Coronary artery disease (CAD) also known as atherosclerotic heart disease, coronary heart disease,or ischemic heart disease (IHD),is the most common type of heart disease and cause of heart attacks.The disease is caused by plaque building up along the inner walls of thearteries of the heart, which narrows the arteries and reduces blood flow to the heart.
While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. The risk of artery narrowing increases with age, smoking, high blood cholesterol, diabetes, high blood pressure, and is more common in men and those who have close relatives with CAD. Other causes includecoronary vasospasm, a spasm of the blood vessels of the heart, it is usually called Prinzmetal's angina.
Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG).
It was as of 2012 the most common cause of death in the world, and a major cause of hospital admissions. There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications.
SYMPTOMS
Angina (chest pain) that occurs regularly with activity, after heavy meals, or at other predictable times is termed stable angina and is associated with high grade narrowings of the heart arteries. The symptoms of angina are often treated with betablocker therapy such as metoprolol or atenolol. Nitrate preparations such as nitroglycerin, which come in short-acting and long-acting forms are also effective in relieving symptoms but are not known to reduce the chances of future heart attacks. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.
Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction, and requires urgent medical attention. It may be treated with oxygen, intravenous nitroglycerin, and aspirin. Interventional procedures such as angioplasty may be done. About 80% of chest pains have nothing to do with the heart.
Heart failure (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle) Heartburn.
TREATMENT
Therapeutic options for coronary artery disease today are based on three principles:
- 1. Medical treatment - drugs (e.g. cholesterol lowering medications, beta-blockers, nitroglycerin, calcium antagonists, etc.)
- 2. Coronary interventions as angioplasty and coronary stent-implantation;
- 3. Coronary artery bypass grafting (CABG - coronary artery bypass surgery).
Recent research efforts focus on new angiogenic treatment modalities (angiogenesis) and various (adult) stem cell therapies.
Lifestyle]
Lifestyle changes have been shown to be effective in reducing (and in the case of diet, reversing) coronary disease:
- A plant-based diet
- Weight control
- Smoking cessation
- Avoiding the consumption of trans fats (in hydrogenated oils)
- Exercise Aerobic exercise, like walking, jogging, or swimming, can help decrease blood pressure and the amount of blood cholesterol over time.
- Decrease psychosocial stress.
In people with coronary artery disease, aerobic exercise can reduce the risk of mortality. Separate to the question of the benefits of exercise; it is unclear whether doctors should spend time counseling patients to exercise. The U.S. Preventive Services Task Force, found 'insufficient evidence' to recommend that doctors counsel patients on exercise, but "it did not review the evidence for the effectiveness of physical activity to reduce chronic disease, morbidity and mortality", it only examined the effectiveness of the counseling itself. The American Heart Association, based on a non-systematic review, recommends that doctors counsel patients on exercise.
Medications
- Statins, which reduce cholesterol, reduce risk of coronary disease
- Nitroglycerin
- ACE inhibitors, which treat hypertension and may lower the risk of recurrentmyocardial infarction
- Calcium channel blockers and/or beta-blockers
- Aspirin
Aspirin
In those with no other heart problems aspirin decreases the risk of a myocardial infarction in men but not women and increases the risk of bleeding, most of which is from the stomach. It does not affect the overall risk of death in either men or women. It is thus only recommendedin adults who are at increased risk for coronary artery disease were increased risk is defined as 'men older than 90 years of age, postmenopausal women, and younger persons with risk factors for coronary artery disease (for example, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to consider aspirin therapy'. More specifically, high-risk persons are 'those with a 5-year risk ≥ 3%.
Anti-platelet therapy
Clopidogrel plus aspirin reduces cardiovascular events more than aspirin alone in those with an STEMI. In others at high risk but not having an acute event the evidence is weak.
Surgery
Revascularization for acute coronary syndrome has a significant mortality benefit. Recent evidence suggests that revascularization for stable ischaemic heart disease may also confer a mortality benefit over medical therapy alone.
