Coronary Artery Disease

• Coronary artery disease occurs when atherosclerotic plaques deposit in the coronary artery decreasing blood flow.

Pathophysiology

• Endothelial injury leads to a fatty streak, which progresses to fibrous plaque and eventually a complication lesion (Myocardial Infarction).

Risk Factors

• Risk factors include age, hypertension, genetics, tobacco use, diabetes, obesity, sedentary lifestyle, hypercholesterolemia, high triglycerides, metabolic syndrome, stress and illicit drug use.

Types of Angina

• Chronic Stable Angina involves myocardial ischemia caused by an oxygen supply/demand mismatch.
• Chronic Stable Angina causes episodic pain provoked by exertion or stress, occurs intermittently over a long period of time and is predictable and relieved by rest or nitroglycerin (NTG).
• Prinzmetal/variant angina involves coronary vasospasm.
• Prinzmetal/variant angina occurs primarily at rest and is triggered by smoking and some substances like histamine, epinephrine, and cocaine.
• Unstable Angina occurs due to rupture of unstable plaque and needs to rule out myocardial infarction.
• Unstable types of angina include new onset angina and chronic stable angina that changes in character.

Complications

• Complications include sudden cardiac death, dysrhythmias, myocardial infarction, and heart failure.

Diagnostics

• Diagnostic tests include cardiac angiogram and measurement of total cholesterol, LDL, VLDL, HDL, and triglycerides.

Nonpharmacologic Treatment

• Nonpharmacologic includes reduction of risk factors which incldues healthy diet, weight control and smoking cessation.

Pharmacologic Treatment

• Antiplatelet/anticoagulants like aspirin and Plavix inhibit or reduce thrombus formation.
• Nitrates vasodilate vessels, decreasing preload and afterload, promote coronary artery circulation, and can prevent/control vasospasm.
• ACE Inhibitors promote coronary and peripheral vasodilation, reduce endothelial injury, reduce blood pressure, heart rate, and contractility, making the heart work less.

This lesson covers the pathophysiology, and risk factors of coronary artery disease. Coronary artery disease occurs when plaque builds up inside the coronary arteries, limiting oxygen-rich blood flow to the heart.