Abordagem da Doença Arterial Coronariana

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RESUMO
Signs and symptoms
The signs and symptoms of coronary artery atherosclerosis include the following:

Chest pain
Shortness of breath
Weakness, tiredness, reduced exertional capacity
Dizziness, palpitations
Leg swelling
Weight gain
Diaphoresis
Stable angina pectoris
Intermittent claudication
Mesenteric angina
Tachycardia: Common in persons with acute coronary syndrome (ACS) and acute myocardial infarction (AMI)
High or low blood pressure
S4 gallop: A common early finding
S3 gallop: An indication of reduced left ventricular function
Heart murmurs
Tachypnea
Xanthelasmas
Livedo reticularis
Syncope
Leg edema
Rales
See Clinical Presentation for more detail.

Diagnosis
Laboratory tests:

Complete blood count (CBC)
Chemistry panel
Lipid profile
Thyroid function tests: To exclude thyroid disorders
Blood glucose and hemoglobin A1C (HbA1C) measurement: Appropriate in patients with diabetes mellitus
Myocardial fractional flow reserve (FFR)
Coronary flow reserve (CFR)
Lipid studies
C-reactive protein level
Serum markers
Imaging studies:

Echocardiography
Nuclear imaging
Computed tomography
Electron beam CT scanning
Optical coherence tomography imaging
Magnetic resonance imaging
Positron emission tomography
Coronary angiography
Doppler velocity probes
Ultrasonography
See Workup for more detail.

Management
The following are used in the management of angina[1] :

Nitrates
Beta blockers
Statins
Calcium channel blockers
Ranolazine
Other agents used in the treatment of coronary artery stenosis or to aid in the management of stable coronary artery disease after intervention include the following:

Angiotensin-converting enzyme inhibitors to reduce blood pressure
Antiplatelet agents for acute coronary events
Intravenous glycoprotein IIb/IIIa inhibitors
Aspirin
Clopidogrel
Ticlopidine
HMG-CoA reductase inhibitors, or statins to lower LDL cholesterol levels
Treatment procedures for coronary artery atherosclerosis include the following:

Coronary artery bypass grafting (CABG)
Percutaneous coronary intervention (PCI)
Partial ileal bypass
In high- and intermediate-risk patients with 3-vessel disease, PCI was associated with significantly higher rates of revascularization and of major adverse cardiac and cerebrovascular events than CABG[2, 3] ; the 2 procedures were equally effective in the treatment of low-risk patients with 3-vessel disease and in low- and intermediate-risk patients with left main CAD.


Image library

Cardiac catheterization and coronary angiography in the left panel shows severe left anterior descending coronary artery stenosis. This lesion was treated with stent placement in the left anterior descending coronary artery, as observed in the right panel.