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Understanding Coronary Artery Disease: Causes, Symptoms, and Prevention

Learn about coronary artery disease (CAD) and acute coronary syndrome, the leading cause of death in the US and Canada. Discover the causes, symptoms, and risk factors while exploring preventative measures to protect your heart health.

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Understanding Coronary Artery Disease: Causes, Symptoms, and Prevention

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  1. Coronary Artery Disease and Acute Coronary Syndrome

  2. The Heart as a Pump • The heart is a hollow muscular organ about the same size as your fist. • It is a 2 sided pump, with a muscular wall called the septum separating the right and left sides

  3. The Coronary Arteries • As a muscle the heart needs oxygen and nutrients to work • The heart muscle has its own blood supply through the coronary arteries • Women’s coronary arteries tend to be smaller

  4. Description • Coronary Artery Disease (CAD) • A type of blood vessel disorder that is included in the general category of atherosclerosis

  5. Description • Atherosclerosis • Can occur in any artery in the body • Atheromas (fatty deposits) • Preference for the coronary arteries

  6. Description • Atherosclerosis • Terms to describe the disease process: • Arteriosclerotic heart disease (ASHD) • Cardiovascular heart disease (CHD) • Ischemic heart disease (IHD) • CAD

  7. Description • Cardiovascular diseases are the major cause of death in the US and Canada • Heart attacks are still the leading cause of all cardiovascular disease deaths and deaths in general

  8. Etiology and Pathophysiology • Atherosclerosis is the major cause of CAD • Characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery

  9. Process of Coronary Artery Disease - Atherosclerosis • Over time ….a series of events within the artery • A fatty streak (permanent)– can start in infancy & young children • Fatty – ( lipid) deposits throughout the years • Narrowing and impaired blood flow occurs with the gradual occlusion as plaque thickens and blood clots form

  10. Etiology and Pathophysiology • Endothelial lining altered as a result of chemical injuries • Hyperlipidemia • Hypertension

  11. Etiology and Pathophysiology • Bacteria and/or viruses may have role in damaging endothelium by causing local inflammation • C-reactive protein (CRP) • Nonspecific marker of inflammation • Increased in many patients with CAD • Chronic exposure to CRP triggers the rupture of plaques

  12. Etiology and Pathophysiology • Endothelial alteration  • Platelets are activated • Growth factor stimulates smooth muscle proliferation • Cell proliferation entraps lipids, which calcify over time and form an irritant to the endothelium on which platelets adhere and aggregate

  13. Etiology and Pathophysiology • Endothelial alteration  • Thrombin is generated • Fibrin formation and thrombi occur

  14. Response to Endothelial Injury Fig. 33-3

  15. Stages of Development in Atherosclerosis Fig. 33-4

  16. Etiology and PathophysiologyCollateral Circulation • Analogous to “detours” around atherosclerotic plaques • Occur normally in coronary circulation • But collaterals increase in the presence of chronic ischemia • When occlusion occurs slowly over a long period, there is a greater chance of adequate collateral circulation developing

  17. Collateral Circulation Fig. 33-5

  18. Risk Factors for Coronary Artery Disease • Risk factors can be divided: • Unmodifiable risk factors • Modifiable risk factors

  19. Risk Factors for Coronary Artery Disease • Unmodifiable risk factors: • Age • Gender • Ethnicity • Genetic predisposition

  20. Risk Factors for Coronary Artery Disease • Modifiable risk factors: • Elevated serum lipids • Hypertension • Smoking • Obesity • Physical inactivity • Diabetes mellitus • Stressful lifestyle

  21. Diabetes Treatment • Prescribed Meal Plan (sit down with a Dietitian) • Home Blood Sugar monitoring • Regular exercise – at least 150 mins./wkly • ? Medications – pills or Insulin or both • Ongoing Education- Diabetes classes • Support – family and friends • Physician follow-up or Specialist referral A person with Diabetes is considered high risk like someone who has already had a heart attack!

  22. Stress - “We do not laugh because we’re happy – we’re happy because we laugh”William James • Stress may not be the main cause of disease ……. but, managing stress helps us; • maintain health • deal with health problems. Anger, anxiety and depression are major emotions that need to be dealt with for a healthy heart “75% of all good health is under our control!”

