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Coronary artery disease

Coronary Artery Disease Overview: – Symptoms include chest pain, angina, shortness of breath, and heart attack signs. – Disease progression reduces oxygen-rich blood supply to […]

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Coronary Artery Disease Overview:
– Symptoms include chest pain, angina, shortness of breath, and heart attack signs.
– Disease progression reduces oxygen-rich blood supply to the heart.
– Pathophysiology involves atherosclerosis leading to blood flow restriction and potential complications like myocardial infarction.
– Diagnosis methods include ECG, non-invasive tests like CTA, PET, SPECT, and stress echocardiography.

Risk Factors and Prevention:
– Risk factors: Atherosclerosis, smoking, diabetes, high blood pressure, obesity, lack of exercise, poor diet, and genetics.
– Prevention strategies: Healthy diet, regular exercise, maintaining healthy weight, not smoking.
– Up to 90% of cardiovascular disease is preventable.
– High physical activity reduces risk by 25%.
– Lifestyle changes are crucial for managing coronary artery disease.

Treatment and Management:
– Medications: Aspirin, beta blockers, nitroglycerin, statins.
– Procedures: PCI, CABG for severe cases.
– Uncertainty regarding PCI or CABG impact on life expectancy in stable CAD.
– Secondary prevention involves lifestyle changes like weight control, smoking cessation, and avoiding trans fats.

Genetics and Transcriptome:
– Heritability of CAD estimated between 40% and 60%.
– Over 160 genetic susceptibility loci identified for CAD.
– Transcriptome changes associated with CAD impact immune synapse, ciliary length, T cell function, and signaling pathways.
– Endometriosis, depression, adverse childhood experiences, and specific genetic variations are linked to CAD risk.

Specific Conditions and Risk Assessment:
– Stable Angina: Most common form of ischemic heart disease characterized by chest pain during exertion.
– Acute Coronary Syndrome: Diagnosed in the emergency department, treatment varies based on ECG findings.
– Various risk assessment tools like Framingham Score and polygenic score help determine CAD risk.
– Prevention strategies include dietary recommendations like high fruits and vegetables, Mediterranean diet, and avoiding trans fats.

Coronary artery disease (Wikipedia)

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

Coronary artery disease
Other namesAtherosclerotic heart disease, atherosclerotic vascular disease, coronary heart disease
Illustration depicting atherosclerosis in a coronary artery
SpecialtyCardiology, cardiac surgery
SymptomsChest pain, shortness of breath
ComplicationsHeart failure, abnormal heart rhythms, heart attack, cardiogenic shock, cardiac arrest
CausesAtherosclerosis of the arteries of the heart
Risk factorsHigh blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol
Diagnostic methodElectrocardiogram, cardiac stress test, coronary computed tomographic angiography, coronary angiogram
PreventionHealthy diet, regular exercise, maintaining a healthy weight, not smoking
TreatmentPercutaneous coronary intervention (PCI), coronary artery bypass surgery (CABG)
MedicationAspirin, beta blockers, nitroglycerin, statins
Frequency110 million (2015)
Deaths8.9 million (2015)

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 improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and excessive alcohol consumption. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, biomarkers (high-sensitivity cardiac troponins) and coronary angiogram, among others. Ways to reduce CAD risk include eating a healthy diet, regularly exercising, maintaining a healthy weight, and not smoking. Medications for diabetes, high cholesterol, or high blood pressure are sometimes used. There is limited evidence for screening people who are at low risk and do not have symptoms. Treatment involves the same measures as prevention. Additional medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin may be recommended. Procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be used in severe disease. In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improves life expectancy or decreases heart attack risk.

In 2015, CAD affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. The risk of death from CAD for a given age decreased between 1980 and 2010, especially in developed countries. The number of cases of CAD for a given age also decreased between 1990 and 2010. In the United States in 2010, about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45; rates were higher among males than females of a given age.

Clogged artery
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