1. Coronary Artery Disease Jaclyn Fimbres

2. Epidemiology About 13 million people in the United States have coronary artery disease. It is the leading cause of death in both men and women. Each year, more than half a million Americans die from CAD. About 13 million people in the United States have coronary artery disease. It is the leading cause of death in both men and women. Each year, more than half a million Americans die from CAD.

3. What is Coronary Artery Disease? It occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque on their inner walls. The buildup of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. It occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque on their inner walls. The buildup of plaque is known as atherosclerosis. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs.

5. The plaque weakens the wall. As shown in the lower artery, a crack may develop in the plaque and a blood clot may form - this is the mechanism of most heart attacks

7. Plaque There are two types of plaque: Hard & Stable or Soft and Unstable There are two types of plaque: Hard & Stable or Soft and Unstable Hard plaque causes artery walls to thicken and harden. Soft plaque is more likely to break apart from the walls and enter the bloodstream. This can cause a blood clot that can partially or totally block the flow of blood in the artery. When this happens, the organ supplied by the blocked artery starves for blood and oxygen. The organ's cells may either die or suffer severe damage. Hard plaque causes artery walls to thicken and harden. Soft plaque is more likely to break apart from the walls and enter the bloodstream. This can cause a blood clot that can partially or totally block the flow of blood in the artery. When this happens, the organ supplied by the blocked artery starves for blood and oxygen. The organ's cells may either die or suffer severe damage.

9. Coronary angiogram in 49-year-old woman who presented with definite angina. Severe stenosis shown in right coronary artery. Coronary angiogram in 49-year-old woman who presented with definite angina. Severe stenosis shown in right coronary artery.

11. Diffuse coronary artery disease, obtuse marginal branches of circumflex coronary artery. Diffuse coronary artery disease, obtuse marginal branches of circumflex coronary artery.

12. How does it evolve? CAD occurs to some degree as a natural result of aging. There are several reasons, called "risk factors", that it may occur at a younger age or to a more severe degree. Some of these factors can be changed, and some cannot. CAD occurs to some degree as a natural result of aging. There are several reasons, called "risk factors", that it may occur at a younger age or to a more severe degree. Some of these factors can be changed, and some cannot.

13. What are the major risk factors that can't be changed? What are the major risk factors that can't be changed?

14. Major risk factors Increasing age — Over 83 percent of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks. Increasing age — Over 83 percent of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks.

15. Major risk factors Male sex (gender) — Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's. Male sex (gender) — Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.

16. Major risk factors Heredity (including Race) — Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Heredity (including Race) — Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes.

17. What are the major risk factors you can modify, treat or control by changing your lifestyle or taking medicine? What are the major risk factors you can modify, treat or control by changing your lifestyle or taking medicine?

18. Major risk factors Tobacco smoke — Smokers' risk of developing coronary heart disease is 2–4 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease Tobacco smoke — Smokers' risk of developing coronary heart disease is 2–4 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease

19. Major risk factors High blood cholesterol — As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet. High blood cholesterol — As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet.

20. Major risk factors High blood pressure — High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. High blood pressure — High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer.

21. Major risk factors Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to- vigorous physical activity helps prevent heart and blood vessel disease. Physical inactivity — An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to- vigorous physical activity helps prevent heart and blood vessel disease.

22. Major risk factors Obesity and overweight — People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Obesity and overweight — People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop.

23. Major risk factors Diabetes mellitus — Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose (blood sugar) levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. About three-quarters of people with diabetes die of some form of heart or blood vessel disease. Diabetes mellitus — Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose (blood sugar) levels are under control, diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. About three-quarters of people with diabetes die of some form of heart or blood vessel disease.

24. Other factors Stress Stress Too much alcohol Too much alcohol The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers.

