Coronary Artery Disease

Clinical Manifestations
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Dr Sameer Kurmani
BHF Clinical Research Fellow
Department of Cardiovascular Sciences
Email: sak36@le.ac.uk
 Cardiovascular Disease

Coronary Heart Disease Statistics 2010. P Scarborough et al. BHF Health Promotion Research Group
Department of Public Health, Oxford
Underlying Pathology: Atherosclerosis

Thrombosis
Formation of clot in response to plaque rupture with
activation of coagulation cascade and platelets

Embolism
Occlusion of a vessel by an embolus created proximally
to the site of occlusion

Ischaemia
Reduction in oxygen delivery to target tissue as a result
of altered blood flow

Infarction
Necrosis of tissue resulting from Ischaemia

Aneurysm
Abnormal dilation of vascular wall
Heart Disease: Broad Classification

Coronary Artery Disease

Valvular Heart Disease

Arrythmias

Heart Failure

Other Diseases
Myopericarditis, Endocarditis, Congenital & Acquired
Structural Heart Disease, Cardiac Tumours,
Hypertension
History of Presenting Complaint
68yr old man presents to the General Practitioner
with a 3 month history of chest pain. He reports that
while gardening or walking the dog, he gets a
discomfort in the middle of his chest which feels
really heavy. After stopping for a couple of minutes,
this settles before he can carry on again.

Past Medical History

Hypercholesterolaemia
Hypertension

Drug History
Simvastatin 40mg
Amlodipine 10mg
Management of Angina

Good Control of Cardiovascular Risk Factors

Smoking, Hypertension, Hypercholesterolaemia, Diabetes
Mellitus

Anti-Anginal Therapy
Nitrates, -blockers, Ca2+ channel antagonists, If channel
inhibitors, Ranolazine

Percutaneous Coronary Intervention

Drug-Eluting Stents, Bare Metal Stents

Coronary Artery Bypass Grafting

Left Internal Mammary Artery, Right Internal Mammary
Artery, Saphenous Vein Grafts
History of Presenting Complaint
59yr old man presents to the Emergency Department
with a 1 hour history of central crushing chest pain
following an argument with his wife. He describes it
like an elephant sitting on his chest and he is short of
breath and clammy with it.

Past Medical History

Smoker
Hypercholesterolaemia
Hypertension

Drug History
Simvastatin 40mg
Amlodipine 10mg
Stable Angina
Chest pain brought on predictably by exertion/stress which
is relieved by rest or GTN

Acute Coronary Syndromes: UA, STEMI, NSTEMI

Unstable Angina
Anginal pain of unpredictable onset/duration that may be
associated with ischaemic ECG changes but without
evidence of myocardial necrosis

Non ST-elevation Myocardial Infarction

Anginal pain of unpredictable onset/duration that may be
associated with ischaemic ECG changes with evidence of
myocardial necrosis

ST-elevation Myocardial Infarction

Anginal pain of unpredictable onset/duration associated
with ST-segment elevation with evidence of myocardial
necrosis
History of Presenting Complaint
Following an ostensibly successful stent, the patient
remained on the Coronary Care Unit where he
developed progressive shortness of breath and
frequent palpitations. The chest pains have largely
settled.
Complications of Myocardial Infarction
Ischaemic
Re-infarction, Stent thrombosis, Infarct Extension

Mechanical
Heart Failure, Papillary muscle rupture, Ventricular Septal
Defect, Mitral valve dysfunction, Aneurysms, Cardiac
Rupture

Arrhythmic
Atrial & Ventricular arrhythmias, AV nodal dysfunction

Embolic
Central Nervous System, Peripheral Vasculature

Inflammatory
Pericarditis, Dresslers Syndrome
Questions?