CORONARY ARTERY

DEFINATION
Coronary arteries: The vessels that supply the heart muscle with blood rich in
oxygen. They are called the coronary arteries because they encircle the heart in
the manner of a crown. The word "coronary" comes from the Latin "corona" and
Greek "koron" meaning crown. Like other arteries, the coronaries may be subject
to arteriosclerosis (hardening of the arteries). There are a number of coronary
arteries. Those most often bypassed today include the right coronary artery, the
posterior descending coronary artery, the left main coronary artery, the left
anterior descending coronary artery and the left circumflex coronary artery.
Plaques obstructing the coronary arteries may also be treated by balloon
angioplasty, stents, and other techniques.
(Source: http://www.medicinenet.com/script/main/art.asp?articlekey=7250)

SIGNS AND SYMPTOMS

Symptoms
If your coronary arteries narrow, they can't supply enough oxygen-rich blood to
your heart especially when it's beating hard, such as during exercise. At first,
the decreased blood flow may not cause any coronary artery disease symptoms.
As plaque continues to build up in your coronary arteries, however, you may
develop coronary artery disease signs and symptoms, including:

Chest pain (angina).

You may feel pressure or tightness in your chest, as if someone were
standing on your chest. This pain, referred to as angina, usually occurs on
the middle or left side of the chest. Angina is generally triggered by
physical or emotional stress.
The pain usually goes away within minutes after stopping the stressful
activity. In some people, especially women, this pain may be fleeting or
sharp and felt in the neck, arm or back.
Shortness of breath.
If your heart can't pump enough blood to meet your body's needs, you
may develop shortness of breath or extreme fatigue with exertion.
Heart attack.
A completely blocked coronary artery may cause a heart attack. The
classic signs and symptoms of a heart attack include crushing pressure in
your chest and pain in your shoulder or arm, sometimes with shortness of
breath and sweating.

Women are somewhat more likely than men are to experience less typical signs
and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart
attack occurs without any apparent signs or symptoms.
(Source: http://www.mayoclinic.org/diseases-conditions/coronary-arterydisease/symptoms-causes/dxc-20165314)

CAUSES AND RISK FACTORS

Causes

Coronary artery disease is thought to begin with damage or injury to the

inner layer of a coronary artery, sometimes as early as childhood. The
damage may be caused by various factors, including:

Smoking
High blood pressure
High cholesterol
Diabetes or insulin resistance
Sedentary lifestyle

Once the inner wall of an artery is damaged, fatty deposits (plaque) made
of cholesterol and other cellular waste products tend to accumulate at the
site of injury in a process called atherosclerosis. If the surface of the
plaque breaks or ruptures, blood cells called platelets will clump at the
site to try to repair the artery. This clump can block the artery, leading to
a heart attack.

Development of atherosclerosis
Atherosclerosis is a process in which blood, fats such as cholesterol, and other
substances build up on your artery walls. Eventually, deposits called plaques

may form. The deposits may narrow or block your arteries. These plaques
can also rupture, causing a blood clot.

Risk factors
Risk factors for coronary artery disease include:

Age. Simply getting older increases your risk of damaged and

narrowed arteries.
Sex. Men are generally at greater risk of coronary artery disease.
However, the risk for women increases after menopause.
Family history. A family history of heart disease is associated with a
higher risk of coronary artery disease, especially if a close relative
developed heart disease at an early age. Your risk is highest if your
father or a brother was diagnosed with heart disease before age 55
or if your mother or a sister developed it before age 65.
Smoking. People who smoke have a significantly increased risk of
heart disease. Exposing others to your second-hand smoke also
increases their risk of coronary artery disease.
High blood pressure. Uncontrolled high blood pressure can result in
hardening and thickening of your arteries, narrowing the channel
through which blood can flow.
High blood cholesterol levels. High levels of cholesterol in your blood
can increase the risk of formation of plaques and atherosclerosis.
High cholesterol can be caused by a high level of low-density
lipoprotein (LDL), known as the "bad" cholesterol. A low level of
high-density lipoprotein (HDL), known as the "good" cholesterol, can
be a sign of atherosclerosis.
Diabetes. Diabetes is associated with an increased risk of coronary
artery disease. Type 2 diabetes and coronary artery disease share
similar risk factors, such as obesity and high blood pressure.
Overweight or obesity. Excess weight typically worsens other risk
factors.
Physical inactivity. Lack of exercise also is associated with coronary
artery disease and some of its risk factors, as well.
High stress. Unrelieved stress in your life may damage your arteries
as well as worsen other risk factors for coronary artery disease.

