CORONARY

ARTERY
DISEASE
INTRODUCTION
 Coronary artery disease is the buildup of
plaque in the arteries that supply
oxygen-rich blood to the heart.
 Plaque causes a narrowing or blockage
that could result in a heart attack.
 Symptoms include chest pain or
discomfort and shortness of breath.
 Treatments include lifestyle changes
and medications that target risk factors
and/or possibly surgery.
DEFINITION
 A narrowing of the coronary arteries that
prevents adequate blood supply to the
heart muscle is called coronary artery
disease. Usually caused by
atherosclerosis, it may progress to the
point where the heart muscle is
damaged due to lack of blood supply.
Such damage may result in infarction,
arrhythmias, and heart failure.
ALSO KNOWN AS….
 ATHEROSCLEROTIC HEART DISEASE
 CORONARY ATHEROSCLEROSIS
 CORONARY ARTERIOSCLEROSIS
 CORONARY HEART DISEASE
CORONARY
ATHEROSCLEROSIS
 CORONARY ATHEROSCLEROSIS is the
abnormal accumulation of lipid or fatty
substances or fatty atheroma(plaque) in
the lumen of coronary artery
ACS
 ACS is a term used to define potential
complications of [Link] syndrome
includes;  Unstable angina 
Myocardial infartion(ST segment
elevation)  Myocardial infarction(non
ST segment elevation)
WHERE ARE THE CORONARY ARTERIES?
WHAT DO THEY DO?

 Coronary arteries are the blood vessels

that supply oxygen-rich blood to heart
muscle to keep it pumping. The
coronary arteries are directly on top of
heart muscle. We have four main
coronary arteries:
 The right coronary artery.
 The left coronary artery.
 The left anterior descending artery.
 The left circumflex artery.
RISK FACTORS
 Modifiable
 Non Modifiable
MODIFIABLE
 High blood cholesterol level
 Cigarette smoking, tobacco use
 Hypertension
 Diabetes mellitus
 Lack of estrogen in women
 Physical activity
 obesity
NON MODIFIABLE
 Family history of CAD
 increasing age
 Gender(male)
 Race(non white populations)
PATHOPHYSIOLOGY
 DUE TO ETIOLOGICAL FACTORS
 INJURY TO THE ENDOTHELIAL CELL THAT
LINING THE ARTERY
 INFLAMMATION AND IMMUNE REACTIONS
 ACCUMULATION OF LIPIDS IN THE INTIMA
OF ARTERIAL WALL
 T LYMPHOCYTES AND MONOCYTES THAT
BECOMES AS MACROPHAGES INFILTRATE
 THE AREA TO INGEST THE LIPIDS AND DIE 
PROLIFERATION OF SMOOTH MUSCLE CELLS
WITH IN THE VESSEL

