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Slide Lecture Programs
2006 Core Curriculum
Contemporary Management of Myocardial Ischemia
May 17, 2006
Table of Contents - 119 slides
No.
Title
1
Contemporary Management of Myocardial Ischemia
2
Epidemiology of chronic ischemia (angina)
3
Persistent ischemia (angina) despite current drug therapy
4
Persistent ischemia (angina) despite PCI
5
Persistent ischemia (angina) despite optimal revascularization
6
Myocardial ischemia: Significant clinical burden
7
Myocardial ischemia diminishes quality of life
8
Coexistence of myocardial ischemia and depression
9
Myocardial Ischemia: View from the Vessel Wall
10
Causes of inadequate myocardial O
2
supply
11
Ischemia is related to myocardial O
2
supply and demand
12
Symptoms occur at end of ischemic cascade
13
Obstructive plaque and ischemia
14
Impaired microvascular perfusion in the anginal syndrome
15
Subendocardial hypoperfusion: Association with anginal syndrome
16
Accumulating evidence implicates coronary microcirculation dysfunction in IHD
17
New Mechanistic Approaches to Myocardial Ischemia
18
New mechanistic approaches to myocardial ischemia
19
Rho kinase inhibition: Fasudil
20
Metabolic modulation (pFOX): Trimetazidine
21
Metabolic modulation (pFOX) and ranolazine
22
Preconditioning: Nicorandil
23
Sinus node inhibition: Ivabradine
24
Late Na
+
current inhibition: Ranolazine
25
Na
+
and Ca
2+
during ischemia and reperfusion
26
Myocardial ischemia causes enhanced late I
Na
27
Late Na
+
accumulation causes LV dysfunction
28
Na
+
/Ca
2+
overload and ischemia
29
Late I
Na
blockade blunts experimental ischemic LV damage
30
Ranolazine: Key concepts
31
Myocardial ischemia: Sites of action of anti-ischemic medication
32
Summary
33
Clinical Management of Chronic Stable Angina
34
Anti-ischemic strategies in stable CAD
35
Older antianginal drugs: Pathophysiologic effects
36
Older antianginal drugs: Clinical conditions that may limit use
37
"Unmet needs" in antianginal therapy
38
New Therapeutic Options for Chronic Stable Angina
39
New mechanistic approaches to chronic stable angina
40
Evaluation of fasudil in stable angina: Trial design
41
Results: Fasudil improves exercise duration
42
Results: Fasudil improves exercise time to
>
1 mm ST depression
43
TACT: Study design
44
TACT: Trimetazidine reduces angina episodes
45
IONA: Study design
46
IONA: Reduction in primary outcome
47
INITIATIVE: Study design
48
INITIATIVE: Effects of ivabradine vs β-blockade on primary outcome
49
INITIATIVE: Summary
50
Ranolazine: Late Na
+
current inhibitor
51
Ranolazine: Pathophysiologic effects vs older antianginals
52
MARISA: Study overview
53
MARISA: Study design
54
MARISA: Dose-related increase in exercise duration with ranolazine
55
MARISA: Tolerability of treatments
56
MARISA: Summary
57
Antianginals: Effects on exercise duration
58
CARISA: Study overview
59
CARISA: Study design
60
CARISA: Ranolazine increases exercise duration
61
CARISA: Ranolazine reduces angina frequency
62
CARISA: Ranolazine reduces nitrate consumption
63
CARISA: Summary
64
ERICA: Study design
65
ERICA: Ranolazine reduces angina frequency and nitrate consumption
66
ERICA: Summary
67
Ranolazine: Long-term use
68
Ranolazine extended-release tablets: Approved Jan 31, 2006
69
Ranolazine: Drug interactions
70
Ranolazine extended-release tablets: Dosing
71
Electrophysiologic effects of ranolazine
72
Late I
Na
effect mitigates I
Kr
effect
73
Overview of torsade de pointes
74
Ranolazine: No apparent proarrhythmic characteristics
75
Current nonpharmacologic antianginal strategies
76
Potential cardioprotective benefits of exercise
77
Exercise vs PCI in low-risk CAD
78
EECP improves angina class
79
Surgical laser TMR improves angina class
80
SCS vs CABG: Equivalent symptom relief in high-risk patients
81
Summary
82
Practical Considerations in Chronic Ischemic Heart Disease Management
83
Angina treatment: Objectives
84
Comprehensive management of myocardial ischemia
85
CAD: Treatment challenges
86
ACC/AHA guidelines: Chest pain evaluation
87
ACC/AHA guidelines: Chronic stable angina treatment
88
Substantial growth in PCI
89
Stable CAD: PCI vs conservative medical management
90
Major benefit of PCI: Angina symptom relief
91
CAD progression: Major cause of post-revascularization angina
92
Conditions limiting repeat revascularization
93
Diabetes and PCI: Factors influencing outcome
94
CARISA: Ranolazine benefits patients with and without diabetes
95
CARISA: Ranolazine reduces A1C
96
Selective vs routine catheterization: Cost reduction
97
Chronic stable angina: Pharmacotherapy
98
CRUSADE: Nonpharmacologic interventions at discharge
99
CRUSADE: Discharge medications following UA/NSTEMI
100
How important is IHD in women?
101
AHA guidelines: Chest pain evaluation in women
102
IHD vasculopathy: Gender differences
103
Ischemia in women: Microvascular dysfunction
104
Less obstructive CAD: Women vs men
105
Women have more adverse outcomes vs men
106
Higher incidence of major CV events in women
107
Increased risk of death/MI in women with CAD
108
CRUSADE: Gender and discharge medications
109
Euro Heart Survey: Undertreatment of women
110
Ongoing Trials in Managing Myocardial Ischemia
111
MERLIN-TIMI 36: Study design
112
COURAGE: Study design
113
COURAGE: Lifestyle modification goals
114
COURAGE: Medical therapy goals
115
BARI 2D: Study design
116
Biological revascularization: New frontiers
117
Transplanted EPCs: Reduction in fibrosis
118
Stem cell therapy for intractable angina: Study design
119
Summary
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