PENANG CARDIOVASCULAR SYMPOSIUM 2008

ACEI, ARB OR COMBINATION FOR HEART FAILURE

http://docs.google.com/Presentation?docid=dfkxwwtm_3fw6bt9c7&hl=en

Selamat menyambut ramadhan

selamat menyambut ramadhan

SECONDARY PREVENTION FOR PATIENT WITH CORONARY ARTERY DISEASE (AHA/ACC 2006)

Smoking	Complete cessation No exposure to environmental tobacco smoke
Blood Pressure Control	130/80mmhg
Lipid Management	LDL-C, less than 2.0mmol/l
Physical Activity	30 minutes, 7 days per week
Weight Management	BMI 18 to 23kg/m2 Waist circumference (Men <38>
Diabetes Management	HbA1c <7%
Antiplatelet	Aspirin indefinitely (75 to 162mg daily) Add Clopidogrel 75mg daily post acute coronary syndrome or stenting Warfarin for AF
Renin Angiotension Aldosterone blockers	ACE Inhibitors for all patients ARB for ACE Inhibitor intolerance ACE Inhibitor and ARB combination for heart failure Aldosterone receptor blocker for NYHA class III and IV
Beta Blockers	Myocardial infarction, acute coronary syndrome, heart failure

Secondary prevention: "Post cardiac event"

RISIKO PENYAKIT JANTUNG KORONARI

RISIKO BOLEH DI UBAH

1. Tekanan darah tinggi
2. Kandungan lemak berlebihan/hypercholestrolaemia
3. Kencing manis/Type 2 Diabetes Mellitus
4. Tabiat merokok
5. Kegemukan
6. Kurang aktiviti fizikal
7. Ketegangan/stress

RISIKO TIDAK BOLEH DIUBAH

1. Keturunan
2. Jantina lelaki
3. Umur

thesecret

A very interesting video i picked up.
Here is the link..
http://video.google.com/videoplay?docid=-1052811701025164889&ei=N5WGSJ6FOpKywgOVxIiRCA&hl=en

The myth and truth about cardiac CT

I think I am jumping the gun talking about cardiac CT before talking about coronary heart disease in general. The reason being there are a lot of us simply request for cardiac CT for no obvious reason. (cardiac CT=multislice CT=CTA coronary).

Advantage of multislice CT coronary
1. Avoidance for arterial puncture and coronary catheter manipulation, in which deemed fairly safe.
2. Cheaper than conventional coronary angiogram
3. Outpatient setting
4. Highly sensitive for proximal lesions

Disadvantages of multislice CT coronary
1. Excessive radiation exposure – 3x standard coronary angiogram
2. Excessive contrast use – 3x standard coronary angiogram, hence higher risk for kidney complication
3. Image quality dependent upon patient heart rate
4. Distal segments may be poorly visualized in some patient
5. Presence of calcium may cause underestimation of coronary artery narrowing

In my opinion, multisclice CT coronary is appropriate for
1. "Intermediate risk" chest pain that has an equivocal/non interpretable stress test.
2. Atypical chest pain in patients who can’t adequately perform treadmill stress test.
3. Unusual coronary anatomy.
4. New onset heart failure
(based on Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging (JACC Vol 48, No 7, 2006, 1475-97)

Mulitslice CT coronary is not suitable for
1. Known coronary heart disease
2. High probability coronary heart disease based upon clinical assessment

Tasik Temenggor Trip 2008

Dr Suresh, Dr Regu and Me