  23. Risk Factors for Coronary Artery Disease • Health Promotion • Identification of high-risk persons • Management of high-risk persons • Risk factor modification • Physical fitness • Health education in schools • Nutrition (weight control, ↓ fat, ↓ chol intake) • Cholesterol-lowering medications

  24. Types of Angina • Results when the lack of oxygen supply is temporary and reversible • Types of Angina • Stable Angina • Prinzmetal Angina • Unstable Angina

  25. Coronary Artery

  26. Stable Angina Pectoris • Chest pain occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms • Can be controlled with medications on an outpatient basis • Pain usually lasts 3 to 5 minutes • Subsides when the precipitating factor is relieved • Pain at rest is unusual

  27. Silent Ischemia • 80 % of patients with myocardial ischemia are asymptomatic (with pain or without pain the ischemia has the same prognosis)

  28. Prinzmetal’s Angina • Occurs at rest usually d/t spasm of major coronary artery • Spasm may occur in the absence of CAD

  29. Unstable Angina • Angina that is: • New in onset • Occurs at rest • Has a worsening pattern • Unpredictable • Considered to be an acute coronary syndrome • Associated with deterioration of a once stable atherosclerotic plaque

  30. Clinical Manifestations Angina • Chest pain or discomfort (d/t ischemia) • A strange feeling, pressure, or ache in the chest • Constrictive, squeezing, heaving, choking, or suffocating sensation • Indigestion, burning

  31. However… • Up to 80% of patients with myocardial ischemia are asymptomatic • Associated with diabetes mellitus and hypertension

  32. Location of Chest Pain Fig. 33-12

  33. Diagnostic StudiesAngina • ECG • Coronary angiography • Cardiac markers (CK MB, Troponin) • Treadmill exercise testing (stress test) • Serum lipid levels • C-reactive protein (CRP) • Nuclear imaging

  34. Coronary Angiography • A diagnostic test using x-rays to record the passage of a contrast dye in the heart • To identify the presence, location and nature of any coronary artery disease • The heart valves and heart muscle can also be assessed

  35. Coronary Angiogram

  36. Coronary Angioplasty Video Link • http://www.healthscout.com/animation/1/38/main.html

  37. Collaborative CareAngina • Treatment for stable angina: •  oxygen demand and/or  oxygen supply • Nitrate therapy • Stent placement

  38. Collaborative CareAngina • Treatment for stable angina: • Percutaneous coronary intervention • Atherectomy • Laser angioplasty • Myocardial revascularization (CABG)

  39. Coronary Artery Bypass Surgery • Is open heart surgery, which a bypass ( detour) is made to go around an area of blockage in a coronary artery • Bypasses are usually taken from the leg veins or an artery from the inside of the chest wall

  40. Collaborative CareAngina • Drug Therapy • Antiplatelet aggregation therapy • Aspirin: drug of choice (for MI prevention) • First line of treatment for angina

  41. Collaborative CareAngina • Drug Therapy • Nitrates • 1st line therapy for treatment of acute anginal symptoms • Dilation of vessels

  42. Collaborative CareAngina • Drug Therapy • -Adrenergic blockers • Calcium channel blockers

  43. Collaborative CareAngina • Percutaneous coronary intervention • Surgical intervention alternative • Performed with local anesthesia • Ambulatory 24 hours after the procedure

  44. Collaborative CareAngina • Stent placement • Used to treat abrupt or threatened abrupt closure and restenosis following PCI

  45. The Coronary Stent Procedure • A coronary stent is a small tubular wire object inserted into a coronary artery at the time of angioplasty to keep the previously narrowed artery open

  46. Collaborative CareAngina • Atherectomy • The plaque is shaved off using a type of rotational blade • Decreases the incidence of abrupt closure as compared with PCI

  47. Collaborative CareAngina • Laser angioplasty • Performed with a catheter containing fibers that carry laser energy • Used to precisely dissolve the blockage

  48. Collaborative CareAngina • Myocardial revascularization (CABG) • Primary surgical treatment for CAD • Patient with CAD who has failed medical management or has advanced disease is considered a candidate

  49. Clinical Manifestations Myocardial Infarction • Pain • Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration • The hallmark of an MI

  50. Serum Cardiac Markers (Lewis p.817) • Creatine Kinase (creatine phosphokinase) (CK-MB) • Increased in > 90% of MI patients. • Begins to rise 4-6 hours • Peaks 24 hours • Returns to normal in 2 - 3 days • Troponin • Myocardial muscle protein released after an injury • Troponin T and Troponin I are cardiac specific indicators of an MI • Much more specific than CK-MB • Rises quickly and remains elevated for 2 weeks

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