CORONARY ARTERY DISESE IN YOUNG

1. Coronary artery disease
in young
Presented by
DR.Priyank kumar sah
JR1 General medicine
Moderator
DR. [Prof] Sourav
Chattopadhyay sir

2. • Coronary artery disease (CAD) occurring below the age of 45 years
is termed as young CAD. However various studies had considered
the age limit varying from 35 years to 55 years in the spectrum of
young CAD

4. Risk factors
• Prevalence of conventional risk factors like diabetes, hypertension,
smoking, dyslipidemia and obesity accounts for about 85% to 90%
of premature CAD patients.
• The most common risk factor associated with young CAD seems to
be smoking. The prevalence of smoking in younger individuals less
than 45 years of age, with CAD, was reported to be 60% to 90% as
compared to 24% to 56% in subjects greater than 45 years.

5. • The prevalence of diabetes and hypertension seems to higher in
young patients with CAD than without CAD. The prevalence of
hypertension is 25% in young CAD as compared to 13% without
CAD.
• Similarly, the incidence of diabetes and pre diabetes is 14.3% and
7.6% in young CAD as compared to only 5.4% and 4.3% in patients
without CAD respectively. However, prevalence of these risk
factors is much higher in older individuals with CAD as compared
to young CAD

6. • Although, dyslipidemia is an important risk factor for young CAD, there
seems to be a little difference in prevalence of lipid abnormalities in
younger and older patients.
• Obesity is a well established risk factor for CAD. There is little
difference in the prevalence of obesity in young CAD when compared
with older CAD patients.
• Sagittal abdominal diameter to skin fold ratio seems to be a good
indicator in predicting premature CAD, even better than body mass
index (BMI) and waist circumference.

7. OTHER RARE CAUSES
• Cocaine use
• Spontaneous coronary artery dissection (more common
in women, peripartum, idiopathic, atherosclerotic)
• Kawasaki disease
• Low levels of oestrogen
• Oral contraceptive pill
• Hyperhomocysteinaemia

8. RARE RISK FACTORS –
GENETIC POLYMORPHISMS
• Cholesterol ester transfer protein (CETP) gene – significant association
with progression of atherosclerosis
• ApoE4 allele – homozygous individuals at risk of
hyperlipoproteinaemia
• MTHFR gene – homocysteinaemia
• Hepatic lipase – HDL metabolism
• Familial hypercholesterolaemia – mutations in LDL receptor ApoB, PCSK9,
ApoE gene

9. PATHOPHYSIOLOGY OF CAD IN YOUNG
• Conventional CAD accounts for about 80% of CAD in young adults.
• About 4% of heart attacks in young adults are due to congenital abnormalities of
the coronary artery anatomy
• About 5% due to blood clots that originate elsewhere and are carried to otherwise
normal coronary arteries, and block the artery,
• In another 5%, various disorders of the blood clotting system increase the risk of
clot formation.
• The remaining 6% of CAD in young adults is due to spasm or inflammation of the
coronary arteries, radiation therapy for chest tumors, chest trauma, and abuse of
cocaine, amphetamines, and other drugs.

10. Symptoms

12. COMMON SCREENING TESTS
1. Electrocardiogram (ECG)
Where is the infarct ??

13. Treadmill ECG Test
Stress Echocardiogram
Myocardial Perfusion Imaging
Computed Tomography Coronary
Angiogram

14. Noninvasive and invasive methods are useful
in recognizing the atherosclerotic lesions
• Ultrasound imaging carotid artery (transcutaneous) for
atherosclerotic plaque is safe, fast, and cost effective.
• IVUS (intravascular ultrasound) : Not only quantifies the plaque
volume but also the tissue components of plaque IVUS-VH (virtual
histology)— fibrous plaque, central necrosis, etc.
• OCT -optical coherence tomography - cross sectional view of coronary
artery)

15. • CT angiography
• MR angiography
• Catheter-based angiography
• FDG-PET-vascular inflammationVascular inflammation evaluated by
18fluorodeoxy glucose-positron emission tomography (FDG18-PET):

17. ANTI ANGINAL MEDICATIONS
Nitrates
• Nitroglycerin
• isosorbide dinitrate
• Isosorbide 5-mononitrate
Beta clockers
• Atenolol
• Labetalol
• Metoprolol
• Nadolol

18. Calcium channel blocker
• Amlodipine
• Nifedipine
• Verapamil
Oral Anti platelet drugs
• Aspirin
• Clopidogrel

19. ORAL anticoagulants
• Apixaban.
• Rivaroxaban
Parentral anticoagulants
• Enoxaparin
• fondaparinux

20. SURGICAL INTERVENTION
•Percutaneous coronary intervention
•CORONARY ARTERY BYPASS GRAFTING

21. Prevention
• Diet: A low-fat, high-fibre, heart-healthy diet is recommended which
include reduced salt, increased unsaturated fats, reduced sugar, loads of
fresh fruits and vegetables, whole grains, nuts and seeds and fish oils.
• Physical activity: Ideally recommended 30 minutes of light to moderate
activity at least 5 days a week or vigorous activity for at least 20 minutes or
5 days a week.
• Smoking: There is no safe limit on smoking so it has to be absolutely
stopped.

23. • Alcohol consumption: While moderate alcohol consumption is
believed to be healthy for the heart, excessive alcohol
consumption is a strict no. Binge drinking especially is shown to
precipitate abnormal heart rhythm or even heart attacks.
• Weight management: make sure to keep weight under control
by following diet and exercise.

24. CONCLUSION
• The overall prevalence of CAD including the subset of young CAD is on
decreasing trend but mortality of CAD doesn’t seems to be decreasing when
comparing to older CAD patients.
• In addition to conventional risk factors, numerous other risk factors and genes
play an important role in the causation of the disease in young.
• Current smoking and obesity have major impact in long term mortality and
morbidity.
• Young CAD patients with an acute coronary event undergoing PCI and CABG
have an excellent immediate and long term survival rates.
• The prognosis of CAD in younger people is better than older people.

25. THANK YOU