1. Coronary Artery Disease

2. What is coronary artery disease? A narrowing of the coronary arteries that prevents adequate blood supply to the heart muscle. Usually caused by atherosclerosis, it may progress to the point where the heart muscle is damaged due to lack of blood supply. Such damage may result in infarction, arrhythmias, and heart failure.

3. Causes CAD has many risk factors, including: – Smoking, – Radiotherapy to the chest, – Hypertension, – Diabetes, – Hyperlipidemia.

4. Signs & Symptoms Coronary heart disease may be asymptomatic. If not, symptoms can include: – Chest heaviness – Dyspnea – Fatigue – Chest pain – Angina – Myocardial infarction

5. 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 vessels appear to play not only a significant role in stiffening arteries but also for the induction of an early phase of coronary arteriosclerosis.

6. Diagnosis Electrocardiograms Echocardiograms Stress Tests Nuclear Imaging Angiography

7. Electrocardiograms (ECGs or EKGs) provide a record of the heart's electrical activity. This simple test records any abnormal findings in the heart's electrical impulses. Electrodes are placed on the arms and chest to monitor electrical activity.

8. Echocardiograms (ECHOs) It is may be ordered if your doctor suspects a problem with the heart muscle or one of the valves that channel blood through the heart.

9. Stress tests They are used to show how the heart reacts to physical exertion. Exercise stress tests are usually performed on a treadmill or exercise bicycle.

10. 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.

11. Angiography Is the most accurate means by which to examine the coronary arteries. It requires a surgical procedure called cardiac catheterization. During the procedure, catheters (small thin plastic tubes) are placed in the artery of the leg or arm, and directed using an x-ray machine to the opening of each of the coronary arteries

12. Treatment Lifestyle changes: Lifestyle changes that may be useful in coronary disease include: – Weight control – Smoking cessation – Exercise – Healthy diet

13. 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 recurrent myocardial infarction – Calcium channel blockers – Aspirin

14. Treatment (cont..) Surgical intervention – Angioplasty – Stents – Coronary artery bypass grafting (CABG)

15. PCI Procedural refinements: Stents Expandable metal mesh tubes that buttresses the dilated segment, limit restenosis. Drug eluting stents: further reduce cellular proliferation in response to the injury of dilatation.

16. Coronary Artery Bypass Grafting (CABG)

17. CABG Procedural refinements: – arterial rather than vein grafts – avoid the cardiopulmonary bypass machine – smaller thoracotomy incision rather than sternotomy