Munson Health
 
Coronary Artery Disease

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by Carson-DeWitt R

(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)

 

Risk Factors

Major risk factors include:
Other risk factors may include:
  • Stress
  • Excessive alcohol use
  • Depression
  • A diet that is high in saturated fat, trans fat, cholesterol, and/or calories
  • Drinking sugary beverages on a regular basis may increase your risk of CAD.
 

Symptoms

CAD may progress without any symptoms.
Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:
  • Exercise or exertion
  • Emotional stress
  • Cold weather
  • A large meal
Chest pain may indicate more serious unstable angina or a heart attack if it includes the following:
  • It is unrelieved by rest or nitroglycerin
  • Severe angina
  • Angina that begins at rest
  • Angina that lasts more than 15 minutes
Accompanying symptoms may include:
  • Shortness of breath
  • Sweating
  • Nausea
  • Weakness
Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms. It is likely to start with shortness of breath and fatigue.
 

Treatment

Treatment may include:

Nitroglycerin

This medicine is usually given during an attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments.

Blood-Thinning Medications

A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily.
Other blood-thinning medicines include:
  • Warfarin
  • Ticlopidine
  • Clopidogrel
  • Prasugrel

Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors

These may help prevent angina. In some cases, they may lower the risk of heart attack.

Medications to Lower Cholesterol

Medicines, like statins, are often prescribed to people who have CAD. Statins lower cholesterol levels, which can help to prevent CAD events.

Revascularization

Patients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:

Options for Refractory Angina

For patients who are not candidates for revascularization procedures, but have continued angina despite medicine, options include:
  • Enhanced external counterpulsation (EECP)—large air bags are inflated around the legs in tune with the heart beat. The patient receives 5 one-hour treatments per week for seven weeks. This has been shown to reduce angina and may improve symptom-free exercise duration.
  • Transmyocardial revascularization (TMR)—surgical procedure done with laser to reduce chest pain
 

Prevention

To reduce your risk of getting coronary artery disease:
 

RESOURCES

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

 

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

 

References


Arora RR, Chou TM, et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol . 1999;33:1833-1840.


Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med . 2007;356:1503-1516.


Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD%5FWhatIs.html . Updated August 23, 2012. Accessed February 8, 2013.


Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated January 29, 2013. Accessed February 8, 2013.


Coronary artery disease–Coronary heart disease. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease%5FUCM%5F436416%5FArticle.jsp . Accessed February 8, 2013.


What is coronary heart disease? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ . Updated August 23, 2012. Accessed February 8, 2013.


4/10/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med . 2007 Mar 26.


11/7/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med . 2007 Nov 20.


1/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry . 2008;165:515-523.


6/5/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med . 2009;169:562-571.


7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA . 2009;301:2024-2035.


7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr . 2009;89:1037-1042.


2/12/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : FDA approves new indication for Crestor. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm200128.htm . Published February 9, 2010. Accessed February 12, 2010.


11/26/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Kivimaki M, Nyberg S, Batty G, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet . 2012 Oct 27;380(9852):1491-7.

 

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