Coronary Artery Disease(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)
by
Rosalyn Carson-DeWitt, MD Definition TOPCoronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD) is blockage of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In a severe case, the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI). Coronary artery disease is the most common form of heart disease. It is the leading cause of death worldwide.
Causes TOPCauses include:
Risk Factors TOPMajor risk factors include:
Other risk factors may include:
Symptoms TOPCAD may progress without any symptoms. Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:
Chest pain may indicate more serious unstable angina or a heart attack if it includes the following:
Accompanying symptoms may include:
Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms. It is likely to start with shortness of breath and fatigue. Diagnosis TOPIf you go to the emergency room with chest pain, some tests will be done right away. The tests will attempt to see if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease. The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
Treatment TOPTreatment may include: NitroglycerinThis medicine is usually given during an attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments. Blood-Thinning MedicationsA small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily. Other blood-thinning medicines include:
Beta-Blockers, Calcium-Channel Blockers, and ACE-InhibitorsThese may help prevent angina. In some cases, they may lower the risk of heart attack. Medications to Lower CholesterolMedicines, like statins, are often prescribed to people who have CAD. Statins lower cholesterol levels, which can help to prevent CAD events. RevascularizationPatients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:
Options for Refractory AnginaFor patients who are not candidates for revascularization procedures, but have continued angina despite medicine, options include:
Prevention TOPTo reduce your risk of getting coronary artery disease:
RESOURCES:American Heart Association http://www.heart.org National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov CANADIAN RESOURCES:Heart and Stroke Foundation of Canada http://www.heartandstroke.com Public Health Agency of Canada http://www.phac-aspc.gc.ca References:
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