The document discusses coronary artery disease and angina. It defines coronary artery disease as a narrowing of the coronary arteries due to plaque buildup, reducing blood flow to the heart. It describes the different types of angina like stable angina brought on by exertion and unstable angina, a form of acute coronary syndrome. It provides details on symptoms, classifications of angina severity, and differences between angina and a heart attack.

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3. Coronary Arteries
The coronary arteries extend from the aorta to
the heart walls supplying blood to
the atria , ventricles , and septum of the heart.
There are two main coronary arteries: right
coronary artery and left coronary artery.
Right Coronary Artery - Supplies oxygenated
blood to the walls of the ventricles and the
right atrium.
Posterior Descending Artery - Supplies
oxygenated blood to the inferior wall of the left
ventricle and the inferior portion of the
septum.
Left Main Coronary Artery - Directs
oxygenated blood to the left anterior
descending artery and the left circumflex.
Left Anterior Descending Artery - Supplies
oxygenated blood to the anterior portion of the
septum as well as to the walls of the ventricles
and the left atrium (front region of the heart).
Left Circumflex Artery - Supplies oxygenated
blood to the walls of the ventricles and the left
atrium (back region of the heart).
RCA
LCA
LAD

4. Atherosclerosis
Atherosclerosis is a type of arteriosclerosis.
Atherosclerosis causes arteries to narrow,
weaken and be less flexible. It's the term for the
process of fatty buildup in the inner lining of an
artery. The buildup that results is called plaque
and reduces the amount of blood and oxygen
that is delivered to vital organs.
1.Stable plaque: thick fibrous shell
2.Vulnerable plaque: an unstable plaque
develops with a fatty core and thin fibrous
outer shell
3.Plaque rupture: plaque can sometimes rupture
into the bloodstream
4.Thrombosis: thrombosis is the clotting of
blood which begins at the site of the plaque
rupture
5.As the blood clot gets larger, the amount of
blood flowing by it decreases
6.Occlusion: If the blood clot enlarges to
completely block the artery, all tissues supplied
by that artery begin to die below the blockage

5. Definition of Coronary
Artery Disease
Coronary artery disease (also called CAD or
coronary heart disease) is caused by a thickening
of the inside walls of the coronary arteries. This
thickening is called atherosclerosis. A fatty
substance called plaque builds up inside the
thickened walls of the arteries, blocking or
slowing the flow of blood. If your heart muscle
doesn't get enough blood to work properly, you
may have angina or a heart attack.
Coronary Artery Disease
Asymptomatic Symptomatic
Stable angina
Acute coronary
syndrome
Unstable angina Non ST elevation
Myocardial infarction
ST elevation
Myocardial
infarction

6. CORONARY ARTERY DISEASE
https://www.youtube.com/watch?v=3PXdq3ENb2w

7. Coronary Artery
Disease
Coronary artery disease (CAD) is the most
common type of heart disease and cause
of heart attacks. The disease is caused
by plaque building up along the inner walls of
the arteries of the heart, which narrows the
arteries and reduces blood flow to the heart.
While the symptoms and signs of coronary artery
disease are noted in the advanced state of
disease, most individuals with coronary artery
disease show no evidence of disease for decades
as the disease progresses before the first onset
of symptoms, often a "sudden" heart attack,
finally arises.
Symptoms of stable ischemic heart disease
include angina (characteristic chest pain on
exertion) and decreased exercise tolerance.
Unstable IHD presents itself as chest pain or
other symptoms at rest, or rapidly worsening
angina.
Other causes include coronary vasospasm, a
spasm of the blood vessels of the heart, it is
usually called Prinzmetal's angina
Myocardial Ischemia at rest

8. Signs and symptoms of
CAD
The most common symptom of coronary artery
disease is angina (also called angina pectoris).
Angina is often referred to as chest pain. It is
also described as chest discomfort, heaviness,
tightness, pressure, aching, burning, numbness,
fullness, or squeezing. It can be mistaken for
indigestion or heartburn. Angina is usually felt in
the chest, but may also be felt in the left
shoulder, arms, neck, back or jaw.
Other symptoms that may occur with coronary
artery disease include:
- Shortness of breath (SOB)
- Palpitations (irregular heartbeats, skipped
beats or a “flip-flop” feeling in your chest)
- A faster heartbeat
- Dizziness
- Nausea
- Extreme weakness
- Sweating
- Some people don't have any symptoms. In rare
cases, a person can have a "silent" heart attack,
without symptoms.
Dizziness
Nausea
SOB
angina

9. Signs and symptoms of
CAD in women
The symptoms of coronary artery disease and
heart attack can be different for women than
they are in men. Women are also less likely to
recognize the symptoms of a heart attack and
seek treatment.
The most common symptoms of heart disease in
women are:
- Pain or pressure over the chest that travels to
the arm or jaw
- A burning sensation in the chest or upper
abdomen
- Shortness of breath, irregular heartbeat,
dizziness, sweating, fatigue and nausea.
On average, symptoms of heart disease appear
10 years later in women than men. Women tend
to have heart attacks 10 years later than men
do.
In addition, women often report their symptoms
before having a heart attack, although the
symptoms are not typical “heart” symptoms. In a
multi-center study of 515 women who had an
acute myocardial infarction (MI), the most
frequently reported symptoms were unusual
fatigue, sleep disturbances, shortness of breath,
indigestion and anxiety.

