Coronary Artery Disease Jaclyn Fimbres. Epidemiology About 13 million people in the United States have coronary artery disease. It is the leading cause.

Coronary Artery DiseaseCoronary Artery DiseaseJaclyn FimbresJaclyn Fimbres

EpidemiologyEpidemiology

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

What is Coronary Artery What is Coronary Artery Disease?Disease?

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

PlaquePlaque

There are two types of plaque: Hard & There are two types of plaque: Hard & Stable or Soft and UnstableStable or Soft and Unstable

Hard plaque causes artery walls to Hard plaque causes artery walls to

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

How does it evolve?How does it evolve?

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

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

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

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

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

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

High blood pressureHigh blood pressure — High  — High blood pressure increases the blood pressure increases the heart's workload, causing the heart's workload, causing the heart to thicken and become heart to thicken and become stiffer. stiffer.

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

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

Major risk factorsMajor risk factors

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

Other factorsOther factors

StressStress Too much alcoholToo much alcohol The risk of heart disease in The risk of heart disease in

people who drink people who drink moderatemoderate amounts of alcohol (an average amounts of alcohol (an average of one drink for women or two of one drink for women or two drinks for men per day) is lower drinks for men per day) is lower than in nondrinkers. than in nondrinkers.

SymptomsSymptoms

"Angina" is a discomfort often "Angina" is a discomfort often experienced by patients with coronary experienced by patients with coronary artery disease. Despite the fact that the artery disease. Despite the fact that the pain may not be severe, it is still pain may not be severe, it is still important since it indicates that the important since it indicates that the heart muscle is not getting enough heart muscle is not getting enough blood. Pain may also be in the neck, blood. Pain may also be in the neck, back and arms.back and arms.

Many people have no symptoms despite Many people have no symptoms despite having a substantial amount of blockage. having a substantial amount of blockage. They can still be shown to have lack of They can still be shown to have lack of blood supply with exercise tests, but blood supply with exercise tests, but simply don't perceive it as others do. simply don't perceive it as others do. This is termed "asymptomatic ischemia".This is termed "asymptomatic ischemia".

Pains from heart disease:Pains from heart disease:

Usually occur when one is exerting. Usually occur when one is exerting. Generally last from 1 - 20 minutes Generally last from 1 - 20 minutes

(pains lasting less than 5 seconds are (pains lasting less than 5 seconds are generally not from heart disease, nor generally not from heart disease, nor are pains which last continuously for are pains which last continuously for days at a time) days at a time)

Are consistent, occurring in the same Are consistent, occurring in the same area time after time area time after time

Are often not severe Are often not severe Are often eased by taking nitroglycerin Are often eased by taking nitroglycerin

How Is Coronary Artery How Is Coronary Artery Disease Diagnosed?Disease Diagnosed?

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

Doctors may order Doctors may order the following tests:the following tests:

ECG or EKG (electrocardiogramECG or EKG (electrocardiogram. This test . This test measures the rate and regularity of the measures the rate and regularity of the heartbeat. heartbeat.

EchocardiogramEchocardiogram. This test uses sound waves . This test uses sound waves to create a picture of the heart. The picture to create a picture of the heart. The picture is more detailed than an x-ray image. is more detailed than an x-ray image.

Exercise stress testExercise stress test. This test shows how well . This test shows how well the heart pumps at higher workloads when it the heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure needs more oxygen. EKG and blood pressure readings are taken before, during, and after readings are taken before, during, and after exercise to see how the heart responds to exercise to see how the heart responds to exercise. The first EKG and blood pressure exercise. The first EKG and blood pressure readings are done to get a baseline. readings are done to get a baseline.

TestsTests

Chest x rayChest x ray. A chest x ray takes a picture of . A chest x ray takes a picture of the organs and structures inside the chest. the organs and structures inside the chest. These include the heart, lungs, and blood These include the heart, lungs, and blood vessels. vessels.

Cardiac catheterizationCardiac catheterization. A thin, flexible tube . A thin, flexible tube is passed through an artery in the groin or is passed through an artery in the groin or arm to reach the coronary arteries. The tube arm to reach the coronary arteries. The tube allows the doctor to examine the inside of allows the doctor to examine the inside of the arteries to see if there is any blockage. the arteries to see if there is any blockage. The doctor also can determine the pressure The doctor also can determine the pressure and blood flow in the heart's chambers, and blood flow in the heart's chambers, collect blood samples from the heart, and collect blood samples from the heart, and examine the arteries of the heart by x ray. examine the arteries of the heart by x ray.

TestsTests

Coronary angiographyCoronary angiography. This test is usually . This test is usually performed along with cardiac catheterization. A performed along with cardiac catheterization. A dye that can be seen by x ray is injected dye that can be seen by x ray is injected through the catheter into the coronary arteries. through the catheter into the coronary arteries. The doctor can see the flow of blood through The doctor can see the flow of blood through the heart and the location of blockages. the heart and the location of blockages.