PATHOPHYSIOLOGY
 FORMATION OF FIBROUS CAP OVER DEAD
FATTY CORE (ATHEROMA)
 PROTRUSION OF ATHEROMA IN TO THE
LUMEN OF VESSEL
 NARROWING AND OBSTRUCTION
 IF CAP IS THIN THE LIPID CORE MAY GROW
CAUSING IT TO RUPTURE
 HEMORRHAGE INTO PLAQUE ALLOWING
THROMBUS TO DEVOLOP
 THROMBUS AND OBSTRUCT THE BLOOD
FLOW LEADING TO SUDDEN CARDIAC DEATH
OF MYOCARDIAL INFARCTION
 ANGINA AND OTHER SYMPTOMS
HOW DOES PLAQUE BUILD-UP IN THE
ARTERIES?
 Coronary artery disease happens in everyone. The speed
at which it develops differs from person to person. The
process usually starts when are very young.
 Before teen years, the blood vessel walls start to show
streaks of fat. As plaque deposits in the artery’s inner
walls, body fights back against this ongoing process by
sending white blood cells to attack the cholesterol, but the
attack causes more inflammation. This triggers yet other
cells in the artery wall to form a soft cap over the plaque.
 This thin cap over the plaque can break open (due to
blood pressure or other causes). Blood cell fragments
called platelets stick to the site of “the injury,” causing a
clot to form. The clot further narrows arteries. Sometimes
a blood clot breaks apart on its own. Other times the clot
blocks blood flow through the artery, depriving the heart
of oxygen and causing a heart attack.
CLINICAL MANIFESTATION
 The most common symptoms are chest
pain or shortness of breath, especially
after light physical activity like walking
up stairs, but even at rest.
 Symptoms of a heart attack include:
 Chest discomfort (angina) described as
heaviness, tightness, pressure, aching,
burning, numbness, fullness, squeezing or a
dull ache. The discomfort can also spread to
or only be felt in your left shoulder, arms,
neck, back or jaw.
 Feeling tired.
 Dizziness, lightheadedness.
 Nausea.
 Weakness.
 Symptoms of a heart attack in women can be
slightly different and include:
 Discomfort or pain in the shoulders, neck,
abdomen (belly) and/or back.
 Feeling of indigestion or heartburn.
 Unexplained anxiety.
 Cold sweat.
DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Cardiac enzymes
 Electrocardiograms
 Echocardiograms
 Stress Tests
 Nuclear Imaging
 Angiography
 Electrocardiograph tests (EKG): This test
records the electrical activity of the heart. Can
detect heart attack, ischemia and heart
rhythm issues.
 Exercise stress tests: This is a treadmill
test to determine how well heart functions
when it’s working the hardest. Can detect
angina and coronary blockages.
 Pharmacologic stress test: Instead of using
exercise to test heart when it is working its
hardest, medication is given to increase heart
rate and mimic exercise. This test can detect
angina and coronary blockages.
 Coronary calcium scan: This test measures the
amount of calcium in the walls of coronary arteries,
which can be a sign of atherosclerosis.
 Echocardiogram: This test uses sound waves to
see how well the structures of heart are working
and the overall function of your heart.
 Blood test: Many blood tests are ordered for
factors that affect arteries, such as triglycerides,
cholesterol, lipoprotein, C-reactive protein, glucose,
HbA1c (a measure of diabetic control) and other
tests.
 Cardiac catheterization:This test involves
inserting small tubes into the blood vessels of the
heart to evaluate heart function including the
presence of coronary artery disease.
 Nuclear imaging: This test produces
images of the heart after administering
a radioactive tracer.
 Computed tomography
angiogram: Uses CT and contrast dye
to view 3D pictures of the moving heart
and detect blockages in the coronary
arteries.
LIFE STYLE MODIFICATION
 Don’t smoke. If smoke or use tobacco
products, quit.
 Manage health problems like high
cholesterol, high blood pressure and diabetes.
 Eat a heart-healthy diet Good dietary
choices include the DASH diets.
 Limit alcohol use.
 Increase your activity level. Exercise helps
lose weight, improve physical condition and
relieve stress. Most people can reduce their
risk of heart attack by doing 30 minutes of
walking five times per week or walking 10,000
steps per day.
MEDICATIONS
 ANTI ANGINAL MEDICATIONS like
 Nitrates(ISD,)
 Beta adrenergic blockers(ATENOLOL)
 Calcium channel blockers(NEFIDIPINE)
 Ace inhibitors(CAPTOPRIL)
 Statins
 Imipramine for analgesia
SURGICAL TREATMENT
 balloon angioplasty and stenting.
 These procedures are done with a long,
thin tube called a catheter. It is inserted
into an artery in the wrist or the top of
the leg through a small incision and
guided to the blocked or narrowed area
of the artery. The balloon widens the
diameter of the artery to restore blood
flow to the heart. A stent (a small metal
spring-like scaffold) is left in place to
keep the artery open.
 Coronary artery bypass graft (CABG)
surgery
It involves creating a new path for blood to
flow when there is a blockage in the coronary
arteries. In most cases, the surgeon removes
blood vessels from your chest, arm or leg, and
creates a new pathway to deliver oxygen-rich
blood to the heart.
 enhanced external counterpulsation
(EECP).
 In this procedure, inflatable cuffs (like
blood pressure cuffs) are used to squeeze
the blood vessels in the lower body.
 This helps improve blood flow to the heart
and helps create natural bypasses
(collateral circulation) around blocked
coronary arteries.
 Enhanced external counter pulsation is a
possible treatment for those with chronic
stable angina who can’t have an invasive
procedure or bypass surgery and don't get
relief from medication.
COMPLICATION
 Angina.
 Heart attack.
 Heart rhythm problems.
 Heart failure.
 Cardiogenic shock.
 Sudden cardiac arrest.
ACUTE CORONARY
SYNDROME
 Acute coronary syndrome is the name given to
types of coronary disease that are associated
with a sudden blockage in the blood supply to
your heart. Some people have symptoms
before they have acute coronary syndrome,
but you may not have symptoms until the
condition occurs. Some people never have any
symptoms. Changes caused by acute coronary
syndrome can be seen on an
electrocardiogram (ECG) and in blood tests.
Acute coronary syndrome is defined by the
location of the blockage, length of time the
artery is blocked and amount of damage
 Unstable angina: This may be a new
symptom or can happen if you have
stable angina that changes to unstable
angina. You may start to have angina
more often, when you are resting, or it
may be worse or last longer. The
condition can lead to a heart attack. If
you have unstable angina, you will need
medication, such as nitroglycerin or a
procedure to correct the problem.
 Non-ST segment elevation
myocardial infarction (NSTEMI): This
is a type of heart attack (MI) that does
not cause major changes on an ECG.
But, a blood test will show that there is
damage to your heart muscle.
 ST segment elevation myocardial
infarction (STEMI): This type of heart
attack (MI) is caused by a sudden
blockage of the blood supply to the
heart.