CORONARY ARTERY

DISEASE
(CAD)
 Learning outcomes

At the end of the lecture, students should be able to:

1. Explain coronary artery disease.
2. Discuss the risk factor of coronary artery disease:
modifiable and non-modifiable.
3. Discuss the etiology and type of coronary artery
disease.
• Coronary artery disease is characterized by the
progressive narrowing of the coronary arteries
whereby the blood flow to the myocardium is
insufficient to meet the oxygen demand.
• The primary cause of this is atherosclerosis which
usually develops gradually over a period of year.
• Atherosclerosis is process in which the fatty
substances especially cholesterol is deposited as
plaque along the inner lining of the vessel (intima)
leading to narrowing of the lumen.
• Arteriosclerosis is the hardening and thickening of
the medial lining of the artery usually due to
degenerative process.
• Coronary artery disease can be presented as:
1. Asymptomatic (stress test, medical checkup)
2. Heart failure
3. Acute myocardial infarction
4. Dysrhythmias
5. Sudden death
 Risk factors of CAD

Non modifiable Modifiable

1. Age 1. Smoking
2. Sex 2. Hypertension
3. Hereditary 3. Diabetes
4. Race 4. Hyperlipidemia
5. Sedentary life style
6. Obesity
7. Stress
8. Personal type 1 (psychology,
stressful)
COMMON CARDIAC
DISEASE
THORACIC CAVITY
MULTIDISCIPLINARY CARE:

• Cardiology - Medical
• Cardiothoracic – Surgical adult and
peadiatric
• Paediatric Cardiology
• Cardiac Anaesthesia
 TYPES OF DISEASES MANAGED IN
IJN

Cardiac Diseases: Lung Disease:

Coronary Artery Disease • CA Lung
• Cardiac Failure • Pulmonary embolism
• Valve Diseases • Pulmonary Hypertension
• Vascular disease • Pleural Effusion
• Cardiac Dysrhythmia • Pneumothorax
• Congenital Heart Disease • Idiopathic
• Others – thoracic :-
• Hyperhydrosis
• Pectus excavatum
Coronary Artery Disease
 TREATMENT -
INTERVENTIONAL
Percutaneous Coronary Intervention
 Treatment - Surgical
Coronary Artery Bypass Graft
CARDIAC FAILURE
 TREATMENT

• Convention – Anti-Failure Drugs

• Interventional Modification – Parachute
• Ventricular Assist Device
• Heart Transplant
HEART VALVE DISEASE
VALVE DISEASES – MITRAL
VALVE
Treatment:
• Interventional –
Mitraclip
VALVE DISEASES – MITRAL VALVE
Surgical Treatment –
Repair or replacement
 VALVE DISEASES – MITRAL
VALVE
Surgical Treatment –
Mitral Stenosis
Repair/Replacement
 VALVE DISEASES – Aortic Valve
Disease
Normal Aortic Valve vs
Diseased Aortic Valve Treatment:
• Aortic Valve Repair
• Aortic Valve
Replacement
• Prosthetic
• Homograft
 VASCULAR DISEASES

动脉瘤
Thoracic Aneurysm:
• Ascending Aorta
• Descending
Aorta

Ascending Aortic Aneurysm

VASCULAR DISEASES

Abdominal Aortic
Aneurysm
 TREATMENT FOR ANEURYSM
Percutaneous:
TEVAR – Thoracic
Endovascular Aortic Repair

EVAR – Endovascular Aortic Repair

CARDIAC DYSRHYTHMIA
Atrial Fibrillation
 CARDIAC DYSRHYTHMIA
Treatment for Atrial Fibrillation:
• Medication – Digoxin,
Amiodarone
• Interventional – Radiofrequency
Ablation
• Surgical – Maze Procedure

Radiofrequency Ablation
 CARDIAC DYSRHYTHMIA
• Heart Block • Treatment – Pacemaker
• Sick Sinus Syndrome
 CONGENITAL HEART
DISEASE
Acyanotic Congenital Heart
Disease:
• Patent Ductus Arteriosus
• Atrial Septal Defect (ASD)
• Ventricular Septal Defect
(VSD)
Cyanotic Congenital Heart
Disease:
• Tetralogy of Fallot (TOF)
• Transposition of Great
Arteries (TGA)
• Truncus Arteriosus
• Total Anomalous
Pulmonary Artery
Drainage (TAPVD)
• Others
ACYANOTIC HEART DISEASE
PATENT DUCTUS ARTERIOSUS

Treatment:
• Percutaneous PDA
Occlusion
• Surgical PDA Ligation
ATRIAL SEPTAL DEFECT
Treatment:
• Amplatzer ASD
closure
(percutaneous)
• Surgical – ASD
closure
 VENTRICULAR SEPTAL DEFECT

Ventricular Treatment:
Septal Defect • Closure of VSD

Surgical Closure of VSD

VSD Occluder
CYANOTIC HEART DISEASE
TETRALOGY of FALLOT

Treatment:
• Total correction of
TOF
• Closure of VSD
• Enlarging the right ventricular
outflow tract (RVOT)
• Can be done in stages – alleviate
cyanotic symptoms/ train the LV

• Post surgery
complication:
• left heart failure
 TRANSPOSITION OF GREAT
ARTERIES
Treatment: - Arterial
Switch

Transposition of Great Arteries

TOTAL ANAMOLOUS PULMONARY VENOUS
DRAINAGE
Treatment: - Repair
Aim :–
• to restore
deoxygenated blood
drainage from right
side
• Restore outflow of
oxygenated blood from
the left side
 TRUNCUS ARTERIOSUS
Treatment: Rastelli
Operation

Conduit

Truncus Arteriosus
 COARCTATION OF AORTA
Treatment – end to end
anastomosis
 OTHERS

Transplant:- Ventricular Assist Device:

• Heart Transplant • Bridge to transplant
• Lung Transplant • Destination Therapy
• Heart-Lung Transplant
 SURGICAL REPAIR
Open Heart Surgery: Close Heart Surgery:

- perform under ‘still’ heart • Heart beating

• Repair of structure outside the heart
- Deal with heart internal
structure 心脏停跳液 • Eg: Repair of coarctation of aorta, BT
shunt, PDA Ligation
- Cardioplegia solution
- Heart – lung machine
Circulatory arrest:
- eg: valve surgery,
congenital correction • Vascular surgery
• Eg: Triple A op
CARE POST INTERVENTION
/ SURGERY
Intervention: Surgical
• Stabilization / calibration of • Stabilization / calibration of
treatment treatment
• Monitoring for • Monitoring for
complication: complication:
• Arrhythmia • Bleeding
• Haematoma • GIT Bleed
• Bleeding • Infection
• Acute MI • Stroke
• Thrombosis • Multi Organ Failure
• Re-occlusion
 SUMMARY

• Heart Disease – can affect all age

• Treatment for heart disease:
• interventional (cardiologist)
• Surgical (cardiothoracic)
• Post treatment consist mainly on prevention of
complication