1. Coronary Artery Disease Po Hu IMG 310 Sectional Anatomy for Medical Imaging Summer 2016- Pathology Presentation Project

2. Pathology  Coronary artery disease (CAD) is characterized by an inadequate supply of oxygen-rich blood to the heart muscle (moycardium) because of narrowing or blocking of a coronary artery by fatty plaques.  When the arteries become obstructed, the supply of oxygen and nutrients to the muscles of the heart is reduced, which can lead to angina and heart attack and may result in myocardial infarction (News Medical).  CAD is the most common cause of sudden death.

3. Sectional Image (Kelley, 2007, p. 369)

4. Sectional Image (Radiology Assistant)

5. Etiology and Epidemiology  Etiology: As the disease progresses, there’s an increased rick of a heart attack or myocardial infarction. The causes of CAD include:  High blood pressure  High cholesterol  Smoking  Diabetes  Sedentary lifestyle

6. Signs/Symptoms/Risk Factors  Signs/Symptoms: (Mayo Clinic)  Chest pain (angina): Pressure or tightness in the chest. The pain usually goes away within minutes after stopping the activity.  SOB: extreme fatigue with exertion.  Heart attack: a completely blocked coronary artery may cause a heart attack. Pain in shoulder or arm, sometimes with SOB and sweating. Neck or jaw pain.  Sometimes a heart attack happens without any sings or symptoms.  Risk factors:(Mayo Clinic)  Age- the risk increased as you get older  Sex- Men in greater risk. Women risk increased after menopause.  High blood pressure  High cholesterol  Smoking  Obesity  Diabetes  Family history of CAD  Sedentary lifestyle

7. Modalities Best Imaged  Cardiac Computed Tomography Angiography (CCTA) Study: Less –invasive imaging modality for the diagnosis of CAD and is often used particularly to avoid coronary angiography in low- and intermediated-risk patients.  Nuclear Medicine Myocardial Perfusion Imaging (MPI): Perfusion imaging is frequently used to separate patients into low ( 3%) likelihoods for the major coronary events (Heart, 2004).

8. Cardiac Computed Tomography Angiography (CCTA) Sectional Images  CCTA is a heart imaging test that can help to determine if the plaque buildup has narrowed the patient’s coronary arteries.  The IV contrast is used to ensure the best possible images of the heart blood vessels. Image of soft and calcified plaque in proximal and mid LAD (Sharma, 2010)

9. Nuclear Medicine Myocardial Perfusion Imaging (MPI) (Lakeview Imaging)

10. Abnormal MPI. A large reversible cardiac perfusion defect(arrows) in the territory of the left anterior descending artery. (Padma, 2014)

11. Treatment and Prognosis  Treatment for CAD generally involved with 3 types of approach;: (News Medical) 1.Medication management to reduce cholesterol, blood pressure and blood sugar. 2. Coronary angioplasty and implantation of coronary stents 3. Coronary artery bypass grafting (CABG)  Prognosis: change diet, change lifestyle, quite smoking, exercise frequently.

12. References  Bateman, T. (2004). Assessment of prognosis in chronic coronary artery disease. Retrieved from http://heart.bmj.com/content/90/suppl_5/v10.full http://heart.bmj.com/content/90/suppl_5/v10.full  Encyclopaedia Britannica. Coronary heart disease. Retrieved from http://www.britannica.com/science/coronary-heart-disease http://www.britannica.com/science/coronary-heart-disease  Kelley, L. L., & Petersen, C. M. (2007). Sectional anatomy for imaging professionals. St. Louis, MO: Mosby/Elsevier.  Lakeview Imaging - Normal Myocardial Perfusion Scan. (n.d.). Retrieved from http://www.lakeviewimaging.com.au/casestudies/myocardial1.html http://www.lakeviewimaging.com.au/casestudies/myocardial1.html  Mayo Clinic. Coronary artery disease. Retrieved from http://www.mayoclinic.org/diseases- conditions/coronary-artery-disease/symptoms-causes/dxc-20165314http://www.mayoclinic.org/diseases- conditions/coronary-artery-disease/symptoms-causes/dxc-20165314  News Medical. Retrieved from http://www.news-medical.net/health/What-is-Coronary-Artery- Disease.aspxhttp://www.news-medical.net/health/What-is-Coronary-Artery- Disease.aspx  Padma, S., & Sundaram, P. (2014). Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries. World J Nucl Med World Journal of Nuclear Medicine, 13(1), 6. doi:10.4103/1450-1147.138568  Radiology Assistant. Retrieved from http://www.radiologyassistant.nl/en/p48275120e2ed5/coronary-anatomy-and-anomalies.html http://www.radiologyassistant.nl/en/p48275120e2ed5/coronary-anatomy-and-anomalies.html  Sharma, R. K., Voelker, D. J., Sharma, R. K., Singh, V. N., Bhatt, G., Moazazi, M.,... Reddy, H. K. (2010). Coronary computed tomographic angiography (CCTA) in community hospitals: “current and emerging role”. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879291/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879291/