Management of Coronary Artery Disease

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Management of Coronary Artery DiseaseCut, Stent
or Pills

• Dr Mark Abelson
• Cardiologist
• Vergelegen Medi Clinic

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Atherosclerosis of the Aorta
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• Symptoms due to impaired
• Blood and oxygen supply to
• heart muscle
• Chest dyscomfort / pain
• Fatigue
• Shortness of breath

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Heart Attack due to Completely blocked Artery Hear
t muscle dies - 25 sudden death - 8 in hospital
mortality
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Management
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Case 1
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Case 2
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Case 3
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Case 1 - Stents
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Occluded vessel treated with stentBest treatment
for heart attack
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Stent problems
Bare metal stents 10-15 scar tissue occlusion
Restenosis
Drug eluting stents 5 scar tissue
occlusion Acute stent thrombosis
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Case 2
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CABG
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CABG

• More invasive higher risk
• Longer recovery
• But more complete restoration of blood
• supply
• Less repeat intervention than stents
• But increasing need to stent old vein grafts or
  need 2nd bypass
• Best for younger stronger patients
• Many patients grey zone could have either

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Medical Treatment

• Diffuse small vessel disease
• Too much to stent
• Too small to bypass
• Can do very well with medical treatment
• - aspirin
• - statin
• - bilocor/bisocor/carloc/ravamil/verahexal
• - elantan / isordil
• - coralin

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Can I improve (or worsen) his prognosis with
stents??
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• Thank You