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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 |