Coronary Artery disease| Symptoms | Prevention

Coronary Artery Disease

Coronary artery disease is almost due to a patchy focal disease of the arterial wall i.e. called atheroma or atherosclerosis. This is the most common form of heart disease & important cause of sudden death.

Risk Factors

Age: this is most common in elderly people.
Gender: Males get more affected than females
Family History: Coronary artery disease is often run in families due to genetic factor or shared lifestyle & eating habits.
Smoking, tobacco chewing, alcohol, hyperlipidaemia, coagulation abnormalities, diabetes, hypertension, obesity, sedentary lifestyle, dietary deficiency, mental stress.

Prevention

Population strategy aims to modify the risk factors of the whole population through diet & lifestyle e.

g. reduction in smoking, maintain average cholesterol, maintain ideal body weight etc.
Individuals with established cardiac events have most to gain from preventive measures such as smoking cessation, regular medication e.g. aspirin, beta adrenocepter antagonist.

Clinical Features

This includes following types

1. Angina

Angina is the discomfort due to transient myocardial ischemia which occurs whenever there is an imbalance between myocardial oxygen & its demand. It causes central chest pain may radiates to neck, jaw or arms, sometimes breathlessness.

Types of angina

Stable- is due to fixed atheromatous stenosis of one or more than one coronary artery.
Unstable angina: Ischemias due to dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis & spasm.

Investigation

ECG, Exercise ECG, Isotope scanning, Coronary arterography can be done.

Treatment

It includes bed rest, aspirin 75 to300 mg daily.
Anti-anginal drugs like Nitrates, sublingual Glyceryl trinitrate (GTN), buccal GTN, transdermal GTN, beta adrenocepter antagonist e.g. Atenolol, Metoprolol, calcium antagonist e.g. Nifedipine, Amlodipine.
In high risk patient Heparin should be given.

2. Myocardial Infarction

This is due to acute occlusion of a coronary artery due to plaque rupture & thrombosis resulting in myocardial necrosis.
Patient presents with severe pain, tightness, heaviness or constriction in chest, breathlessness, vomiting, sweating, cold peripheries, collapse or syncope.

Investigation

ECG will confirm the diagnosis.
Secondly Plasma enzymes CPK-MB (creatinine kinase), LDH, SGOT ESR, chest radiography to see the previous or present myocardial damage, echocardiography.

Treatment

Early management includes bed rest, oral Aspirin, high flow oxygen, intravenous analgesic.
Patient should thrombolise with Streptokinase 1.5 million units in 100 ml of saline intravenous infusion.
Subcutaneous heparin twice daily for 7 days should be given to prevent re-infarct.
Beta adrenocepter antagonist, nitrates should be given.
Complications of myocardial infarction are arrhythmia, ventricular fibrillation, atrial fibrillation, sinus bradycardia, heart block.

3. Heart Failure

It is the condition where the heart fails to maintain output sufficient for the needs of the body, usually a disturbance of ventricular function.

Symptoms

Left ventricular failure- cough, exertional. Breathlessness, nocturnal dyspnoea, insomnia, weakness, fatigue.
Right ventricular failure: cough, dyspnoea, haemoptysis, abdominal fullness, pain in hypochondriac region, oliguria, edema feet

Treatment

Salt restricted diet, Oxygen should be given, diuretics like fursemide 40 mg orally or intravenous.
Digitalis, Vasodilators like Nitrates, Nitroprusside.

4. Arrhythmia

It is a disturbance of electrical activity of the heart due to myocardial ischemia or infarction.

Types of arrhythmia: ventricular fibrillation, ventricular ectopics, ventricular tachycardia, atrial fibrillation, atrial tachycardia, sinus bradycardia, heart block.
Arrhythmia presents with palpitation uneasiness and can be diagnosed only on ECG

Treatment

Anti-arrhythmic drugs are Quinidine, Lignocane, Propanol, Metoprolol, Amiodaron, and Digoxin.

5. Sudden Cardiac Death

Sudden death is also due to an arrhythmia related to acute myocardial ischemia, infarction, and heart failure also in patient with other cardiac abnormalities. Ventricular fibrillation is most common cause of sudden death.

Invasive Treatment for coronary artery disease

PTCA (Percutaneous transluminal coronary angioplasty)

CABG (coronary artery bypass grafting).

Prognosis

Prognosis of coronary artery disease is related to the number of diseased vessels (coronary arteries) & the degree of left ventricular (LV) dysfunction.
Patient with single vessel disease & good LV function has an excellent outlook i.e. 5 years survival>90 % whereas patient with severe LV dysfunction & extensive three vessel disease have poor prognosis (5 year survival < 30%)

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Coronary Artery disease| Symptoms | Prevention | Risk Factors