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Management of Angina in Egypt

Hello, my name is Magdy Abdelhamid, the professor of cardiovascular medicine at Cairo University and the immediate past president of the Egyptian Society of Cardiology. Welcome to angina updates educational initiatives. This is very important educational activity because angina is a very common symptom in patients with coronary artery disease. So I think the objectives for management of patients with chronic coronary arteries syndromes presenting with angina, which is a very common presentation in the daily practice. 

So we need to do basic assessment. We need to do proper diagnosis as well as risk assessment because the aim of management of patients with angina is to relieve symptoms and improve quality of life as well as to improve prognosis. So the general approach for those patients should focus on assessment of symptoms of angina, because typical angina in the chest pain related to effort to review the virus and or something or nitrates. We have to evaluate the general condition of the patient and associated comorbidities. Quality of life is very important. Basic assessment including biochemistry and echocardiography and then before asking for not invasive investigation, so we have to do a pre-test on the probability of coronary artery disease the clinical likely hold of coronary arteries should be estimated. Then we have many non-invasive diagnostic tools like my aquarium diffusion amaging witamins dress Echo CT coronary and geography and after that we need to assist the risk of the patients for development of cardiovascular events and mortality because according to the risk assessment the therapeutic strategy will be determined in the pharmacological treatment, which is the cornerstone, of course for treatment of patients with the angina or revascularization, which should be indicated in the high risk patients.

Stations implementation of healthy lifestyle is very important – stop smoking, healthy food, reduction of body weight, encourage physical activity and anti-ischemic treatment should be individualized of course, and recently we have a very important study which is an ischemia trial for comparison between conservative strategy versus invasive strategy and I’m proud to be one of the investigators in the ischemia trial because it gives a proper management strategy based on the angina after excluding patients with the left mean coronary disease, patients with heart failure. 

The conservative strategy can be the cornerstone for treatment in patients with the stable coronary arteries, but at the end the short decision-making between physician and patient is very important to decide the proper therapeutic treatment, especially in patients who have frequent episodes of angina because in  ischemia  trial the Interventional treatment improved quality of life in those patients who should be subjected to revascularization to improve quality of life of course. In Egypt there we have what’s known as a high prevalence and epidemic of coronary arteries. Why? Because we have many risk factors which contribute to coronary of disease. We have a high prevalence of hypertension 25%, dyslipidemia, obesity 40% in women and 23% in men, diabetes 17% So we are seeing a coronary artery disease at a younger age and according to our national data. The prevalence of coronary artery disease is 10 years earlier earlier than European countries. So proper management of those patients – we are following the new EC guidelines 2019 for management of chronic coronary syndrome and uninvasive investigations and pharmacological treatment and revascularization in patients who are not responding properly to medical treatment with frequent episodes of angina. 

So at the end – this is a very important educational program for management of patients who have angina, which is a common complaint as seen in the daily practice for cardiologists Thank you for your attention.