coronary artery disease: diagnosis and treatment
DESCRIPTION
Northwestern Memorial Hospital Healthy Transitions Fall Program October 7, 2013. Coronary Artery Disease: Diagnosis and Treatment. Mark J. Ricciardi, MD Director, Interventional Cardiology and Cardiac Catheterization Northwestern Bluhm Cardiovascular Institute. Outline. - PowerPoint PPT PresentationTRANSCRIPT
Coronary Artery Disease: Coronary Artery Disease: Diagnosis and TreatmentDiagnosis and Treatment
Mark J. Ricciardi, MDMark J. Ricciardi, MDDirector, Interventional Cardiology and Cardiac Director, Interventional Cardiology and Cardiac CatheterizationCatheterizationNorthwestern Bluhm Cardiovascular InstituteNorthwestern Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
Healthy Transitions Fall ProgramOctober 7, 2013
OutlineOutline
Coronary artery disease (CAD) basicsCoronary artery disease (CAD) basics Diagnosis of CADDiagnosis of CAD
– Cardiac Catheterization / Coronary Cardiac Catheterization / Coronary AngiographyAngiography
Treatment of CADTreatment of CAD– Coronary Angioplasty / StentCoronary Angioplasty / Stent– Past, present, futurePast, present, future
Coronary DiseaseCoronary Disease
AtherosclerosisAtherosclerosis– ‘‘Arteriosclerosis’Arteriosclerosis’– Fatty buildup in lining of artery wallFatty buildup in lining of artery wall
Plaque Plaque
– Impinges on flow Impinges on flow Reduces amount of blood and oxygen Reduces amount of blood and oxygen
delivered to the heart muscledelivered to the heart muscle
Cholesterol depositionCholesterol deposition
Early CADEarly CAD
Vulnerable Plaque
Plaque Rupture
Coronary ThrombosisCoronary Thrombosis“Heart Attack”“Heart Attack”
CADCADthe goal…the goal…
is preventionis prevention– Primary preventionPrimary prevention
Prevent early / sub-clinical stagesPrevent early / sub-clinical stages Heart healthy lifestyleHeart healthy lifestyle
– Starting in childhoodStarting in childhood MedicationsMedications
– Targeted at high risk groupsTargeted at high risk groups
Diagnosis of CADDiagnosis of CAD
History History – SymptomsSymptoms– AnginaAngina
Diagnosis of CADDiagnosis of CAD
History History – SymptomsSymptoms– AnginaAngina
Non-invasive imagingNon-invasive imaging– Stress testingStress testing
provocationprovocation
– CT angiogramCT angiogram good, not greatgood, not great
Diagnosis of CADDiagnosis of CAD
History History – SymptomsSymptoms– AnginaAngina
Non-invasive imagingNon-invasive imaging– Stress testingStress testing– CT angiogramCT angiogram
Invasive imagingInvasive imaging– Left heart catheterization / coronary Left heart catheterization / coronary
angiography … the gold standard for Dxangiography … the gold standard for Dx
Coronary AngiographyCoronary AngiographyPurposesPurposes
Define coronary anatomy, and Define coronary anatomy, and presence, absence, degree presence, absence, degree obstructionobstruction
Most commonlyMost commonly used to: used to: – determine extent of CAD determine extent of CAD – assess feasibility and appropriateness of assess feasibility and appropriateness of
mechanical revascularizationmechanical revascularization
CatheterizationCatheterization
CatheterizationCatheterization
Coronary AngiographyCoronary Angiography
Coronary AngiographyCoronary Angiography
Arterial access Arterial access Femoral arteryFemoral artery
Most common access siteMost common access site– since 1980ssince 1980s
Easy and reliableEasy and reliable
Often requires 20-30 Often requires 20-30 minutes of pressure to minutes of pressure to prevent bleeding - followed prevent bleeding - followed by bed-restby bed-rest
1% risk significant bleeding1% risk significant bleeding There are new strategies There are new strategies
