Coronary Artery Disease

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Coronary Artery Disease

NIH - Medical Encyclopedia Coronary heart disease

"Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease. Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms. Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. … Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person.

There are two main types of chest pain:

• Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women.

• Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. Adults with typical chest pain have a higher risk of CHD than those with atypical chest pain.

Other symptoms include: • Shortness of breath • Heart attack -- in some cases, the first sign of CHD is a heart attack…

Tips for preventing CHD or lowering your risk of the disease: • Avoid or reduce stress as best as you can. • Don't smoke. • Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables. • Get regular exercise. If your weight is considered normal, get at least 30 minutes of exercise every day. If you are overweight or obese, experts say you should get 60 to 90 minutes of exercise every day. • Keep your blood pressure, blood sugar, and cholesterol under control"

Highlighted Articles

[Heart disease and stroke] (Tidsskr Nor Laegeforen. 2007)

"Most cases of heart disease and stroke are caused by atherosclerosis, and the two diseases have much in common with regards to risk factors, treatment and prognosis. Heart disease may also be a direct cause of stroke. About one in four cerebral infarctions are due to embolism from the heart to the brain, mainly because of atrial fibrillation, but also because of diseases such as acute myocardial infarction, dilated cardiomyopathy and prosthetic heart valves (cardioembolic stroke). Stroke can also be caused by a cardiogenic fall in blood pressure in patients with stenoses in pre- or intracerebral arteries (haemodynamic stroke). Patients with symptoms of atherosclerosis in one artery system should be treated as if they have a high risk of developing symptoms from other artery systems. The possibility of a cardiac embolic source should always be considered in patients with acute brain infarctions."

Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007)

"Background In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. … Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."

Visit InfoMedSearch's Home Page for all InfoMedLinks Cardiovascular Topics: Atherosclerosis, Atrial Fibrillation, Coronary Artery Disease, Cholesterol - Lipids, General Cardiovascular, Heart Failure, Hypertension, Myocardial Infarction (Heart Attack), Peripheral Artery Disease, and Stroke.

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Coronary Artery Disease

Diagnosis, Imaging, and Screening

NEWS:

CT angiography highly accurate, multicenter trials show "Computed tomography (CT) angiography is as accurate as an invasive angiogram in detecting coronary artery disease, according to the findings of the first two prospective multicenter 64-slice scanner trials presented today at the annual meeting of the Radiological Society of North America (RSNA)."

Elevated Troponin Levels May Be a Marker for Increased Mortality in ACS "Patients with acute coronary syndrome presenting to the emergency department with transient elevation in the ST segment of their electrocardiogram (ECG) who also have elevated troponin levels may be at increased risk for death. The finding suggests that such patients should be treated more aggressively."

Urine Test Results Can Point to Heart Dangers "Albumin is normal and necessary in blood, but its presence in urine indicates leakage in the kidney filtration system and possible damage to cells that line the kidney's blood vessels, according to background information in the study. "We found that virtually any degree of albuminuria, even albumin below the level we call microalbuminuria, placed a patient at significantly higher risk of cardiovascular events," … "

ARTICLES:

Severe Chest Pain May Be Angina Pectoris "The fundamental cause of angina pectoris is an imbalance between the oxygen requirement of the heart and the oxygen supplied to the heart by way of the coronary vessels.2 Angina is also a symptom of ischemic heart. … Episodes of pain or discomfort typically start under the breastbone but may radiate to other areas such as the arms, left shoulder, back, neck, jaw, or stomach. Patients also may experience other symptoms, such as1,3 : • Episodes of difficulty in breathing or shortness of breath • Sweating, light-headedness, dizziness, extreme weakness, or anxiety • Feeling of indigestion • Nausea or vomiting • Rapid or irregular heartbeats "

JOURNAL ARTICLES:

Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris (European Heart Journal 2007) "Conclusion: Non-invasive CTCA is a potentially useful tool, in the diagnostic work-up of patients with typical angina pectoris, both to detect and to exclude significant CAD"

Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients. (J Endocrinol Invest. 2007)

Chest Pain on Exercise Treadmill Test Predicts Future Cardiac Hospitalizations. (Clin Cardiol. 2007)

CT of Coronary Artery Disease. (J Thorac Imaging. 2007)

Extent and distribution of coronary artery disease: a comparative study of invasive versus noninvasive angiography with computed angiography. (Am Heart J. 2007)

Independent association of high serum uric Acid concentration with angiographically defined coronary artery disease. (Tohoku J Exp Med. 2007) "In conclusion, we have demonstrated that high serum uric acid is independently associated with CAD and that uric acid determination could be useful as one of the markers of clinically significant CAD."

Intraindividual Comparison of 3D Coronary MR Angiography and Coronary CT Angiography. (Acad Radiol. 2007) "CONCLUSIONS: CT provided a better image quality with superior accuracy for the detection of CAD. Despite its overall inferiority, MR imaging proved to be helpful method in interpreting coronary stenosis in severely calcified segments."

Positron emission tomography in coronary artery disease. (Curr Opin Cardiol. 2007) "SUMMARY: Cardiac positron emission tomography, done correctly with attention to technical details, provides definitive noninvasive assessment of early or advanced coronary atherosclerosis as the basis for invasive procedures or for lifelong intense risk factor management, demonstrates progression or regression of disease, predicts clinical outcomes and serves as the primary definitive noninvasive guide for managing coronary artery disease."

Practicality, safety and accuracy of computed tomography coronary angiography in the evaluation of low TIMI-risk score chest pain patients: A pilot study. (Emerg Med Australas. 2007) "Conclusions: The majority of acute chest pain patients with low TIMI risk scores were successfully scanned with a 16-slice CT to produce CT-CA studies with good diagnostic quality and accuracy. No major adverse events were found. The place of CT-CA in diagnostic workup for chest pain remains to be defined."

Prognostic Value of Multislice Computed Tomography Coronary Angiography in Patients With Known or Suspected Coronary Artery Disease (Journal of the American College of Cardiology 2007) " Multislice computed tomography coronary angiography provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD. An excellent prognosis was noted in patients with a normal MSCT."

The value of myocardial perfusion single-photon emission computed tomography in screening asymptomatic patients with atrial fibrillation for coronary artery disease. (J Am Coll Cardiol. 2007)

Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result. (Am J Cardiol. 2007) "In conclusion, in patients with chest pain possibly ischemic in origin, no previously known CAD, and a negative or nondiagnostic ETT result, contrast-enhanced 64-slice MDCT scanning was a useful tool to provide direct noninvasive coronary angiography and rapidly advance diagnostic triage."

Usefulness of cardiac magnetic resonance imaging for coronary artery disease detection. (Minerva Cardioangiol. 2007)

What is the best test for a patient with classic angina (Cleveland Clinic Journal of Medicine 2007)

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