coronary heart diseases- hana alharbi

7/28/2019 Coronary Heart Diseases- Hana AlHarbi

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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

coronary heart diseases- hana alharbi

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