Coronary artery disease

definition,etiology,signs and symptoms,evaluations

1. CORONARY ARTERY DISEASE PRESENTED BY: SONIA DAGAR

2. INTRODUCTION Coronary artery disease (CAD) is characterized by accumulation of fatty deposits (atheroma and plaque) along the inner most layer (intima) of coronary artery. It can cause a critical narrowing (75% occlusion) of the coronary artery lumen, resulting in a decreased coronary blood flow and inadequate supply of oxygen to the heart muscle.

3. CORONARY ATHEROSCLEROSIS

4. DEFINITION: Atherosclerosis is an abnormal accumulation of the lipid or fatty substances and fibrous tissue in vessel walls. These deposits, called atheromas or plaque, protrude into the lumen of the vessel, narrowing it and obstructing or reducing blood flow to the myocardium. Artery and arteriole walls become thickened and hardened and lose elasticity. Arteriosclerosis is referred to as hardening of the arteries.

5. RISK FACTORS: MODIFIABLE RISK FACTORS High blood cholesterol level (Hyperlipidemia). Cigarette smoking Tobacco use Hypertension Diabetes mellitus Physical inactivity: sedentary life style Obesity Stress and type A personality NON-MODIFIABLE RISK FACTORS Family history Increasing age Gender Race

6. Cont… E levated serum homocrystein : foods that contain folic acid (fruits, green leafy vegetables) reduce homocrysteine levels. Lack of estrogen in women

7. CLINICAL MENIFESTATIONS: Inadequate blood supply to heart muscle cells (ischemia) Chest pain Inadequate cardiac output Diaphoresis: Excessive sweating Dyspnea Changes on the electrocardiogram (ECG) High level of cardiac enzyme Dysrhythmias Angina pectoris, MI or congestive heart failure Sudden cardiac death

8. DIAGNOSTIC EVALUATIONS: Electrocardiogram Exercise thallium test Echocardiography Coronary angiography Positron emission tomography (PTE) scanning Blood test

9. MEDICAL MANAGEMENT: NON-PHARMACOLOGIC INTERVENTIONS : Stop smoking A healthy diet and low in cholesterol and fat Physical exercise OXYGEN ADMINISTRATION: Oxygen therapy initiated at the onset of chest pain to increase oxygen amount in myocardium and to decrease chest pain.

10. Pharmacologic interventions: Nitrates: nitroglycerin Beta blockers such as propranolol & metaprolol Calcium channel blockers such as amlodipin & verapmil Antiplatelet and anticoagulant medications such as aspirin & heparin Cholestrol lowering agents such as statins. Antihypertensive agents

11. SURGICAL MANAGEMENT: Coronary angioplasty Coronary artery bypass surgery Atherectomy Coronary stent Surgical revascularization of affected artery: Embolectomy : Removal of blood clot from artery Thrombectomy : Removal of thrombus from the artery Endarterectomy : Removal of atherosclerotic plaque from the artery