Coronary Artery Disease

• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
• Treatment

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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.

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Coronary Artery Disease

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Causes of death in patients undergoing percutaneous coronary intervention with drug-eluting stents in a real-world setting. (J Invasive Cardiol. 2009)

Drug-eluting coronary stents: many meta-analyses, little benefit. (Prescrire Int. 2009)

Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis (The Lancet 2009) “Sequential innovations in the catheter-based treatment of non-acute coronary artery disease showed no evidence of an effect on death or myocardial infarction when compared with medical therapy. These results lend support to present recommendations to optimise medical therapy as an initial management strategy in patients with this disease.”

UT Southwestern researchers find drug-coated stents less risky for heart bypass patients

Implantable Defibrillators Lower Risk of Death in Older Heart Patients

Comparison of drug-eluting stents and bare-metal stents for the treatment of unprotected left main coronary artery disease in acute coronary syndromes. (Am J Cardiol. 2009)

Drug Side-Effects and Interactions

RE-LY: Post Hoc Analysis Confirms Benefit of Dabigatran Relative to Warfarin at All INR Levels

Amiod arone-induced pulmonary toxicity mimicking acute pulmonary edema. (J Cardiovasc Med (Hagerstown). 2009)

Beta-Blockers Can Have Helpful, or Harmful, Effect on Heart “Heart disease is the leading cause of death in the United States. Patients with heart disease usually have higher levels of catecholamines -- hormones that activate the beta-adrenergic receptors to stimulate cardiac muscle contraction. In this process, the heart initially grows to become a more efficient pump. Unfortunately, the researchers found, this growth also predisposes the heart to eventual failure. Traditionally, beta-blockers targeting the beta-adrenergic receptors have been utilized as a long-term therapy for heart failure. Interestingly, blocking adrenergic receptors has been widely used clinically for nearly 50 years without a full understanding of the molecular consequences of these drugs, said co-author and graduate student David Cervantes. “

Amiodarone-induced thyrotoxicosis: A review (Canadian Journal of Cardiology 2009)

Drugs

Using Nitroglycerin for Sudden Chest Pain “Nitroglycerin is a vasodilator, a medicine that opens blood vessels to improve blood flow. It is used to treat angina, a type of chest pain that happens when there is not enough blood flowing to the heart. To improve blood flow to the heart, nitroglycerin opens up (dilates) the arteries in the heart (coronary arteries), which improves symptoms and reduces how hard the heart has to work. Nitroglycerin comes in quick-acting forms and long-acting forms. Quick-acting forms of nitroglycerin are used to relieve sudden chest pain or used just before activities that typically cause chest pain. The quick-acting forms include tablets or oral sprays. The tablets are placed under the tongue (sublingual) or between the cheek and gum (buccal). The spray is used on or under the tongue. This topic covers these quick-acting forms of nitroglycerin. Long-acting forms of nitroglycerin are used to prevent chest pain from happening. They are not used to stop sudden chest pain. These long-acting forms include pills, tablets, skin ointment, and skin patches. This topic does not cover these long-acting forms of nitroglycerin.”

Statin use is associated with lower risk of atrial fibrillation in women with coronary disease: the HERS trial. (Heart. 2009)

Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial (The Lancet 2009)

Aspirin Improves Survival In Women With Stable Heart Disease, According To Study “The study also provides new insight into aspirin dosing for women, suggesting that a lower dose of aspirin (81 milligrams, or mg) is as effective as a higher dose (325 mg). This is good news for women who might be concerned with internal bleeding, a well-known risk of aspirin that may be more likely with higher doses of aspirin, according to other studies. However, randomized clinical trials are needed to determine the optimal doses of aspirin in women with cardiovascular disease. … Compared to those who did not report taking aspirin, regular aspirin users had a 25 percent lower risk of death from cardiovascular disease and a 14 percent lower risk of death from any cause. Overall, aspirin use did not significantly decrease the risk of heart attack, stroke, or other cardiovascular events, except among women in their seventies. There were no significant differences in death rates or other outcomes between women taking 81 mg of aspirin compared to those taking 325 mg. “

Exercise

Exercise Training Boosts Benefits of Cardiac Resynchronization Therapy “Providing heart-failure patients with a structured exercise program on top of cardiac resynchronization therapy (CRT) boosts the functional and hemodynamic improvements of biventricular pacing, prompting investigators to suggest it is reasonable to provide exercise programs to all patients after CRT [1].”