that hasten recovery timethat hasten recovery time– Bleeding still an issueBleeding still an issue
Arterial access Arterial access Radial arteryRadial artery
Lower risk of Lower risk of significant bleedingsignificant bleeding
No bed rest requiredNo bed rest required
Arterial access Arterial access Radial arteryRadial artery
““Down side” Down side”
-the learning -the learning curvecurve
Arterial access Arterial access Radial arteryRadial artery
CAD TreatmentCAD Treatment
CAD TreatmentCAD TreatmentThe past…The past…
CAD TreatmentCAD Treatment
Secondary preventionSecondary prevention– Lifestyle modificationLifestyle modification
Diet, exercise, tobacco cessationDiet, exercise, tobacco cessation Rx underlying risk factorsRx underlying risk factors
– Aspirin and ‘statin’ medicationsAspirin and ‘statin’ medications– Anti-anginal medicationsAnti-anginal medications
Beta blockersBeta blockers
Coronary BypassCoronary Bypass
Coronary AngioplastyCoronary Angioplasty
Coronary AngioplastyCoronary Angioplasty
Coronary StentingCoronary Stenting
Coronary StentingCoronary Stenting
Drug StentsDrug Stents
Northwestern Memorial Hospital Northwestern Memorial Hospital
Cardiac Catheterization CenterCardiac Catheterization Center
Chicagoland’s First:Chicagoland’s First:– Coronary Stent (1990s)Coronary Stent (1990s)– Drug eluting stent (early 2000s)Drug eluting stent (early 2000s)
Northwestern Memorial Hospital Northwestern Memorial Hospital
Cardiac Catheterization CenterCardiac Catheterization Center
Chicagoland’s First:Chicagoland’s First:– Coronary Stent (1990s)Coronary Stent (1990s)– Drug eluting stent (early 2000s)Drug eluting stent (early 2000s)– Bio-absorbable stent (2013)Bio-absorbable stent (2013)
Next Generation StentsNext Generation Stents
Bioabsorbable / Bioabsorbable / dissolving stentsdissolving stents
In clinical trials at In clinical trials at NorthwesternNorthwestern
ConclusionsConclusions
CADCAD– Sub-clinical plaque formationSub-clinical plaque formation
Symptomatic CADSymptomatic CAD– Angina, heart attackAngina, heart attack– Non-invasive and invasive testingNon-invasive and invasive testing
CAD TreatmentCAD Treatment– Behavioral, pharmacologic, mechanicalBehavioral, pharmacologic, mechanical– NW big part of the past, present and NW big part of the past, present and
future of CAD Rxfuture of CAD Rx
Questions?Questions?
http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=angiog
http://www.scai.org/PatientEducation/default.aspx
Judkins TechniqueJudkins Technique
JL and JR cathetersJL and JR catheters Melvin JudkinsMelvin Judkins
CineangiographyCineangiographyAngiographic viewsAngiographic views
Femoral Artery Hemostasis Femoral Artery Hemostasis Perclose Suture-Mediated Closure System Perclose Suture-Mediated Closure System (Abbott Vascular)(Abbott Vascular)
Non-braided polyester Non-braided polyester suturesuture
Automated knot tyingAutomated knot tying Closure of 5-8Fr. access Closure of 5-8Fr. access
sites sites
‘‘pre-closure’pre-closure’
Transradial Angiography / Transradial Angiography / InterventionInterventionAnatomyAnatomy
No associated major nerveNo associated major nerve Median N in carpal tunnelMedian N in carpal tunnel Ulnar N runs with UAUlnar N runs with UA
Dual arterial supply to handDual arterial supply to hand RA and UA join in 2 arches RA and UA join in 2 arches Superficial and deep palmar archesSuperficial and deep palmar arches
Radial Artery Compression Radial Artery Compression DevicesDevices
The most important The most important bleeding avoidance bleeding avoidance strategy?strategy?
FemoralFemoral RadialRadial