Risk factors often occur in clusters and may build on one another, such as
obesity leading to type 2 diabetes and high blood pressure. When grouped
together, certain risk factors put you at an even greater risk of coronary
artery disease. For example, metabolic syndrome a cluster of conditions
that includes elevated blood pressure, high triglycerides, elevated insulin

levels and excess body fat around the waist increases the risk of
coronary artery disease.
Sometimes coronary artery disease develops without any classic risk
factors. Researchers are studying other possible factors, including:

Sleep apnoea. This disorder causes you to repeatedly stop and start
breathing while you're sleeping. Sudden drops in blood oxygen
levels that occur during sleep apnea increase blood pressure and
strain the cardiovascular system, possibly leading to coronary artery
disease.
High sensitivity C-reactive protein. High sensitivity C-reactive
protein (hs-CRP) is a normal protein that appears in higher amounts
when there's inflammation somewhere in your body. High hs-CRP
levels may be a risk factor for heart disease. It's thought that as
coronary arteries narrow, you'll have more hs-CRP in your blood.
High triglycerides. This is a type of fat (lipid) in your blood. High
levels may raise the risk of coronary artery disease, especially for
women.
Homocysteine. Homocysteine is an amino acid your body uses to
make protein and to build and maintain tissue. But high levels of
homocysteine may increase your risk of coronary artery disease.

(Source: http://www.mayoclinic.org/diseases-conditions/coronaryartery-disease/symptoms-causes/dxc-20165314)

DIAGNOSIS
Coronary Artery Disease Diagnosis
Doctors know that some people are at high risk of this kind of heart disease
because of certain physical and behavioural characteristics. For example, men
generally are at greater risk for heart disease but the risk increases for women
after menopause. Other characteristics for arteriosclerosis include:
Age
Diabetes
Family history of heart disease
High blood cholesterol
High blood pressure
Obesity
Sedentary lifestyle
Smoking
Stress
Arteriosclerosis is diagnosed through various tests including:
Coronary Angiography Coronary angiography, also called cardiac
catheterization, is a minimally invasive study that is considered the gold
standard for diagnosing coronary artery disease. This test is performed under
local anaesthesia and involves injecting X-ray dye or contrast medium into the
coronary arteries via tubes called catheters. An X-ray camera films the blood flow
to show the location and severity of artery narrowing. This test can show if the
blood vessels in your heart have narrowed, your heart is pumping normally and
blood is flowing correctly and your heart valves are functioning properly. It also
can identify any heart abnormalities you may have been born with or congenital
abnormalities.
Echocardiogram (ECHO) This non-invasive test translates sound waves from
your chest into pictures of your heart. It provides information about how the
heart is pumping, how blood flows in the heart and blood vessels, how large the
heart is and how the valves are working.
Electrocardiogram (ECG or EKG) The electrocardiogram records the heart's
electrical activity. Small patches called electrodes are placed on your chest, arms
and legs, and are connected by wires to the ECG machine. Your heart's electrical
impulses are translated into a wavy line on a strip of paper, enabling doctors to

determine the pattern of electrical current flow in the heart and to diagnose
arrhythmias and heart damage.
Stress Echocardiogram Stress tests are performed to see how the heart
performs under physical stress. The heart can be stressed with exercise on a
treadmill or in a few instances, a bicycle. If you can't exercise on a treadmill or
bicycle, medications can be used to cause the heart rate to increase, simulating
normal reactions of the heart to exercise. During the stress test, you will wear
ECG electrodes and wires while exercising so that the electrical signals of your
heart can be recorded at the same time.
Stress Thallium Test Stress thallium tests have two components a treadmill
stress test and heart scan after injection of a radionuclide material, such as
thallium, which allows doctors to see the coronary arteries and the shape and
function of the heart. It has been used in this manner safely for many years to
demonstrate the amount of blood the heart is getting under various condition
rest and stress.
(Source: http://www.mayoclinic.org/diseases-conditions/coronary-arterydisease/diagnosis-treatment/diagnosis/dxc-20165331)

TREATMENT
Treatment for coronary artery disease usually involves lifestyle changes and, if
necessary, drugs and certain medical procedures.

