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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 O2 supply
11  Ischemia is related to myocardial O2 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 Ca2+ during ischemia and reperfusion
26  Myocardial ischemia causes enhanced late INa
27  Late Na+ accumulation causes LV dysfunction
28  Na+/Ca2+ overload and ischemia
29  Late INa 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 INa effect mitigates IKr 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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