25. Symptoms "Angina" is a discomfort often experienced by patients with coronary artery disease. Despite the fact that the pain may not be severe, it is still important since it indicates that the heart muscle is not getting enough blood. Pain may also be in the neck, back and arms. "Angina" is a discomfort often experienced by patients with coronary artery disease. Despite the fact that the pain may not be severe, it is still important since it indicates that the heart muscle is not getting enough blood. Pain may also be in the neck, back and arms. Many people have no symptoms despite having a substantial amount of blockage. They can still be shown to have lack of blood supply with exercise tests, but simply don't perceive it as others do. This is termed "asymptomatic ischemia". Many people have no symptoms despite having a substantial amount of blockage. They can still be shown to have lack of blood supply with exercise tests, but simply don't perceive it as others do. This is termed "asymptomatic ischemia".

26. Pains from heart disease: Usually occur when one is exerting. Usually occur when one is exerting. Generally last from 1 - 20 minutes (pains lasting less than 5 seconds are generally not from heart disease, nor are pains which last continuously for days at a time) Generally last from 1 - 20 minutes (pains lasting less than 5 seconds are generally not from heart disease, nor are pains which last continuously for days at a time) Are consistent, occurring in the same area time after time Are consistent, occurring in the same area time after time Are often not severe Are often not severe Are often eased by taking nitroglycerin Are often eased by taking nitroglycerin

27. How Is Coronary Artery Disease Diagnosed? There is no single test to diagnose coronary artery disease. Doctors will ask about medical history and the family’s medical history, assess risk factors, and do a physical exam and several tests. There is no single test to diagnose coronary artery disease. Doctors will ask about medical history and the family’s medical history, assess risk factors, and do a physical exam and several tests.

28. Doctors may order the following tests: ECG or EKG (electrocardiogram. This test measures the rate and regularity of the heartbeat. ECG or EKG (electrocardiogram. This test measures the rate and regularity of the heartbeat. ECG or EKG (electrocardiogram ECG or EKG (electrocardiogram Echocardiogram. This test uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray image. Echocardiogram. This test uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray image. Echocardiogram Exercise stress test. This test shows how well the heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how the heart responds to exercise. The first EKG and blood pressure readings are done to get a baseline. Exercise stress test. This test shows how well the heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how the heart responds to exercise. The first EKG and blood pressure readings are done to get a baseline. Exercise stress test Exercise stress test

29. Tests Chest x ray. A chest x ray takes a picture of the organs and structures inside the chest. These include the heart, lungs, and blood vessels. Chest x ray. A chest x ray takes a picture of the organs and structures inside the chest. These include the heart, lungs, and blood vessels. Chest x ray Chest x ray Cardiac catheterization. A thin, flexible tube is passed through an artery in the groin or arm to reach the coronary arteries. The tube allows the doctor to examine the inside of the arteries to see if there is any blockage. The doctor also can determine the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x ray. Cardiac catheterization. A thin, flexible tube is passed through an artery in the groin or arm to reach the coronary arteries. The tube allows the doctor to examine the inside of the arteries to see if there is any blockage. The doctor also can determine the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x ray. Cardiac catheterization Cardiac catheterization

30. Tests Coronary angiography. This test is usually performed along with cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. The doctor can see the flow of blood through the heart and the location of blockages. Coronary angiography. This test is usually performed along with cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. The doctor can see the flow of blood through the heart and the location of blockages. Coronary angiography Coronary angiography Nuclear heart scan. This test uses radioactive tracers to outline heart chambers and major blood vessels leading to and from the heart. The test shows any damage to the heart muscle. Nuclear heart scan. This test uses radioactive tracers to outline heart chambers and major blood vessels leading to and from the heart. The test shows any damage to the heart muscle. Nuclear heart scan Nuclear heart scan Electron beam computed tomography. This test identifies and measures calcium buildup in and around the coronary arteries. Electron beam computed tomography. This test identifies and measures calcium buildup in and around the coronary arteries.

