Coronary Artery Disease
(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)
|Coronary Artery Disease|
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- Thickening of the walls of the arteries that feed the heart muscle
- Build up of fatty plaques within the coronary arteries
- Sudden spasm of a coronary artery
- Narrowing of the coronary arteries
- Inflammation within the coronary arteries
- Development of a blood clot within the coronary arteries that blocks blood flow
- Sex: male—men have a greater risk of heart attack than women
- Age: 45 and older for men, 55 and older for women
- Heredity: strong family history of heart disease
- Obesity and being overweight
- High blood pressure
- Inactive lifestyle
- High cholesterol, specifically, high LDL cholesterol and low HDL cholesterol
- Metabolic syndrome —a combination of high blood pressure, abdominal obesity, and insulin resistance
- Exercise or exertion
- Emotional stress
- Cold weather
- A large meal
- It is unrelieved by rest or nitroglycerin
- Severe angina
- Angina that begins at rest
- Angina that lasts more than 15 minutes
- Shortness of breath
- You may need to have your bodily fluids tested. This can be done with blood tests.
- You may need to have your heart function tested. This can be done with:
- You may need to have pictures taken of your heart. This can be done with:
- Warfarin (Coumadin)
- Ticlopidine (Ticlid)
- Clopidogrel (Plavix)
- Prasugrel (Effient)
Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors
Medications to Lower Cholesterol
- Percutaneous coronary interventions (PCI)—such as balloon angioplasty, in some cases, a wire mesh stent is placed to hold the artery open
- Coronary artery bypass grafting (CABG)—segments of vessels are taken from other areas of the body and are sewn into the heart arteries to reroute blood flow around blockages
Options for Refractory Angina
- 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
- Maintain a healthy weight.
- Eat a heart healthy diet that is low in saturated fat, red meat and processed meats, and rich in whole grains, fruits, and vegetables.
- Begin a safe exercise program with the advice of your doctor.
- If you smoke, quit.
- Treat your high blood pressure and/or diabetes.
- Treat high cholesterol or triglycerides.
- Ask your doctor about taking a low-dose aspirin every day.
- In certain patients, taking medication to treat high cholesterol may be another option. Talk to your doctor.
- Find ways to reduce stress.
American Heart Association http://www.heart.org
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
Heart and Stroke Foundation of Canada http://www.heartandstroke.com
Public Health Agency of Canada http://www.phac-aspc.gc.ca
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.
- Reviewer: Michael J. Fucci, DO
- Review Date: 09/2012 -
- Update Date: 02/08/2013 -
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
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