Nuclear heart scanNuclear heart scan. This test uses radioactive . This test uses radioactive tracers to outline heart chambers and major tracers to outline heart chambers and major blood vessels leading to and from the heart. blood vessels leading to and from the heart. The test shows any damage to the heart The test shows any damage to the heart muscle. muscle.

Electron beam computed tomographyElectron beam computed tomography. This test . This test identifies and measures calcium buildup in and identifies and measures calcium buildup in and around the coronary arteries. around the coronary arteries.

What is the prognosis? What is the prognosis?

The prognosis of coronary artery The prognosis of coronary artery disease is highly variable, and disease is highly variable, and depends on many factors:depends on many factors:

How well the heart muscle is How well the heart muscle is functioning and how many vessels are functioning and how many vessels are involved with blockages. involved with blockages.

The long-term prognosis can be The long-term prognosis can be greatly influenced by the patient's greatly influenced by the patient's behavior including smoking, control of behavior including smoking, control of blood pressure and cholesterol, blood pressure and cholesterol, follow-up with diet and exercise follow-up with diet and exercise programs, etc programs, etc

Myocardial InfarctionMyocardial Infarction

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

TreatmentTreatment

The goals of treatment are to: The goals of treatment are to: Relieve symptoms Relieve symptoms Slow or stop atherosclerosis by Slow or stop atherosclerosis by

controlling or reducing the risk controlling or reducing the risk factors factors

Lower the risk of having blood Lower the risk of having blood clots form, which can cause a clots form, which can cause a heart attack heart attack

Widen or bypass clogged arteries Widen or bypass clogged arteries

Lifestyle Changes Lifestyle Changes

Eat a healthy diet to prevent or Eat a healthy diet to prevent or reduce reduce high blood pressurehigh blood pressure and and high blood cholesterolhigh blood cholesterol and to and to maintain a healthy weightmaintain a healthy weight

Quit smoking, if you smoke Quit smoking, if you smoke Exercise Exercise Lose weight, if you are Lose weight, if you are

overweight or obese overweight or obese Reduce stress Reduce stress

MedicineMedicine

Cholesterol-lowering medicinesCholesterol-lowering medicines help to reduce your cholesterol help to reduce your cholesterol to a doctor-recommended level. to a doctor-recommended level.

AnticoagulantsAnticoagulants help to prevent help to prevent clots from forming in arteries and clots from forming in arteries and blocking blood flow. blocking blood flow.

Aspirin, and other antiplatelet Aspirin, and other antiplatelet medicines, help to prevent clots medicines, help to prevent clots from forming in your arteries and from forming in your arteries and blocking blood flow. blocking blood flow.

MedicineMedicine

ACE (angiotensin-converting enzyme) ACE (angiotensin-converting enzyme) inhibitors help to lower blood pressure and inhibitors help to lower blood pressure and reduce strain on your heart. reduce strain on your heart.

Beta blockers slow your heart rate and Beta blockers slow your heart rate and lower your blood pressure to decrease the lower your blood pressure to decrease the workload on your heart. They are also used workload on your heart. They are also used to relieve angina. to relieve angina.

Calcium channel blockers relax blood Calcium channel blockers relax blood vessels (arteries and veins) and lower your vessels (arteries and veins) and lower your blood pressure. These medicines can reduce blood pressure. These medicines can reduce your heart's workload, help widen coronary your heart's workload, help widen coronary arteries, and relieve and control angina. arteries, and relieve and control angina.

Nitroglycerin widens the coronary arteries, Nitroglycerin widens the coronary arteries, increasing blood flow to the heart muscle increasing blood flow to the heart muscle and relieving chest pain. and relieving chest pain.

Special ProceduresSpecial Procedures

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

Special ProceduresSpecial Procedures

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

ReferencesReferences

Medline Plus:Medline Plus:http://www.nlm.nih.gov/medlineplus/http://www.nlm.nih.gov/medlineplus/

coronarydisease.htmlcoronarydisease.htmlHeartPoint:HeartPoint:http://www.heartpoint.com/http://www.heartpoint.com/

coronartdisease.htmlcoronartdisease.htmlAmerican Heart Association:American Heart Association:http://www.americanheart.org/http://www.americanheart.org/

presenter.jhtml?identifier=4726presenter.jhtml?identifier=4726National Heart, Lung, & Blood Institute:National Heart, Lung, & Blood Institute:http://www.nhlbi.nih.gov/health/dci/Diseases/http://www.nhlbi.nih.gov/health/dci/Diseases/

Cad/CAD_WhatIs.htmlCad/CAD_WhatIs.html