Effects of physical exercise on inflammatory parameters and risk for repeated acute coronary syndrome in patients with ischemic heart disease. (Vojnosanit Pregl. 2009) "CONCLUSION: Moderate aerobic exercise resulted in a significant reduction of inflammatory state by decreasing CRP and VCAM-1 levels with significant obesity reduction but without visceral obesity reduction. The obtained results indicate that regular physical activity is clinically desirable in primary and secondary prevention of coronary heart disases."

General Information

Long-term prognosis in stable angina; medical treatment or coronary revascularization in patients younger than 70years? (Int J Cardiol. 2009)

Many heart disease patients not referred for rehab “Despite evidence that cardiac rehabilitation helps patients following discharge from the hospital, almost half of heart disease patients eligible for such rehabilitation are not referred for it, according to a new study. Cardiac rehabilitation involves exercise and counseling on diet and other risk factors. It has been shown to decrease the likelihood of future heart problems.”

Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials (The Lancet 2009) “Long-term mortality is similar after CABG and PCI in most patient subgroups with multivessel coronary artery disease, so choice of treatment should depend on patient preferences for other outcomes. CABG might be a better option for patients with diabetes and patients aged 65 years or older because we found mortality to be lower in these subgroups.”

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease (NEJM 2009)

Transmyocardial laser revascularization versus medical therapy for refractory angina. (Cochrane Database Syst Rev. 2009)

Treatment options for refractory angina pectoris: enhanced external counterpulsation therapy. (Curr Treat Options Cardiovasc Med. 2009)

Guidelines

Immunotherapy

Internet Sites

Treatment Information

Anticoagulation Resource

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Impact of Homocysteine-Lowering Vitamin Therapy on Long-Term Outcome of Patients With Coronary Artery Disease (The American Journal of Cardiology 2009)

Folic Acid-Based Intervention in Non-ST Elevation Acute Coronary Syndromes (Asian Cardiovasc Thorac Ann 2009) “Folic acid-based supplementation is not beneficial and may even be harmful in the secondary prevention of cardiovascular events in patients with unstable angina and non-ST-elevation myocardial infarction.”

Music Reduces Stress In Heart Disease Patients

Potential impact of omega-3 treatment on cardiovascular disease in type 2 diabetes (Current Opinion in Lipidology 2009) "Summary: This systematic review and meta-analysis confirms the triglyceride lowering effects of omega-3 PUFAs, demonstrates potential dose-response effects and shows improvements in thrombogenesis. Omega-3 PUFAs raise LDL levels without concomitant changes in lipid particle size. Changes seen in conventional risk factors are insufficient to explain the cardiovascular disease risk reductions suggested to occur with omega-3 PUFAs.NT."

Prevention of sudden cardiac death with omega-3 fatty acids in patients with coronary heart disease: A meta-analysis of randomized controlled trials (Annals of Medicine 2009) "Conclusions. Dietary supplementation with omega-3 fatty acids reduces the incidence of sudden cardiac death in patients with MI, but may have adverse effects in angina patients."

Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction (Cardiovascular Research 2009) "Conclusion: Dietary supplementation with -3 PUFA derived from fish, but not from vegetable sources, increased plasma adiponectin, suppressed inflammation, and prevented cardiac remodelling and dysfunction under pressure overload conditions."

Surgery

Transplantation

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