Lifestyle changes
Making a commitment to the following healthy lifestyle changes can go a long
way toward promoting healthier arteries:
Quit smoking.
Eat healthy foods.
Exercise regularly.
Lose excess weight.
Reduce stress.

Drugs
Various drugs can be used to treat coronary artery disease, including:
Cholesterol-modifying medications. By decreasing the amount of cholesterol
in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol,
these drugs decrease the primary material that deposits on the coronary
arteries. Your doctor can choose from a range of medications, including statins,
niacin, fibrates and bile acid sequestrants.
Aspirin. Your doctor may recommend taking a daily aspirin or other blood
thinner. This can reduce the tendency of your blood to clot, which may help
prevent obstruction of your coronary arteries.
If you've had a heart attack, aspirin can help prevent future attacks. There are
some cases where aspirin isn't appropriate, such as if you have a bleeding
disorder or you're already taking another blood thinner, so ask your doctor
before starting to take aspirin.

Beta blockers. These drugs slow your heart rate and decrease your blood
pressure, which decreases your heart's demand for oxygen. If you've had a heart
attack, beta blockers reduce the risk of future attacks.
Nitro-glycerine. Nitro-glycerine tablets, sprays and patches can control chest
pain by temporarily dilating your coronary arteries and reducing your heart's
demand for blood.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II
receptor blockers (ARBs). These similar drugs decrease blood pressure and
may help prevent progression of coronary artery disease.

Procedures to restore and improve blood flow

Coronary artery stent

Sometimes more aggressive treatment is needed. Here are some options:
Angioplasty and stent placement (percutaneous coronary
revascularization).Your doctor inserts a long, thin tube (catheter) into the

narrowed part of your artery. A wire with a deflated balloon is passed through the
catheter to the narrowed area. The balloon is then inflated, compressing the
deposits against your artery walls.
A stent is often left in the artery to help keep the artery open. Some stents slowly
release medication to help keep the artery open.
Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked
coronary arteries using a vessel from another part of your body. This allows blood
to flow around the blocked or narrowed coronary artery. Because this requires
open-heart surgery, it's most often reserved for cases of multiple narrowed
coronary arteries.

Alternative medicine
Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce
inflammation throughout the body, a contributing factor to coronary artery
disease. However, recent studies have not shown them to be beneficial. More
research is needed.
Fish and fish oil. Fish and fish oil are the most effective sources of omega-3
fatty acids. Fatty fish such as salmon, herring and light canned tuna contain
the most omega-3 fatty acids and, therefore, the most benefit. Fish oil
supplements may offer benefit, but the evidence is strongest for eating fish.
Flax and flaxseed oil. Flax and flaxseed oil also contain beneficial omega-3
fatty acids, though studies have not found these sources to be as effective as
fish. The shell on raw flaxseeds also contains soluble fibre, which can help lower
blood cholesterol.
Other dietary sources of omega-3 fatty acids. Other dietary sources of
omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods
contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and
evidence for their benefit to heart health isn't as strong.
Other supplements may help reduce your blood pressure or cholesterol level, two
contributing factors to coronary artery disease. These include:
Alpha-linolenic acid (ALA)
Artichoke
Barley
Beta-sitosterol (found in oral supplements and some margarines, such as
Promise Activ)
Blond psyllium
Cocoa
Coenzyme Q10
Garlic
Oat bran (found in oatmeal and whole oats)

Sitostanol (found in oral supplements and some margarines, such as Benecol)

(Source: http://www.mayoclinic.org/diseases-conditions/coronary-arterydisease/diagnosis-treatment/treatment/txc-20165340)

EXTRA INFO
About the Coronary Artery
The heart receives its own supply of blood from the coronary arteries. Two major
coronary arteries branch off from the aorta near the point where the aorta and
the left ventricle meet. These arteries and their branches supply all parts of the
heart muscle with blood.

Heart

Disease: Causes of a Heart Attack

What Is Heart Disease?

Heart disease refers to conditions that involve the heart, its vessels, muscles,
valves, or internal electric pathways responsible for muscular contraction.
Common heart disease conditions include:

Coronary artery disease

Heart failure
Cardiomyopathy
Heart valve disease
Arrhythmias

What Is a Heart Attack?

