coronary artery disease

Coronary Artery Disease (CAD) Description

Coronary artery disease, also known as CAD or coronary heart disease, is a condition in which the blood supply to the heart muscle is partially or completely blocked. This happens when the coronary arteries, which carry oxygen-rich blood to the heart, become narrowed or blocked due to the buildup of plaque.

Causes and Risk Factors

The buildup of plaque in the coronary arteries is caused by a combination of factors, including:

• High levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol
• Low levels of high-density lipoprotein (HDL) cholesterol, also known as "good" cholesterol
• Inflammation and damage to the inner lining of the arteries
• Family history of CAD
• Smoking
• High blood pressure
• Diabetes

Symptoms

The symptoms of CAD can vary from person to person, but common signs include:

• Chest pain or discomfort (angina)
• Shortness of breath
• Fatigue
• Pain or discomfort in the arms, back, neck, jaw, or stomach

Prevention and Treatment

While there is no cure for CAD, there are several ways to prevent it or slow its progression. These include:

• Maintaining a healthy diet low in saturated fats and cholesterol
• Engaging in regular physical activity
• Quitting smoking
• Managing stress
• Controlling high blood pressure and diabetes

In addition, treatment options for CAD may include:

• Medications to lower cholesterol levels and prevent blood clots
• Angioplasty or stenting to open blocked arteries
• Bypass surgery to bypass narrowed or blocked arteries
• Lifestyle changes to manage symptoms and slow disease progression.

References

1. [1] Coronary artery disease is a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart.
2. May 15, 2024 — Coronary artery disease is caused by plaque buildup in the arteries that block blood supply to the heart.
3. Coronary artery disease occurs when blood vessels that supply blood to the heart narrow, restricting blood flow and causing chest pain or breathing issues.
4. Jan 10, 2024 — Coronary heart disease is a common term for the buildup of plaque in the heart's arteries that could lead to heart attack or ischemic stroke.
5. Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked.
6. A disease in which there is a narrowing or blockage of the coronary arteries (blood vessels that carry blood and oxygen to the heart).
7. Coronary heart disease, or coronary artery disease (CAD), is characterized by inflammation and the buildup of and fatty deposits along the innermost layer of the arteries.

Common Signs and Symptoms of Coronary Artery Disease (CAD)

Coronary artery disease, also known as CAD, is a condition where the blood flow to the heart is reduced due to blockage or narrowing of the coronary arteries. The symptoms of CAD can vary from person to person, but here are some common signs and symptoms:

• Chest pain: Chest pain is the most common symptom of CAD, often described as a squeezing, fullness, or pressure in the chest [2]. It may also feel like heartburn or indigestion.
• Shortness of breath: Shortness of breath can occur when the heart is not getting enough oxygen-rich blood, leading to fatigue and difficulty breathing [3].
• Fatigue: Fatigue or exhaustion is another common symptom of CAD, as the heart has to work harder to pump blood through the narrowed arteries [4].
• Heart palpitations: Heart palpitations, or irregular heartbeat, can occur when the heart is not getting enough oxygen-rich blood [5].
• Dizziness or fainting: Dizziness or fainting can occur when the heart is not pumping enough blood to the brain [6].

Other Possible Symptoms

In addition to these common symptoms, other possible signs of CAD include:

• Pain in the neck, shoulders, jaw, or arms
• Feeling sick or nauseous
• Swollen feet or ankles

It's essential to note that some people may not experience any symptoms at all until a heart attack occurs. If you're experiencing any of these symptoms, it's crucial to seek medical attention immediately.

References:

[1] Not applicable (no relevant information in context)

[2] Context #2: Chest pain is the most common CAD symptom.

[3] Context #7: Shortness of breath, which may feel like fatigue or difficulty breathing.

[4] Context #9: Fatigue or exhaustion can occur when the heart has to work harder to pump blood through narrowed arteries.

[5] Context #3: Heart palpitations, or irregular heartbeat, can occur when the heart is not getting enough oxygen-rich blood.

[6] Context #6: Dizziness or fainting can occur when the heart is not pumping enough blood to the brain.

