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Common Congenital Heart Lesions - page 68 / 126

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68 / 126

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        • Ischemic regions are already max dilated, so this drug-induced vasodilation increases flow to health arteries and promotes stealing of blood from diseased segments to perfuse other parts

        • Cold spots are visible in image

  • Coronary Angiography

    • o

      Contrast material injected into arteryÆregions of stenosis are visible

      • o

        Low risk, but more than the non-invasive tests

      • o

        Gold standard for CAD diagnosis

      • o

        But you always have to think about the functional effects on the patient

      • o

        Does not tell you anything about the composition of the plaque and whether it is likely to rupture

Natural History:

  • We don’t know why some plaques rupture and some don’t.

  • Location and extent of stenosis relates to mortality

  • Some predictors of mortality =

    • o

      Degree of impaired LV contractile function

      • o

        Poor exercise capacity

      • o

        Anginal symptoms

  • Stop smoking, eat less fat, lower cholesterol, control BP, control diabetes mellitus, get more exercise

Treatment: goal of treatment is to reduce the frequency of anginal attacks by restoring balance of supply and demand, prevent MI, prolong survival.

Acute Anginal Attack

  • Stop physical activity

  • Sublingual nitroglycerin = drug of choice

    • o

      Works mostly through venodilation = preload, O2 consumption

      • o

        Also dilates coronary arteriesÆ may not help much of the vessels are already max dilated

Preventing Recurrent Ischemic Episodes: decrease cardiac workload and reduce demand

  • Organic Nitrates

    • o

      SYMPTOMATIC RELIEF ONLY Æ will not prolong survival

      • o

        Venodilation

      • o

        Sublingual or spray = rapid onset

      • o

        Can be used prophylactically

      • o

        Longer acting options

        • Isosorbide dinitrate or transdermal patches of nitroglycerin

        • Drug tolerance limits effectiveness

      • o

        Side effects= headache, palpitations, tachycardia

  • Beta Blockers

      • o

        Reduce myocardial oxygen demand

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