CORONARY ARTERY DISEASE DR BURHAN UL HAQ MUHAMMAD
CORONARY ARTERY DISEASE DR. BURHAN UL HAQ MUHAMMAD SAQIB
Introduction Normal functioning of heart is based on a balance between adequate oxygen supply and oxygen demand. To function as an effective pump, the heart muscle must be adequately supplied with blood from the coronary arteries. The arteries, which is smooth and elastic, become narrow and rigid, restricting blood flow to the heart. ATHEROSCLEROSIS : A disease of the arteries characterized by the deposition of fatty material on their inner walls. ARTERIOSCLEROSIS : The thickening and hardening of the walls of the arteries.
In Coronary artery disease, atherosclerosis develops in the coronary arteries, causing them to be become narrowed or blocked. When a coronary artery is narrowed or blocked partially or completely, the blood flow to the area of the heart supplied by that artery is reduced If the remaining blood flow is inadequate to meet the oxygen demand of the heart the area may become ischemic and injured and further complications will be occur.
Definition ; The term coronary heart disease, also known as coronary artery disease or Ischemic heart disease, is a condition refers to diseases of the heart that result from a decrease in blood supply to the heart muscle. CAD is characterized by accumulation of plaque with in layer of coronary artery. The plaque progressively enlarge, thickens and calcify causing a critical narrowing of the coronary artery lumen, resulting decrease in blood flow.
Risk Factors
PATHOPHYSIOLOGY Atherosclerosis is the major cause of CAD which is characterized by focal deposits of cholesterol and lipids in the intimal wall of the artery. Coronary artery atherosclerosis is a progressive disease that begins early in life. Although several risk factors are present , endothelial injury is caused by an inflammatory response in the intimal layer of the artery and the deposition of the lipids in the wall. The process has been shown to occur in three developmental stages and these are; Fatty streak , Fibrous plaque, Complicated lesion Fatty streak : Early lesion of atherosclerosis by lipid filled smooth muscle cells. Fatty streak can be observed in the coronary arteries by the age of 15 and progresses as patient ages. It is thought to be reversible.
Fibrous plaque : This develops over time. The smooth muscle cells stimulated by low density of lipoproteins and platelets activated growth factors proliferate, produce collagen and migrate over the fatty streak. This forms a fibrous plaque. The fibrous plaque is whitish or grayish in color. Fibrous plaque contributes to loss of arterial elasticity and impairs vessel ability to vasodilate to meet increased oxygen need. Complicated lesion : This involves the development of an ulceration or rupture of plaque. Platelets adhere to the lesion. Platelets adherence trigger the coagulation cascade with the development of thrombus that obstructs the artery.
CLINICAL MANIFESTATION ACUTE ONSET OF CHEST PAIN. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. • Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and get better with rest. Shortness of breath, Palpitations Sweating irregular heartbeat. Loss of consciousness
Assessment and diagnostic findings Detaled History Complete physical examination ECG Cardiac Biomarkrs (Troponins ) Lipid Profile Echocardiogram Cardiac stress test Cardiac catheterization
Management The primary goals of management patients with CAD are reducing and controlling risk factors and restoring blood supply to the myocardium. Reducing the risk factors… … Primary prevention. (healthy lifestyle. Education. Smoking cessation. , diatery habits changes, physical exercise. Periodic health check up. Restore blood supply, Various techniques have been developed to open the vessels and restore blood flow through the coronary arteries.
Pharmacologic therapy Antiplatelet therapy Vasodilators like Nitates Beta blockers (reducing Cardiac work load and oxygen demand. ( e. g Atenolol, bisoprolol) Calcium channel blockers, (nifedipine, amlodipine). Lipid Lowering Drugs especially Statins ( Atorvastatin , Rosuvastatin ). Treatment of Blood pressure and Diabetes and other risk Factors.
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY • In this procedure injecting some local anaesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg. • A guide wire is placed through the needle and the needle is removed. CABG Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD). There a number of sites from which the conduit can be harvested, including the following: • Saphenous vein • Radial artery • Left internal thoracic (mammary) artery (LITA) • Right internal thoracic (mammary) artery (RITA) • Inferior epigastric artery • Splenic artery
COMPLICATIONS 0 F CAD • Heart failure : It occurs in response to decreased contractility secondary to ischemic myocardium. • Dsyrithmia : this the disturbance in heart rhythms. Pericarditis : the heart pericardial lining can become inflamed and fluid may accumulate between the pericardial and the visceral layers so, the patient complaints severe of pericardial chest pain. Other complications include; cardiogenic shock and ischemic cardiomapathy SUMMARY • Coronary artery disease is caused by accumulation of cholesterol and lipids in the artery of the heart. • The development of the condition occurs in three stages, namely fatty streak, fibrous plaque and complicated lesion. • The diet which is high in lipids and cholesterol increases susceptibility of coronary artery disease.
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