Coronary Artery Disease (CAD)
Coronary artery disease (CAD) is one of the most common forms of heart disease and a leading cause of death of both men and women in Canada. The dominant effect of coronary artery disease (CAD) is the loss of oxygen and nutrients to myocardial tissue because of diminished coronary blood flow. This disease is near epidemic in the Western world.CAD occurs more often in men than in women, in whites, and in middle-aged and elderly people. In the past, this disorder rarely affected women who were premenopausal; however, that's no longer the case, perhaps because many women now take oral contraceptives, smoke cigarettes, and are employed in stressful jobs that used to be held exclusively
Both men and women can get CAD. It can be hereditary (run in your family). It might also develop as you get older and plaque builds up in your arteries over the years. You may get CAD if you are overweight or if you have high blood pressure or diabetes. High cholesterol may also lead to CAD . CAD can stem from making unhealthy choices such as smoking, eating a high-fat diet and not exercising enough.
Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow.
Signs and symptoms
The classic symptom of CAD is angina, the direct result of inadequate flow of oxygen to the myocardium. It's usually described as a burning, squeezing, or tight feeling in the substernal or precordial chest that may radiate to the left arm, neck, jaw, or shoulder blade.
Typically, the patient clenches his fist over his chest or rubs his left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool extremities. Anginal episodes most often follow physical exertion but may also follow emotional excitement, exposure to cold, or a large meal.
Angina has three major forms:
Severe and prolonged anginal pain generally suggests MI, with potentially fatal arrhythmias and mechanical failure.
DiagnosisThe patient history - including the frequency and duration of angina and the presence of associated risk factors-is crucial in evaluating CAD. Additional diagnostic measures include the following:
The goal of treatment in patients with angina is to either reduce myocardial oxygen demand or increase oxygen supply. Therapy consists primarily of nitrates, such as nitroglycerin (given sublingually, orally, transdermally, or topically in ointment form), isosorbide dinitrate (given sublingually or orally), beta-adrenergic blockers (given orally), or calcium channel blockers (given orally). Obstructive lesions may necessitate coronary artery bypass surgery and the use of vein grafts.
Angioplasty may be performed during cardiac catheterization to compress fatty deposits and relieve occlusion in patients with no calcification and partial occlusion. A certain risk is associated with this procedure, but its morbidity is lower than that for surgery. Percutaneous transluminal coronary angioplasty may be done in combination with coronary stenting. Stents provide a framework to hold an artery open by securing flaps of tunica media and intima against the artery wall.
Although great advances have been made in treating coronary artery disease, changing your habits remains the single most effective way to stop the disease from progressing. Here are the most beneficial changes you can make:
Because CAD is so widespread, prevention is of incalculable importance. Dietary restrictions aimed at reducing intake of calories (in obesity) and of dietary fats and cholesterol serve to minimize the risk, especially when supplemented with regular exercise. Abstention from smoking and reduction of stress are also beneficial.
Other preventive actions include control of hypertension (with sympathetic blocking agents, such as methyldopa and propranolol, or diuretics, such as hydrochlorothiazide), control of elevated serum cholesterol or triglyceride levels (with antilipemics, such as HMG-reductase inhibitors like cerivastatin sodium (Baycol), atorvastatin calcium (Lipitor), pravastatin sodium (Pravachol), or simvastatin (Zocor), and measures to minimize platelet aggregation and the danger of blood clots (with aspirin).
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