Laboratory
EKG at rest and at effort
Pulmonary Rx
Echocardiography
Coronaroangiography
INVESTIGATIONS
Laboratory investigations
Complete haemoleucograme
Creatinine
Glycaemia a jeun
Lipidic profile (Cholesterol, HDL, LDL,
Triglyceride)
PCR
Homocistein
EKG
INVESTIGATIONS
BETWEEN CRISIS DURING CRISIS
ST subdenivelation
( subendocardiac
lesions) Normal aspect in 1/3
Normal aspect in over cases
1/3 cases ST subdenivelation
Negative T wave Negative or Flat T
( subepicardiac wave negative
lesions) Intraventricular
HighT wave (idem) blocks
QT lengthening
EKG at
effort
The Possibility of diagnosis in
primary medicine.
Anamnesis
EKG signs of ischemia ; EKG at rest ; EKG at effort
( EKG manifestations)
Laboratory investigations (CK si CKMB detemination
excludes the possibility of an AMI)
sudden reduction of arterial pressure during the effort
test denotes a severe ischemia
Associated diseases
Risk factors
Precocious diagnosis of ischemic cardiopathy
TREATMENT
1. Unpharmacological treatment: identifying and controlling risk
factors
2. Pharmacological treatment
a). Acute attack - medium - sublingual nitoglycerine or
spray
- severe - nitroglycerine i.v.
b). chronic -among the prolonged prophylactic medicines
reccomended in angina pectoris are indicated :
1.Betablokers (propanolol, athenol, metroprolol);
2.Nitrates (nitroglycerine, isosorbide dinitrate);
3.Calcium channels blockers.
4.Reducing the atherosclerosis process:
- hipolipemiante medication- statins,
fenofibrats
- metabolic trimetazidina
- antiagregants - aspirin , clopidogrel)
- antioxidants
MEDICINES USED IN THE CHRONIC
TREATMENT OF ANGINA PECTORIS
GROUP ACTIVE COMERCIAL DOSE
SUBSTANCE NAME
NITRATES Nitroglycerine- Nitroretard 6,25 mg 2-3x/
retard Pentacard 20 mg 2x /d
Isosorbid Maycor, Isodinit 20 mg 2 x / d
mononitrate Nitropector 20 mg 2 x / d
Isosorbid dinitrate
Pentaerithrityl Inderal 20 mg 2-3 x /d
Tetranitrate
BETA- Propanolol
Propanolol Inderal 20 mg 3-4/d
BLOCKERS Metroprolol Betaloc zok 50 mg 2 x /d
Bisoprolol Concor 5 mg 2 x/d
Atenolol Atenolol 50-100mg 1x/d
Betaxolol Lokren 20 mg 1x/d
Carvedilol Dilatrend 12,5-25 mg
2x/d
DRUGS USED IN CHRONIC TREATMENT OF
ANGINA PECTORIS
2). Stentation
education
Treatment aspects
Periodic evaluation aspects
complications- approach
The determination of associated clinical
conditions - associated diseases dyslipidemia,
diabetes, obesity, arteriopathies, AHT
The patients cardiovascular risk factors
determination :
The modification of the way of living
The fully qualified medical officers
attitude towards a patient with angina
pectoris
1.The patients information about the main risk factors for
angina pectoris
2. Modifying the way of living and the patients instruction
for his own disease nursing.
3. The determination of a chronic treatment for the angina
together with the specialized doctor.
4. The monitorisation of the compliance to the treatment
and of its efficiency through periodical examinations and
investigations.
5. The recommendations for patients with unstable angina
or for non responsive patients concerning the importance of
the invasive investigations for the surgical treatment
opportunity appreciation.
6. The cooperation with specialists both in the evaluation
stage of the diagnosis and of the treatment and the future
appreciation of the evolution under treatment.
DYSLIPIDEMIA
Dyslipidemia has no symptom but it
is a very important risk factor for the
systematic vascular disease and
especially for coronation and for
cerebral circulation
It represents the total cholesterol
increase (TC) associated with the LDL
increase and the HDL decrease (and
the VLDL increase)
TC represents the sum of the seric
lipoprotein fraction (LDL, HDL, VLDL)
NORMAL VALUES
TC= LDL+HDL+VLDL
VLDL= TGL/5
TC<190 mg/dl and LDL< 115 mg/dl
CT<175 mg/dl and LDL< 100 mg/dl for
diabetical patients or patients with
manifest cardiovascular disease
HDL>40 mg/dl for men
HDL>46 mg/dl for women
TGL<150 mg/dl
The risk factors for coronary disease
include according to their
importation:
1.An LDL increase
2.A HDL decrease
3.A TC increase
4.A TGL increase (the studies proved
that a higher level of the TGL
announces the appearance of the
diabetes long time before)
THE DYSLIPIDEMIA CAUSES