Coronary Artery Disease (CAD)

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1- Introduction

2- Pathophysiological Overview

 

3- Symptoms 

4- Treatment 

Introduction

Coronary artery disease (CAD), also known as coronary heart disease (CHD), is a condition characterized by the narrowing or blockage of the coronary arteries due to the buildup of atherosclerotic plaques. These plaques consist of fat, cholesterol, and other substances that can restrict blood flow to the heart muscle, potentially leading to serious complications such as angina, heart attacks, and heart failure.

Pathophysiological Overview

  • Atherosclerosis Development

    1. Endothelial Injury:

      • Initiated by factors such as hypertension, smoking, diabetes, hyperlipidemia, and inflammatory processes.
      • Endothelial injury leads to increased permeability of the arterial wall, allowing lipoproteins to enter the intima.

    2. Lipoprotein Accumulation:

      • Low-density lipoprotein (LDL) cholesterol accumulates within the arterial intima.
      • LDL undergoes oxidation, which is highly atherogenic.

    3. Inflammatory Response:

      • Oxidized LDL attracts monocytes from the bloodstream.
      • Monocytes enter the intima and differentiate into macrophages.
      • Macrophages engulf oxidized LDL, becoming foam cells, which accumulate and form fatty streaks.

    4. Plaque Formation:

      • Foam cells release cytokines and growth factors, promoting the migration of smooth muscle cells from the media to the intima.
      • Smooth muscle cells proliferate and produce extracellular matrix components, contributing to plaque stability.
      • A fibrous cap forms over the lipid core, consisting of collagen and smooth muscle cells.

    5. Plaque Progression:

      • Over time, plaques can become larger and more complex.
      • Calcification of the plaques may occur.
      • The plaque can either remain stable or become unstable.

Symptoms

  • Chest Pain or Discomfort (Angina): A common symptom, often described as pressure, squeezing, fullness, or pain in the center of the chest.
  • Shortness of Breath: Occurs when the heart cannot pump enough blood to meet the body’s needs.
  • Heart Attack: Severe symptoms, including chest pain or discomfort, upper body pain, shortness of breath, sweating, nausea, and lightheadedness.
  • Fatigue: Feeling unusually tired, especially with exertion.
  • Palpitations: Irregular or rapid heartbeats.

Treatment

  • Lifestyle Changes:

    • Smoking cessation.
    • Healthy diet (low in saturated fats, trans fats, cholesterol, and sodium).
    • Regular physical activity.
    • Weight management.
    • Stress reduction.

  • Medications:

    • Antiplatelet Agents (e.g., aspirin) to prevent blood clots.
    • Cholesterol-Lowering Medications (e.g., statins).
    • Blood Pressure Medications (e.g., beta-blockers, ACE inhibitors).
    • Anti-Anginal Medications (e.g., nitrates).
    • Diabetes Medications.

  • Procedures and Surgeries:

    • Angioplasty and Stent Placement: A balloon catheter is used to open up blocked arteries, often followed by placing a stent to keep the artery open.
    • Coronary Artery Bypass Grafting (CABG): A surgical procedure where a blood vessel from another part of the body is grafted to bypass a blocked coronary artery.
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