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Coronary Artery Disease
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What is coronary
artery disease?
A narrowing of the coronary arteries that prevents adequateblood supply to the heart muscle. Usually caused byatherosclerosis, it may progress to the point where the heartmuscle is damaged due to lack of blood supply. Suchdamage may result in infarction, arrhythmias, and heart
failure.
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Causes
CAD has many risk factors, including:
Smoking,
Radiotherapy to the chest,
Hypertension,
Diabetes,
Hyperlipidemia.
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Signs & Symptoms
Coronary heart disease may be
asymptomatic. If not, symptoms can
include:
Chest heaviness
Dyspnea
Fatigue
Chest pain
Angina
Myocardial infarction
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Pathophysiology
coronary artery disease occurs when part of the smooth, elastic
lining inside a coronary artery (the arteries that supply blood to
the heart muscle) develops atherosclerosis.
With atherosclerosis, the artery's lining becomes hardened,
stiffened, and swollen with all sorts of "grunge" - including
calcium deposits, fatty deposits, and abnormal inflammatory
cells - to form a plaque. Deposits of calcium phosphates
(hydroxyapatites) in the muscular layer of the blood vesselsappear to play not only a significant role in stiffening arteries but
also for the induction of an early phase of coronary
arteriosclerosis.
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Diagnosis
Electrocardiograms
Echocardiograms
Stress Tests
Nuclear Imaging
Angiography
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Electrocardiograms (ECGs or EKGs)
provide a record of the heart's electrical
activity.
This simple test records any abnormalfindings in the heart's electrical impulses.
Electrodes are placed on the arms and
chest to monitor electrical activity.
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Echocardiograms (ECHOs)
It is may be ordered if your doctor
suspects a problem with the heart muscle
or one of the valves that channel bloodthrough the heart.
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Stress tests
They are used to show how the heart
reacts to physical exertion. Exercise stress
tests are usually performed on a treadmillor exercise bicycle.
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Nuclear cardiac imaging
involves the use of small amounts of short-
lived radioactive material, which is injected
into the bloodstream.
A special camera (live-motion x-ray)detects the radioactivity of these materials,
and the images displayed show how your
heart pumps blood.
This is useful in identifying any areas of
abnormal motion or for assessing the
blood supply to the heart muscle.
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Angiography
Is the most accurate means by which to
examine the coronary arteries.
It requires a surgical procedure called
cardiac catheterization. During theprocedure, catheters (small thin plastic
tubes) are placed in the artery of the leg or
arm, and directed using an x-ray machineto the opening of each of the coronary
arteries
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Treatment
Lifestyle changes:
Lifestyle changes that may be useful in
coronary disease include:
Weight control
Smoking cessation
Exercise
Healthy diet
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Treatment (cont..)
Medications to treat coronary disease
Cholesterol lowering medications, such as
statins, are useful to decrease the amount
of "bad" (LDL) cholesterol.
Nitroglycerin
ACE inhibitors, which treat hypertension
and may lower the risk of recurrentmyocardial infarction
Calcium channel blockers
Aspirin
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Treatment (cont..)
Surgical intervention
Angioplasty
Stents
Coronary artery bypass grafting (CABG)
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PCI Procedural refinements: Stents
Expandable metal mesh tubes that buttresses thedilated segment, limit restenosis.
Drug eluting stents: further reduce cellular
proliferation in response to the injury of dilatation.
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Coronary Artery Bypass Grafting (CABG)
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CABG
Procedural refinements:
arterial rather than veingrafts
avoid the cardiopulmonarybypass machine
smaller thoracotomy
incision rather thansternotomy
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