3. Coronary artery disease
The coronary arteries are the blood vessels that
supply the oxygenated blood to heart.
Coronary artery disease is a condition characterized
by the narrowing or blockage of the coronary
arteries , usually caused by atherosclerosis.
Atherosclerosis is the collection of cholesterol and
fatty deposits (called plaques) inside the arteries.
4. These plaques
can deposit in
the arteries or
damage the
arteries, which
limits or stops
blood flow to the
heart muscle.
6. Causes for CAD
Smoking
High blood pressure
High cholesterol
Diabetes or insulin resistance
Sedentary lifestyle
Atherosclerosis
7. Risk Factors
Modifiable risk factors
Being overweight or obese
Diabetes
Unhealthy diet , including a lot of food that
has high saturated fat, trans fat, salt, and
sugar
Smoking or secondhand smoker
Lack of physical activity
High blood pressure and high cholesterol
High stress
8. Non-modifiable risk factors
Age, especially being older than 65
Race . African Americans have a higher risk than
people of other
Gender. Men have a greater risk of heart
attack, However, the risk for women increases
after menopause
Family history
Continued….
9. Other possible risk factors
Sleep apnea. Sudden drops in blood oxygen levels
that occur during sleep apnea increase blood
pressure and strain the cardiovascular system,
possibly leading to coronary artery disease.
High-sensitivity C-reactive protein (hs-
CRP). High hs-CRP levels may be a risk factor for
heart disease.
High triglycerides. High levels may raise the risk of
coronary artery disease, especially for women.
10. Homocysteine. Homocysteine is an amino acid
body uses to make protein and to build and maintain
tissue. But high levels of homocysteine may
increase risk of coronary artery disease.
Preeclampsia. Occurs in women during pregnancy
causes high blood pressure and a higher amount of
protein in urine. It can lead to a higher risk of heart
disease later in life
11. Autoimmune diseases. People who have
conditions such as rheumatoid arthritis and lupus
(and other inflammatory conditions) have an
increased risk of atherosclerosis.
Alcohol use. Heavy alcohol use can lead to heart
muscle damage. It can also worsen other risk factors
of coronary artery disease.
Contraceptive uses
12. 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
Pathophysiology
13. Proliferation of smooth muscle cells with in the vessel
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
14. Hemorrhage into plaque allowing thrombus to develop
Thrombus and obstruct the blood flow leading to
sudden cardiac death of myocardial infarction
Angina and other symptoms
15. Clinical features
The most common symptom is angina, or chest pain
which is
Aching , Burning , Fullness , Heaviness , Numbness ,
Pressure , Squeezing type.
(People mistake with indigestion or heartburn.)
The pain may radiated to Arms ,Back ,Jaw ,Neck
.Shoulder
Nausea / Vomiting.
Faster heartbeat
21. Treatment
Treatment for coronary artery disease usually involves
lifestyle changes and, if necessary, drugs and certain
medical procedures.
Lifestyle changes
Quit smoking.
Eat healthy foods.
Exercise regularly.
Lose excess weight.
Reduce stress.
22. Management
Anti anginal medications : Nitroglycerin tablets,
sprays and patches can control chest pain.
Beta adrenergic blockers : Slow the heart rate
and decrease blood pressure ex- Atenolol
Calcium channel blockers :- Nefidipine
23. Ace inhibitors / Angiotensin-converting enzyme
(ACE) inhibitors : Drugs decrease blood pressure
and may help prevent progression of coronary artery
disease (captopril)
Statins / Cholesterol-lowering medications:
Atorvastatin, Rosuvastatin, Fluvastatin
Oxygen administartion.
Nitroglycerin.
Morphine :
24. Surgical management
Surgical procedures to help restore blood
flow to the heart
Percutaneous transluminal coronary
angioplasty (PTCA)
Coronary artery bypass grafting (CABG)
25. Percutaneous transluminal coronary
angioplasty (PTCA)
PTCA is accomplished using a balloon-tipped
catheter inserted through an artery in the groin or
wrist to enlarge a narrowing in a coronary artery
26. Coronary artery bypass grafting (CABG)
CABG is the most common type of open-heart
surgery , a healthy artery or vein from the body is
connected, or grafted, to the blocked coronary
artery.