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Coronary Artery Disease - ECAB

Coronary Artery Disease - ECAB

R R Kasliwal

(2009)

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Book Details

Abstract

Coronary artery disease or CAD is the end result of the process of accumulation of atheromatous plaques within the walls of the arteries supplying the myocardium. Atherosclerosis is a chronic systemic disease process, affecting all the vascular beds in body and many factors responsible for its evolution have been identified. A rising incidence of this disease among people of Indian origin and an emerging role of genetic factors leading to atherosclerosis necessitates modifications in ourstrategies to handle it. The importance of the risk factors in causation of the disease need to be emphasized even more and masses need to be educated about the role of lifestyle modifications in its management. Further, early detection of preclinical or sub-clinical disease would add another dimension to the overall preventive strategy for this condition.

This book is designed to update the readers on the evergrowing list of risk factors for CAD and the increasing significance of lifestyle modifications in prevention of the disease. Besides these, the therapeutic approach towards this chronic disease and methods of early detection has also been discussed. Typical supportive case scenarios are also included to exemplify and highlight the various points discussed. Thus, it provides an excellent opportunity to widen one’s perspective in this area.


Table of Contents

Section Title Page Action Price
Front Cover Front Cover
Front Matter ia
Elsevier Clinical Advisory Board:Cardiology id
Copyright if
About the Authors ig
Contents ii
ECAB Clinical Update Information i
Foreword v
Introduction 1
Emerging Risk Factors for Coronary Artery Disease 3a
Risk Factors for Coronary Artery Diseases 4
Modifiable Risk Factors 4
Non-Modifiable Risk Factors 5
Emerging Risk Factors for CAD 6
Genetic Factors 6
Nutritional Factors 7
Metabolic Syndrome 7
Conditional Risk Factors 8
Predisposing Risk Factor 10
Miscellaneous Risk Factors 11
Early Detection of Sub-clinical Atherosclerosis 15a
Abstract 15
Keywords 15
Introduction 15
Detection and Assessment of Sub-Clinical Atherosclerosis 16
Carotid Intima-Media Thickness 18
Methodology 18
Definition of Abnormal CIMT 19
Reproducibility of CIMT Measurement 20
Clinical Applications 20
Association with Risk Factors 20
Prediction of Cardiovascular Risk 21
As a Surrogate Marker of Presence of Disease 22
Assessment of Response to Therapy 22
Carotid IMT or Carotid Plaque? 23
Limitations 24
Brachial Artery Flow-Mediated Dilatation 24
Technique 24
Definition of Abnormal BAFMD 26
Clinical Applications 26
Association with Risk Factors 26
Prediction of Cardiovascular Risk 27
As a Surrogate Marker of Presence of Disease 27
Assessment of Response to Therapy 28
Limitations 28
Pulse Wave Velocity and Pulse Wave Analysis 29
Pathophysiological Mechanisms Linking Arterial Stiffness and Cardiovascular Risk 29
Methodological Considerations 30
Basic Principles in the Measurement 30
Technical Considerations during PWA and Measurement of PWV 32
Definition of Abnormal Values 33
Reproducibility of the Measurements 33
Clinical Significance 33
Association with Cardiovascular Risk Factors 33
Prediction of Cardiovascular Risk 33
Assessment of Response to Therapy 34
Limitations 34
Coronary Artery Calcium Scoring 35
Pathophysiology 35
Techniques for Coronary Calcium Scoring 36
Definition of Abnormal Values 37
Clinical Implications 37
Prediction of CV Risk 37
Assessment of Symptomatic Patients 38
Limitations 39
Conclusions 39
Clinical Case Example: Utility of Early Detection of Sub-Clinical Atherosclerosis 40
Behavioral Management of Coronary Artery Disease 55a
Effect of Globalization, Industrialization and Urbanization 56
Behavioral Approach to Management of Coronary Artery Disease 59
Dietary Factors 60
Calorie Intake 60
Dietary Fats 61
Fish 61
Vegetables and Fruits 63
Salt Intake 63
Antioxidants 63
Physical Activity 64
Aerobic Exercise 64
Muscle Strengthening Activity (Resistance Training) 66
Safety of Resistance Training 67
Screening/Clearance 67
Overweight/Obesity 68
Tobacco 69
Psychological Factors 71
Alcohol 72
Reasons for Failure of Lifestyle Modification Regimens 77
Medical Management of Coronary Artery Disease 91a
Goals of Therapy 92
Pharmacological Management of Stable Coronary Artery Disease 93
Nitrates 94
Nitrate Preparations 95
Beta Blockers 95
Calcium Channel Blockers 99
Choice of Agent 99
When to Use 101
Side Effects 101
Relative Effectiveness of Medical Therapies 102
Angina that Persists with Monotherapy 103
Angiotensin Converting Enzyme Inhibitors 103
Antiplatelet Therapy 103
Follow-Up 104
Inhibition of Fatty Acid Oxidation 104
Ranolazine 105
Newer Agents 105
Trimetazidine 105
Perhexiline 105
Nicorandil 105
Ivabradine 106
Fasudil 106
HMG Co-A Reductase Inhibitors 106
Medical Treatment of Stable Coronary Disease: Key Points 106
Clinical Case Scenario: Story of a Life Time 109
Section I 109
Case Illustration 109
Answer 110
Step 1: Calculate the Framingham Risk Score 110
Three Levels of 10-year Risk 110
Risk Score Results 111
Step 2: Establish LDL Goal of Therapy (See Table 1) 111
Assessing Mr. M.S. Based on This Concept 113
Section II 113
Section III 115
Revascularization in Chronic Stable Angina 117
Forthcoming Books 121