Coronary Artery Disease
- Diagnosis, Imaging, Screening
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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"
NHS – Coronary Heart Disease (Videos) “The main symptom of coronary heart disease is angina. Angina can be a mild, uncomfortable feeling similar to indigestion. In severe cases, it causes a feeling of extreme pressure on the chest, breathlessness, trapped air and belching. It is usually triggered by physical exercise or stressful situations, and tends to go away when you stop what you're doing, when you rest or when you take medication. Other symptoms include: Heart palpitations When you become aware of your heart beating irregularly or harder than normal. Heart attack If your arteries become completely blocked, you will have a heart attack. … Heart failure Heart failure occurs when the heart gradually gets too weak to pump blood around the body. This can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or over a period of time (chronic heart failure).”
Highlighted Articles
Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study. (BMJ. 2008) “Smoking, hypertension, hypercholesterolaemia, and diabetes are established risk factors for coronary heart disease, a leading cause of morbidity and mortality in Western industrialised countries.1 2 However, psychological factors, such as emotions, may also have a role in the development of coronary heart disease.3 4 Several prospective studies have found anxiety, hostility/anger, and depression to be associated with an increased risk of coronary heart disease in healthy participants.3 5 As the relative importance of these three negative emotions on risk of coronary heart disease remains largely undefined,6 7 they have been hypothesised to be the components of a single underlying factor, labelled negative affect. Negative affect refers to “stable and pervasive individual differences in mood and self-concept characterised by a general disposition to experience a variety of aversive emotional states.”5 8 High negative affect has been described as a general tendency to report “distress, discomfort, dissatisfaction, and feelings of hopelessness over time and regardless of the situation,” and low negative affect is characterised by “calmness and serenity.”8 9 Supporting this conceptualisation, a considerable neurobiological and psychological overlap between anxiety, hostility/anger, and depression has previously been shown.10 11 As attempts to link psychological factors to heart disease have focused on negative emotions, mostly depression,7 whether positive emotions might also have a role in the development of coronary heart disease remains unclear.“
[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.
Coronary Artery Disease
Diagnosis, Imaging, and Screening
NEWS:
Weighing the Costs of a CT Scan’s Look Inside the Heart “CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk. Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart. “If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer. … Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care. No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments. … But others — like artificial spinal disks, which can cost tens of thousands of dollars to implant but have not been shown to reduce back pain in many patients, and Vytorin, a new cholesterol drug that costs 20 times as much as older medicines but has not been proved superior — have been criticized for not justifying their costs. And sometimes, the new technologies prove harmful. Physicians were stunned, for example, when clinical trials showed last year that expensive anemia medicines might actually hasten death in kidney and cancer patients. Such drugs are used more widely in the United States than elsewhere. … Once the F.D.A. approves a test or device, Medicare rarely demands evidence that it benefits patients before agreeing to pay for it. But last year, Medicare officials raised questions about the benefits of CT heart scans and said it would demand more studies before paying for them. But after heavy lobbying by cardiologists, Medicare backed down. Private insurers, while initially reluctant to pay for the tests, are also covering them. … Cardiologists who oppose wide use of the scans agree that they can sometimes find dangerous blockages that require immediate surgery in asymptomatic patients. But they said such cases are extremely rare — not common enough to justify using the scans routinely, given their cost and radiation risks. … Even cardiologists who think the CT scans are overused say they may one day prove valuable. If manufacturers can produce scanners that can determine which plaques are stable and which are likely to rupture, the machines could revolutionize the treatment of heart disease. Patients found to be at low risk might be able to avoid taking medicine entirely, while others would be given intensive treatment. … Based on a reporter’s notes about the duration of the scan and the power output reported by the scanner, Dr. Brenner of the Center for Radiological Research estimated that Mr. Franks had received 21 millisieverts of radiation — even more than a typical test, equal to about 1,050 conventional chest X-rays. … “The biggest problem we have with radiation is that the doses are cumulative and additive,” Dr. Brindis said. “So the concept of doing serial CT testing on asymptomatic patients, I think, is abhorrent. I cannot justify that.” … And so CT angiograms seem destined to continue, in ever greater numbers. “Once the train leaves the station, once the technology gets on the marketplace, we don’t get the evidence,” said Dr. Redberg, the University of California, San Francisco, cardiologist. “We’re spending a lot of money on technology of unclear benefit and risk.””
ARTICLES:
JOURNAL ARTICLES:
64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis (Heart 2008) “Conclusions: 64-Slice CT is highly sensitive for patient-based detection of CAD and has high NPV. An ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing.”
Multi-slice computed tomography coronary angiography for ruling out suspected coronary artery disease: what is the prevalence of a normal study in a general clinical population? (Eur Heart J. 2008)
Noninvasive Evaluation With Multislice Computed Tomography in Suspected Acute Coronary Syndrome: Plaque Morphology on Multislice Computed Tomography Versus Coronary Calcium Score (J Am Coll Cardiol 2008)
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