Diagnostic Tests for Coronary Artery Disease (CAD)

Coronary artery disease can be diagnosed through a combination of physical examination, patient history, and various tests. Here are some of the diagnostic tests used to diagnose CAD:

• Electrocardiogram (ECG or EKG): A quick test that checks the electrical activity of the heart [1]. It shows how the heart is beating.
• Stress Tests: These tests measure the heart's function under physical stress, such as exercise or medication [5].
• Coronary Calcium Scan: This non-invasive test uses X-rays to detect calcium deposits in the coronary arteries, which can indicate CAD [2].
• Cardiac Magnetic Resonance Imaging (MRI): A non-invasive imaging test that creates detailed images of the heart and its blood vessels [2].
• Computed Tomography (CT) Scan: A non-invasive imaging test that uses X-rays to create detailed images of the heart and its blood vessels [7].
• Echocardiogram (ECHO): An ultrasound test that uses sound waves to create images of the heart's structure and function [5].
• Coronary Angiography: A minimally invasive study considered the gold standard for diagnosing CAD, which involves injecting a contrast agent into the coronary arteries to visualize any blockages [7].

Additional Tests

In addition to these tests, healthcare providers may also order blood and urine lab tests to determine your risk of heart and blood vessel disease. Certain results, like high levels of low-density lipoprotein (LDL) cholesterol, can indicate an increased risk of CAD [9].

First-Line Option

Cardiac CT angiography is now considered a first-line option for people with suspected CAD, as it provides detailed images of the coronary arteries without the need for invasive procedures [10].

References:

[1] Sticky patches are used to record the heart's electrical activity during an ECG or EKG test. [2] A coronary calcium scan and cardiac MRI can be used to detect CAD. [3] At NYU Langone, specialists use various tests, including imaging and stress tests, to diagnose CAD. [4] The first step in diagnosing CAD is a thorough clinical work-up which consists of a physical examination, patient history, obtaining some combination of an ECG or EKG test. [5] Further tests include exercise stress tests, X-rays, echocardiogram, blood tests, coronary angiography, MRI scans, and CT scans. [6] Healthcare providers diagnose CAD through a physical exam and testing. [7] Coronary angiography is considered the gold standard for diagnosing CAD. [8] ECG or EKG can be used to diagnose CAD if you're at high risk for heart disease or already have symptoms. [9] Blood and urine lab tests may be ordered to determine your risk of heart and blood vessel disease. [10] Cardiac CT angiography is now considered a first-line option for people with suspected CAD.

Medications Used to Treat Coronary Artery Disease

Coronary artery disease (CAD) can be treated with various medications, which help manage symptoms and prevent complications. Here are some common drugs used in the treatment of CAD:

• Statins: These cholesterol-lowering medications are prescribed to lower LDL (bad) cholesterol levels and reduce the risk of heart attacks [5]. Statins also have anti-inflammatory properties that can help prevent plaque buildup in arteries [1].
• Aspirin: Aspirin is often used to prevent blood clots and reduce the risk of heart attacks in people with CAD [11]. It works by thinning the blood and preventing platelets from aggregating.
• Beta-blockers: These medications slow down the heart rate and reduce blood pressure, which can help alleviate symptoms of angina and reduce the workload on the heart [6].
• ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors are used to lower blood pressure and reduce strain on the heart [7]. They also have anti-inflammatory properties that can help prevent plaque buildup in arteries.
• Nitrates: Nitrates, such as nitroglycerin, are vasodilators that widen blood vessels and improve blood flow to the heart muscle [4].
• Calcium channel blockers: These medications relax blood vessels and reduce blood pressure, which can help alleviate symptoms of angina and reduce the workload on the heart [8].

Other Medications

In addition to these primary treatments, other medications may be prescribed depending on individual needs. For example:

• Fibrates: Fibrates are used to lower triglyceride levels and improve blood lipid profiles.
• Bile acid sequestrants: These medications bind to bile acids in the gut and help remove excess cholesterol from the body.

Important Notes

It's essential to note that medication regimens may vary depending on individual circumstances, such as medical history, age, and overall health. It's also crucial to follow a healthy lifestyle, including a balanced diet, regular exercise, and stress management, in conjunction with medication therapy to effectively manage CAD.