31. What is the prognosis? The prognosis of coronary artery disease is highly variable, and depends on many factors: The prognosis of coronary artery disease is highly variable, and depends on many factors: How well the heart muscle is functioning and how many vessels are involved with blockages. How well the heart muscle is functioning and how many vessels are involved with blockages. The long-term prognosis can be greatly influenced by the patient's behavior including smoking, control of blood pressure and cholesterol, follow-up with diet and exercise programs, etc The long-term prognosis can be greatly influenced by the patient's behavior including smoking, control of blood pressure and cholesterol, follow-up with diet and exercise programs, etc

32. Myocardial Infarction If an artery closes completely and suddenly and there is no flow to the heart muscle, that part of the muscle will die and eventually scar over. If an artery closes completely and suddenly and there is no flow to the heart muscle, that part of the muscle will die and eventually scar over.

33. Treatment The goals of treatment are to: The goals of treatment are to: Relieve symptoms Relieve symptoms Slow or stop atherosclerosis by controlling or reducing the risk factors Slow or stop atherosclerosis by controlling or reducing the risk factors Lower the risk of having blood clots form, which can cause a heart attack Lower the risk of having blood clots form, which can cause a heart attack Widen or bypass clogged arteries Widen or bypass clogged arteries

34. Lifestyle Changes Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weighthigh blood pressurehigh blood cholesterolmaintain a healthy weighthigh blood pressurehigh blood cholesterolmaintain a healthy weight Quit smoking, if you smoke Quit smoking, if you smoke Exercise Exercise Lose weight, if you are overweight or obese Lose weight, if you are overweight or obese Reduce stress Reduce stress

35. Medicine Cholesterol-lowering medicines help to reduce your cholesterol to a doctor-recommended level. Cholesterol-lowering medicines help to reduce your cholesterol to a doctor-recommended level. Cholesterol-lowering medicines Cholesterol-lowering medicines Anticoagulants help to prevent clots from forming in arteries and blocking blood flow. Anticoagulants help to prevent clots from forming in arteries and blocking blood flow. Anticoagulants Aspirin, and other antiplatelet medicines, help to prevent clots from forming in your arteries and blocking blood flow. Aspirin, and other antiplatelet medicines, help to prevent clots from forming in your arteries and blocking blood flow. Aspirin

36. Medicine ACE (angiotensin-converting enzyme) inhibitors help to lower blood pressure and reduce strain on your heart. ACE (angiotensin-converting enzyme) inhibitors help to lower blood pressure and reduce strain on your heart. ACE (angiotensin-converting enzyme) inhibitors ACE (angiotensin-converting enzyme) inhibitors Beta blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart. They are also used to relieve angina. Beta blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart. They are also used to relieve angina. Beta blockers Beta blockers Calcium channel blockers relax blood vessels (arteries and veins) and lower your blood pressure. These medicines can reduce your heart's workload, help widen coronary arteries, and relieve and control angina. Calcium channel blockers relax blood vessels (arteries and veins) and lower your blood pressure. These medicines can reduce your heart's workload, help widen coronary arteries, and relieve and control angina. Calcium channel blockers Calcium channel blockers Nitroglycerin widens the coronary arteries, increasing blood flow to the heart muscle and relieving chest pain. Nitroglycerin widens the coronary arteries, increasing blood flow to the heart muscle and relieving chest pain. Nitroglycerin

37. Special Procedures Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a device called a stent is placed in the artery to keep the artery propped open after the procedure. Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a device called a stent is placed in the artery to keep the artery propped open after the procedure.

38. Special Procedures Coronary artery bypass surgery. In this procedure arteries or veins from other areas in the body are used to bypass your narrowed coronary arteries. Bypass surgery can improve blood flow to the heart, relieve chest pain, and possibly prevent a heart attack Coronary artery bypass surgery. In this procedure arteries or veins from other areas in the body are used to bypass your narrowed coronary arteries. Bypass surgery can improve blood flow to the heart, relieve chest pain, and possibly prevent a heart attack

39. References Medline Plus: http://www.nlm.nih.gov/medlineplus/coronarydiseas e.html http://www.nlm.nih.gov/medlineplus/coronarydiseas e.htmlHeartPoint: http://www.heartpoint.com/coronartdisease.html American Heart Association: http://www.americanheart.org/presenter.jhtml?identi fier=4726 http://www.americanheart.org/presenter.jhtml?identi fier=4726 National Heart, Lung, & Blood Institute: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/C AD_WhatIs.html