Coronary Artery Disease - ECAB

Author: Kasliwal> R R  

Publisher: Elsevier Health Sciences APAC‎

Publication year: 2009

E-ISBN: 9788131231722

P-ISBN(Paperback): 9788131215272

Subject: R541.4 coronary artery (atherosclerosis), coronary heart disease (CHD)

Keyword: 内科学

Language: ENG

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Description

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.

Chapter

Foreword

Introduction

Emerging Risk Factors for Coronary Artery Disease

Risk Factors for Coronary Artery Diseases

Modifiable Risk Factors

Non-Modifiable Risk Factors

Emerging Risk Factors for CAD

Genetic Factors

Nutritional Factors

Metabolic Syndrome

Conditional Risk Factors

Predisposing Risk Factor

Miscellaneous Risk Factors

Early Detection of Sub-clinical Atherosclerosis

Abstract

Keywords

Introduction

Detection and Assessment of Sub-Clinical Atherosclerosis

Carotid Intima-Media Thickness

Methodology

Definition of Abnormal CIMT

Reproducibility of CIMT Measurement

Clinical Applications

Association with Risk Factors

Prediction of Cardiovascular Risk

As a Surrogate Marker of Presence of Disease

Assessment of Response to Therapy

Carotid IMT or Carotid Plaque?

Limitations

Brachial Artery Flow-Mediated Dilatation

Technique

Definition of Abnormal BAFMD

Clinical Applications

Association with Risk Factors

Prediction of Cardiovascular Risk

As a Surrogate Marker of Presence of Disease

Assessment of Response to Therapy

Limitations

Pulse Wave Velocity and Pulse Wave Analysis

Pathophysiological Mechanisms Linking Arterial Stiffness and Cardiovascular Risk

Methodological Considerations

Basic Principles in the Measurement

Technical Considerations during PWA and Measurement of PWV

Definition of Abnormal Values

Reproducibility of the Measurements

Clinical Significance

Association with Cardiovascular Risk Factors

Prediction of Cardiovascular Risk

Assessment of Response to Therapy

Limitations

Coronary Artery Calcium Scoring

Pathophysiology

Techniques for Coronary Calcium Scoring

Definition of Abnormal Values

Clinical Implications

Prediction of CV Risk

Assessment of Symptomatic Patients

Limitations

Conclusions

Clinical Case Example: Utility of Early Detection of Sub-Clinical Atherosclerosis

Behavioral Management of Coronary Artery Disease

Effect of Globalization, Industrialization and Urbanization

Behavioral Approach to Management of Coronary Artery Disease

Dietary Factors

Calorie Intake

Dietary Fats

Fish

Vegetables and Fruits

Salt Intake

Antioxidants

Physical Activity

Aerobic Exercise

Muscle Strengthening Activity (Resistance Training)

Safety of Resistance Training

Screening/Clearance

Overweight/Obesity

Tobacco

Psychological Factors

Alcohol

Reasons for Failure of Lifestyle Modification Regimens

Medical Management of Coronary Artery Disease

Goals of Therapy

Pharmacological Management of Stable Coronary Artery Disease

Nitrates

Nitrate Preparations

Beta Blockers

Calcium Channel Blockers

Choice of Agent

When to Use

Side Effects

Relative Effectiveness of Medical Therapies

Angina that Persists with Monotherapy

Angiotensin Converting Enzyme Inhibitors

Antiplatelet Therapy

Follow-Up

Inhibition of Fatty Acid Oxidation

Ranolazine

Newer Agents

Trimetazidine

Perhexiline

Nicorandil

Ivabradine

Fasudil

HMG Co-A Reductase Inhibitors

Medical Treatment of Stable Coronary Disease: Key Points

Clinical Case Scenario: Story of a Life Time

Section I

Case Illustration

Answer

Step 1: Calculate the Framingham Risk Score

Three Levels of 10-year Risk

Risk Score Results

Step 2: Establish LDL Goal of Therapy (See Table 1)

Assessing Mr. M.S. Based on This Concept

Section II

Section III

Revascularization in Chronic Stable Angina

Forthcoming Books

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