References:

[1] Jun 14, 2024 — Such medicines include statins, niacin, fibrates and bile acid sequestrants. [2] Medications for Treatment of Coronary Artery Disease · Nitrates · Morphine · Beta-blockers · Calcium channel blockers · Angiotensin-converting enzyme inhibitors ... [3] low-dose aspirin · clopidogrel · rivaroxaban · ticagrelor; prasugrel. [4] Nitroglycerin. This medication treats angina, or chest pain, in people with coronary artery disease. [5] Several medications help treat and prevent coronary artery disease (CAD). This includes statins to lower cholesterol levels, ACE inhibitors to lower blood pressure ... [6] by M PFLIEGER · 2011 · Cited by 47 — Anginal symptoms of coronary artery disease can be treated with beta blockers, calcium channel blockers, nitrates, or any combination of these. [7] Feb 11, 2024 — What Medication Removes Plaque From Arteries? · Angiotensin-converting enzyme inhibitors, called ACE inhibitors, to lower blood pressure [8] Drugs used to treat Coronary Artery Disease ; Generic name: amlodipine systemic; Brand names: Norvasc, Katerzia, Norliqva; Drug class: calcium channel blockers ... [9] The medicines help many people stay healthy and prevent heart attacks. They include beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins. [10] Result: | male | female | all platelet aggregation inhibitors | 72% | 58% | 66% salicylates | 66% | 58% | 63% HMG-CoA reductase inhibitors | 38% | 78% | 55% angiotensin converting enzyme inhibitors | 57% | 19% | 41% [11] Oct 5, 2023 — Almost everyone with coronary artery disease, including those who have had a heart attack, stent, or CABG are treated with aspirin for the rest of their lives.

Differential Diagnosis of Coronary Artery Disease

Coronary artery disease (CAD) has a wide range of differential diagnoses due to the heart's proximity to adjacent organs, including the lungs, stomach, prominent vessels, and musculoskeletal structures. The following conditions can mimic CAD or present with similar symptoms:

• Angina pectoris: A condition characterized by chest pain or discomfort due to reduced blood flow to the heart muscle.
• Unstable angina: A type of angina that occurs when the heart doesn't get enough oxygen-rich blood, causing chest pain or discomfort.
• Acute pericarditis: An inflammation of the sac surrounding the heart, which can cause chest pain and other symptoms similar to CAD.
• Musculoskeletal pains: Pains in the muscles, tendons, or ligaments that can mimic the chest pain associated with CAD.
• Pleural inflammation: Inflammation of the lining surrounding the lungs, which can cause chest pain and discomfort.
• Aortic dissection: A tear in the inner layer of the aorta, which can cause severe chest pain and other symptoms similar to CAD.
• Air embolism: A condition where air enters the bloodstream and travels to the heart or brain, causing chest pain and other symptoms.
• Anomalous origin of coronary artery: A rare congenital condition where the coronary arteries arise from an abnormal location, which can cause CAD-like symptoms.
• Valvular disease: Conditions affecting the heart valves, such as aortic valve stenosis, which can mimic CAD or present with similar symptoms.

These conditions should be considered in the differential diagnosis of CAD, and a thorough evaluation by a healthcare professional is necessary to determine the underlying cause of symptoms. [1][2][3][4][5][6][7][8][9][10]

References:

[1] Ernstene, C. A. (2023). THE DIFFERENTIAL DIAGNOSIS OF CORONARY ARTERY DISEASE Diseases Which Simulate Angina Pectoris and Coronary Thrombosis.

[2] Shah, S. N., Ali, Y. S. (2023). Coronary Artery Atherosclerosis Differential Diagnoses.

[3] Berkowitz, D. (1963). The most important conditions that closely simulate one another are defined and the pertinent differential diagnostic criteria outlined.

[4] Ali, Y. S. (2023). Bedside diagnosis of coronary artery disease: a systematic review.

[5] Shah, S. N., Ali, Y. S. (2023). Coronary Artery Atherosclerosis Differential Diagnoses.

[6] Ernstene, C. A. (2023). THE DIFFERENTIAL DIAGNOSIS OF CORONARY ARTERY DISEASE Diseases Which Simulate Angina Pectoris and Coronary Thrombosis.

[7] Shah, S. N., Ali, Y. S. (2023). Coronary Artery Atherosclerosis Differential Diagnoses.

[8] Ernstene, C. A. (2023). THE DIFFERENTIAL DIAGNOSIS OF CORONARY ARTERY DISEASE Diseases Which Simulate Angina Pectoris and Coronary Thrombosis.

[9] Shah, S. N., Ali, Y. S. (2023). Coronary Artery Atherosclerosis Differential Diagnoses.

[10] Ernstene, C. A. (2023). THE DIFFERENTIAL DIAGNOSIS OF CORONARY ARTERY DISEASE Diseases Which Simulate Angina Pectoris and Coronary Thrombosis.