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    Integrating Multi Modality in Chronic Coronary Syndrome/Disease

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    Astrina Vina

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    Integrating Multi Modality in Chronic Coronary Syndrome/Disease

    Uploaded by

    Astrina Vina
    3 views40 pages

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    PJK

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    3 views40 pages

    Integrating Multi Modality in Chronic Coronary Syndrome/Disease

    Uploaded by

    Astrina Vina

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 40

    INTEGRATING MULTI MODALITY IN CHRONIC

    CORONARY SYNDROME/DISEASE
    Cardiovascular
    disease

    • Data from Riskesdas  prevalence of cardiovascular disease rise from 25,8% (2013)
    to 34,1% (2018)
    Chronic coronary syndrome
    Clinical classification of suspected
    angina
    Canadian Cardiovascular Society of
    Effort Angina Severity
    STABLE VS UNSTABLE ANGINA
    1.as rest angina, i.e. pain of characteristic nature and
    location occurring at rest and for prolonged periods
    (>20 min);
    2.new-onset angina, i.e. recent (2 months) onset of
    moderate-to-severe angina (Canadian Cardiovascular
    Society grade II or III);
    3.Crescendo angina, i.e. previous angina, which
    progressively increases in severity and intensity, and at
    a lower threshold, over a short period of time.
    PRE-TEST PROBABILITY OF
    CORONARY ARTERY DISEASE
    DIAGONOSIS APPROACH OF
    CORONARY ARTERY DISEASE
    RESTING ECG
    • Resting ECG is recommended in all patients with chest pain without
    an obvious non-cardiac cause
    • Resting ECG is recommended in all patients during or immediately
    after episode of angina suspected to be indicative of clinical instability
    of CAD
    Basic Blood Test
    • Full blood count
    • Creatinine
    • Lipid Profile
    • Screening of type 2 diabetes melitus --> fasting glucose and HbA1c
    • Thyroid function in case of clinical suspicion of thyroid disorder
    Chest X-Ray
    • Chest X-Ray is recommended for patiens with atypical presentation,
    signs and symptoms of heart failure of suspicion of pulmonary disease
    Resting Echocardiography
    Resting transthoracic echocardiogram is recommended in
    all patients for:
    1.Exclusion of alternative causes of angina;
    2.Identification of regional wall motion abnormalities
    suggestive of CAD;
    3.Measurement of LVEF for risk stratification;
    4.Evaluation of diastolic function.
    • Contoh gambar dan video echo
    Pasien laki laki 54 tahun datang dengan keluhan sesak  PTP 20% Pasien laki laki 54 tahun datang dengan keluhan mudah lelah  PTP 12%
    Coronary CTA
    • Anatomical non-invasive evaluation, by visualizing the
    coronary artery lumen and wall using an intravenous
    contrast agent, can be performed with coronary CTA,
    which provides high accuracy for the detection of
    obstructive coronary stenoses defined by ICA
    • stenoses estimated to be 50-90% by visual inspection
    are not necessarily functionally significant, i.e. they do
    not always induce myocardial ischaemia
    Pasien laki laki datang
    dengan dada terasa tidak
    nyaman  atypical angina
     PTP 4%
    Cardiac Magnetic Resonance
    SPECT and PET Scan Cardiac
    Stress ECG/ Treadmill Test
    • Exercise ECG is recommended for the assessment of exercise tolerance, symptoms,
    arrhythmias, BP response, and event risk in selected patients.c I C
    • Exercise ECG may be considered as an alternative test to rule-in and rule-out CAD
    when non-invasive imaging is not available.73,83 IIb B
    • Exercise ECG may be considered in patients on treatment to evaluate control of
    symptoms and ischaemia. IIb C
    • Exercise ECG is not recommended for diagnostic purposes in patients with >_0.1 mV
    ST-segment depression on resting ECG
    Pasien laki laki 44 tahun dengan
    keluhan mudah Lelah PTP 12%
    Duke Treadmill Score
    Pasien laki-laki 49 tahun datang dengan keluhan
    nyeri dada jika aktivitas berat  Typical Angina CCS
    clas 2  PTP22%
    Definition of High Event Risk for
    Different Tests
    Risk Assesment
    Terapi anti angina
    Recomendation

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