When a coronary artery becomes blocked (usually by a blood clot), an area of
heart tissue loses its blood supply. This reduction of blood can quickly damage
and/or kill heart tissue, so quick treatments in an emergency department and/or
catheterization suite are necessary to reduce the loss of heart tissue. Loss of
heart tissue due to a blockage can cause symptoms such as chest pain,
shortness of breath, weakness, and even death. Quick treatments have reduced
the number of deaths from heart attacks in recent years; however, about
610,000 people die from heart disease in the US each year (1 in every 4 deaths)
according to the CDC.

Coronary Artery Disease Symptoms

Coronary artery disease (CAD) occurs when plaque, a sticky substance, narrows
or partially obstructs coronary arteries (like sticky material stopping up a straw)
and can result in reduced blood flow. This reduced blood flow may cause chest
pain (angina), a warning sign of potential heart problems such as a heart attack.
Plaque may also trap small blood clots, completely blocking a coronary artery
suddenly, resulting in a heart attack.

How Plaque, Blood Clots can Cause Heart Attack

Plaque can occur in coronary and other arteries (for example, carotid arteries).
Some plaque may be hard or firm on the outside, but soft and mushy or sticky on
the inside. If the hard shell-like area cracks open, blood components like platelets
and small blood clots form a large clot and effectively block blood flow through
the artery. The heart tissue downstream from the clot then suffers from lack of
blood and becomes damaged or dies.

Statistics About CAD

IHD [ischemic heart disease] causes more deaths and disability and incurs greater economic costs
than any other illness in the developed world.... [and it] is likely to become the most common
cause of death worldwide by 2020. Antman et al., 2008

Prevalence
Approximately 1 of every 13 Americans aged 18 years and older has CAD. It is the leading cause of
death for people of most racial and ethnic groups in the United States (CDC, 2013a). In the United
States, CAD is most common among Hispanic Americans and least common among Asian
Americans, Pacific Islanders, American Indians, and Alaska Natives.
Coronary artery disease develops gradually, so it is typically a disease of elders; in fact, the
strongest risk factor for CAD is age. Although the disease may become clinically apparent by age
40, people 65 years of age and older account for approximately 85% of deaths from CAD (Boudi,
2013).

Incidence
Each year about 935,000 Americans have a heart attack. Of these, 610,000 are a first heart attack
and 325,000 are a repeat heart attack (CDC, 2013a).

Mortality
Heart disease is the leading cause of death for American men and women, accounting for 1 out of
every 4 deaths each year. Every 34 seconds someone has a heart attack and each minute
someone dies from a heart disease-related event. There are approximately 715,000 heart attacks
and 600,000 deaths each year due to heart disease in the United States (CDC, 2012a).
Although the frequency of CAD is similar in both black and white populations, the death rate from
CAD is greater for blacks than for whites. In 2009 African Americans were 30% more likely to die
from heart disease than non-Hispanic white men (OMH, 2012).
Heart Disease Death Rates, 20072009, Men Ages 35+, by County

Death rates vary throughout the United States. The highest death rates (darkest colors) are in the South and around the regions drained
by the Ohio, Mississippi, and Red Rivers. Source: CDC, 2012b.

There is one hopeful statistic. Despite the fact that CAD is the leading cause of death in the United
States, there has been a 30% reduction in the mortality rate since the latter part of the twentieth

century. Factors such as coronary artery bypass, thrombolytic therapy, and an emphasis on lifestyle
modification are some of the reasons for this reduction (Boudi, 2013).
Deaths from CAD often happen to people with no previous heart symptoms. Although some people
may feel a rapid heartbeat or dizziness that alerts to a dangerous heart rhythm, over half of the
people who have sudden cardiac deaths were previously asymptomatic (WebMD, 2012).

Morbidity
Illness from CAD strains the American health system. Cardiovascular disease, including heart
disease and stroke, costs the United States $312.6 billion each year. This total includes the cost of
healthcare services, medications, and lost productivity. Cardiovascular diseases are also a leading
cause of disability, preventing affected persons from working and enjoying family activities (CDC,
2013b).
(Source: https://www.atrainceu.com/course-module/1711371-102_coronary-artery-disease-cadmodule-02 )