Clinical and coronary angiographic correlation of patients with unstable Angina.

Jeyasingh, P (2014) Clinical and coronary angiographic correlation of patients with unstable Angina. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION : UA is a clinical syndrome caused by atherosclerotic plaque rupture and thrombosis within a coronary artery . It is defined as angina that is new onset or abruptly increased in intensity ,duration or frequency within the past 60 days. It may present as rest angina,new onset severe angina or increasing angina .Initial evaluation includes risk stratification based on history ,clinical exam , ECG , cardiac enzymes . Among patients with UA who undergo angiogram ,85% will have significant CAD. CABG confers a survival benefit in patients with > 50% LM stenosis or triple vessel disease with LV dysfunction, Importantly patients with no significant lesions at angiography benefit from reorientation of their management.Symptomatic patients with normal coronaries may have significant atherosclerosis by IVUS secondary to coronary artery remodeling AIM : 1. Risk stratification based on clinical history & presentation, ECG, Enzymes, 2. To Correlate the clinical profile with Coronary angiographic profile 3. To identify the high risk predictors for early intervention MATERIALS AND METHODS : Study design : Observational and Cross sectional StudyStudy population:Unstable angina patients admitted for coronary angiogram in cardiology ward GRH, Madurai. Inclusion Criteria Patients admitted with a history of chest pain diagnosed as unstable angina and subsequently underwent CAG in cardiology ward. RESULTS AND CONCLUSION : Unstable angina commonly affects the age group 45-60yrs in both sexes. 30% of patients in our study was women. Women have normal coronaries compared to men in patients with unstable angina, (30% vs 20%) which suggests a different patho physiological mechanism for their symptoms which leads to difficulty in making a firm diagnosis of UA. Smoking, diabetes, Hyperlipidemia, Hypertension are major risk factors for unstable angina in this study Braunwald class III angina (Rest angina) predicted severity of lesion ( left main & triple vessel disease) in our study. Patients who had High TIMI risk scoring had more severe coronary lesions compared to low TIMI risk score which helps in risk stratification and early intervention. Significant ST-T changes in ECG predicted more extensive disease which helps in decision making regarding treatment strategy (conservative vs invasive) aVR ST elevation in background of unstable angina predicts left main disease &Triple vessel disease in our study which helps risk stratification and early intervention. ECHO evidence of LV dysfunction predicted Triple vessel disease /LM disease. Out of the 100 pts who underwent coronary angiogram in our study 27 pts had Single Vessel disease ( type A lesions predominantly) 24 pts had two Vessel disease .( type B lesions predominantly) 26% had three vessel disease. (type B lesions predominantly) 14 patients had Left Main Coronary artery disease. 23 patients had normal or insignificant coronary artery lesions. 9 patients had thrombus containing lesion who had rest angina, out of whom 6 patients had SVD and 3 patients had multivessel disease. 3 patients had total occlusion with TIMI ‘0’ flow.

Item Type: Thesis (Masters)
Uncontrolled Keywords: coronary angiographic correlation ; patients ; unstable Angina.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 06 Jul 2017 06:22
Last Modified: 06 Jul 2017 10:26
URI: http://repository-tnmgrmu.ac.in/id/eprint/1084

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