Coronary artery disease (atherosclerotic heart disease) is due to accumulation of atheromatous plaques in the coronary vessel walls. Coronary arteries are the major blood vessels that supply the heart with blood, oxygen and nutrients. Fatty streaks or plaques will narrow the coronary arteries and reduce the blood flow to the heart. Because coronary artery disease often develops over decades, it can go virtually unnoticed until it produces a heart attack.

 

Symptoms

Chest pain or angina

Angina- chest pain or tightness starts with exertion/stress or worsens with exertion or exercise. Rest and nitroglycerine relives chest pain.

Heart attack

Myocardial infarct- left sided heavy chest pain, radiating to left shoulders, arm, back and abdomen. Associated with dyspnea, nausea, vomiting and sweating

Dyspnea- develops shortness of breath or extreme fatigue with exertion.

Risk factors

Non modifiable risk factors

• Increasing age – older than 45 yrs
• Sex- Male and postmenopausal women
• Family history of heart disease
• Race and ethnicity

Modifiable risk factors

• Hypertension
• Diabetes mellitus
• Smoking
• Elevated serum triglycerides, total cholesterol, and LDL cholesterol
• Stress and type A personality
• Obesity
• Sedentary life style
• Drug abuse with cocaine
• Increased homocysteine and fibrinogen  levels
• Increased C- reactive proteins and lipoprotein A

Causes

• Smoking
• Hypertension
• High cholesterol
• Diabetes mellitus
• Radiation therapy to the chest

Complications

• Angina pectoris
• Myocardial infarct
• Arrhythmia
• Heart failure

Tests and diagnosis

• ECG
• Stress ECG/Treadmill
• 2D-echo
• Cardiac enzymes- troponin- T and I and creatine kinase
• CT (spiral) – angiogram- invasive and non invasive
• Chest X-ray

Prevention

• Quit smoking or use of tobacco products
• Get active- end sedentary life styles
• Eat heart healthy diet- diet rich in proteins and vitamins, reduced fats and carbohydrates
• Ideal weight for height- Dietary modifications and exercise are first line treatment to reduce over weight and obesity.
• Regular screening for heart disease- blood glucose, blood pressure and cholesterol levels.
• Reducing and managing stress and tension

Cardiac care

Myocardial infarct (MI) and angina

If you suspect that your may be having a heart attack, call for emergency ambulance or go to emergency department.

Chewing 2 tablets of Asprin 150 mg, it reduces the risk of death by as much as 24% if taken in early stage of heart attacks.

Nitroglycerin tablets under the tongue or transdermal patch over the chest will reduce the chest pain and improve the blood supply to heart.

• Oxygen 5-6 lts by facial mask.
• Morphine sulphate may be administered for relief of pain and anxiety.
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• Antithrombotic agent- aspirin 325 mg (if not taken) should be administered immediately. Use clopidogrel in case of aspirin allergy.
• Thrombolytic therapy- with Streptokinase, Alteplase, Reteplase.
• Platelet aggregation inhibitors- Abciximab, Tirofiban, and Eptifibatide.
• Heparin and low molecular weight heparin.
• ACE inhibitors and beta blockers also form main management of myocardial infarct.
• A good control on hypertension, diabetes mellitus, obesity, smoking, cholesterol/triglycerides levels and tackling other risk factors is very important.

Surgical management

• Angioplasty is a way of unblocking an artery. Metallic stent is placed in the artery to keep it expanded.
• Cardiac bypass surgery is done in triple vessel block, if medical treatment is unsuccessful.