10. Typical angina
Typical angina is usually described as a heavy
chest pressure, discomfort, or squeezing feeling
associated with shortness of breath or
dizziness. The discomfort often radiates to the
left shoulder, neck, or arm. It typically builds
slowly in intensity over a few minutes. However,
the main feature of typical angina is not the
type, location, or associated characteristic of
the pain but the fact that the discomfort is
triggered by activities and relieved by rest. While
describing substernal chest pain or discomfort,
the patient often clenches a fist and presses it
over the midsubsternal area. This is known as
the Levines sign, which is more specific to the
diagnosis of angina than other signs. During the
interview with a patient with possible angina, to
elicit an unbiased description of symptoms the
patient should be asked: “What happens if you
walk briskly up a hill, against the wind, in cold
weather?” Be careful not to suggest to the
patient that pain or discomfort might occur
with this situation.
Levines sign

11. Atypical symptoms can present as a sensation of
burning, indigestion, stomach pain, jaw pain,
burping, or breathlessness. These symptoms may
be accompanied by less-specific symptoms, such
as fatigue, nausea, or a sense of impending
doom, especially in women. Symptoms can occur
in atypical locations, such as between the
shoulder blades, the jaw, the neck, or the arms.
A patient with asymptomatic CAD may develop
any kind of noncardiac chest pain unrelated to
the obstructive coronary lesion. The most
important feature suggestive of coronary origin
is that the symptom is caused by exertion and
relieved by rest.
Atypical angina
The most important feature suggestive of
coronary origin is that the symptom is
caused by exertion and relieved by rest.

12. Non-anginal chest pain Atypical angina Typical Angina
Age Men Women Men Women Men Women
30–39 4 2 34 12 76 26
40–49 13 3 51 22 87 55
50–59 20 7 65 31 93 73
60–69 27 14 72 51 94 86
70–79 54 24 69 37 89 68
>80 65 32 78 47 93 76
Clinical pretest probability in patients with chest pain.

13. Classification of angina severity
The Canadian Cardiovascular Society (CCS) system provides a quantitative means to
describe exertional capacity and is divided into four classes:
Class I Minimal limitation of ordinary activity. Angina occurs with strenuous, rapid, or
prolonged exertion at work or recreation.
Class II Slight limitation of ordinary activity; angina occurs on walking or climbing stairs
rapidly; walking in cold, in wind, or under emotional stress.
Class III Marked limitation of ordinary physical activity; angina occurs on walking 50–100
m on level ground or climbing 1 flight of stairs at a normal pace in normal
conditions.
Class IV Inability to perform any physical activity without discomfort; angina symptoms
may be present at rest.

14. Types of angina:
Stable angina
A type of angina brought on by an imbalance
between the heart’s need for oxygen-rich blood
and the amount available.
It is "stable," which means the same activities
bring it on; it feels the same way each time; and
is relieved by rest and/or oral medications.
Stable angina is a warning sign of heart disease
and should be evaluated by a doctor. If the
pattern of angina changes, it may progress to
unstable angina. STABLE ANGINA
Exertion,
emotional
stress
60 days
Less than 20
minutes
Nitroglycerin

15. Types of angina:
Unstable angina
This type of angina is considered an acute
coronary syndrome. It may be a new symptom or
a change from stable angina.
The angina may occur more frequently, occur
more easily at rest, feel more severe, or last
longer.
Although this angina can often be relieved with
oral medications, it is unstable and may progress
to a heart attack.
Usually more intense medical treatment or a
procedure is required. Unstable angina is an
acute coronary syndrome and should be treated
as an emergency.
acute coronary syndrome
may progress to a heart attack.
should be treated as an emergency.

16. Variant angina
(Prinzmetal's angina
or coronary spasm)
A coronary artery can go into spasm, disrupting
blood flow to the heart muscle (ischemia). It can
occur in people without significant coronary
artery disease. However, two thirds of people
with variant angina have severe disease in at
least one vessel, and the spasm occurs at the
site of blockage. This type of angina is not
common and almost always occurs when a
person is at rest - during sleep.
You are at increased risk for coronary spasm if
you have: underlying coronary artery disease,
smoke, or use stimulants or illicit drugs (such as
cocaine).
If a coronary artery spasm is severe and occurs
for a long period of time, a heart attack can
occur.
This type of angina is not common and almost
always occurs when a person is at rest - during
sleep.
If a coronary artery spasm is severe and occurs
for a long period of time, a heart attack can
occur.

17. What are the differences between angina and heart attack?

21. OVERVIEW OF CORONARY ARTERY DISEASE
https://www.youtube.com/watch?v=NZ14XjOQoFY

22. REFERENCES
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Oxford University Press, Inc. 2011
3. Dayi Hu, Thach Nguyen, et al.: Evidence-Based Cardiology Practice: A 21st Approach.
Pepple’s Medical Publishing House – USA.2010
4. Glenn N. Levine: Cardiology Secret. Mosby, Inc. an affilliate of Elsevier Inc.2010.3
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6. www.my.clevelandclinic.org
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