniques for evaluating Rhythm disturbances
- Electrocardiographic Monitoring
- Heart Rate Variability
- Signal-Averaged ECG
- Electrophysiologic Testing
- Autonomic Testing (Tilt-Table Testing)
- Antiarrhythmic Drugs
- Radiofrequency Ablation for Cardiac Arrhythmias
- 1. Sinus Arrhythmia, Bradycardia, & Tachycardia
- 2. Atrial Premature Beats (Atrial Extrasystoles)
- 3. Differentiation of Aberrantly Conducted Supraventricular Beats from Ventricular Beats
- 4. Paroxysmal Supraventricular Tachycardia
- Treatment of the Acute Attack
- Prevention of Attacks
- Pathophysiology & Clinical Findings
- 9. Atrioventricular Junctional Rhythm
Revision date: July 7, 2011
Last revised: by Dave R. Roger, M.D.