7  Coronary Artery Disease (CAD)

CAD
    - BMP, CBC
    - A1c
    - Lipids
    - TSH w/ reflex
- Treatment
    - ASA 162/325 (if indicated)
    - BB
    - Other anti-anginal: CCB (if unable to tolerate BB), nitrates (long-acting if refractory to BB), ranolazine (adjunct to BB)
    - Anti-platelet: ASA +/- clopidogrel
    - Statin
    - Optimize BP control, e.g. ACEi/ARB
    - Optimize glycemic control in pts w/ DM
- Lifestyle modifications
    - Smoking cessation
    - Exercise
    - Weight loss
- Diet: low fat, low cholesterol

• Medications:
  • Cholesterol control: statin, ezetimibe, etc.
  • ACEi/ARB
  • BB
  • Anti-platelet
• The most important prognostic factor in pts w/ CAD is the degree of LV dysfunction

7.1 Angina

• Anti-anginal agents
  • β-blockers
  • nitrates
  • CCBs
  • ranolazine - if persistent angina despite maximal standard therapy
  • colchicine
• Stable angina in women: women will present older, describe “burning” and “tenderness” more frequently than men.
• Exacerbating factors
  • exertion
  • cold weather
  • emotional: anger, stress
  • large meals
• Associated symptoms
  • dyspnea
  • nausea or indigestion
  • pain elsewhere(eg, jaw, neck, teeth, back, abdomen)
  • palpitations
  • weakness and fatigue
  • syncope

7.2 Unstable angina

• “Unstable” angina is characterized by one or more of the following:
  • pain at rest
  • new onset
  • ↑ frequency