Coronary Artery Disease Research Paper

CORONARY ARTERY DISEASE

“Prevention is the better then cure” we all have heard this as children and we even preach it to our children, but are we really respecting our bodies or abusing it. Does being regular at the gym and having a attractive body be the benchmark for good health… We have often read & heard that someone died after returning from workout, on the football field, while at work and majority of the times while asleep. These are some of the classic cases of death by what we term as Heart attack, which is the interruption of blood supply to part of the heart, causing heart cells to die. This is most commonly due to blockages in the coronary arteries.

Coronary artery disease (CAD) is the leading single cause of death in
the world. Between 15% and 20% of all hospitalizations are the direct results of CAD.

Coronary artery disease (CAD), or more specifically, coronary atherosclerotic heart disease, is the primary cause of death in both men and women.
Most CAD results from the deposition of atheromatous plaque in the large and medium-sized arteries of the heart. A less frequent and usually idiopathic form of CAD is due to coronary spasm. Coronary artery atherosclerosis starts insidiously and is usually distributed irregularly in various blood vessels. Atherosclerotic blood vessels have reduced expansion with systole and abnormal wave propagation. This can reduce or obstruct blood flow to areas of the myocardium, sometimes with seeming abruptness, resulting in myocardial
ischemia.

The four most common and serious complications of CAD are angina pectoris, unstable angina, myocardial infarction, and sudden cardiac death as the result of arrhythmias.

Risk Factors
• Positive family history
• Age
• Abnormalities in blood lipids/lipid metabolism, for example: high levels of LDL cholesterol and lipoprotein A; low levels of HDL cholesterol and serum vitamin E; hypertriglyceridemia
• High Waist/Hip Ratio (Rexrode et al, 1998)
• Elevated blood homocysteine
• Elevated fibrinogen (Bielak et al, 2000)
• High ultra-sensitive C-reactive protein (Danesh et al, 1998)
• High levels of iron stores (Salonen et al, 1992)
• Low levels of selenium (Suadicani et al, 1992)
• Sedentary lifestyle/poor physical fitness
• Cigarette smoking
• Alcohol abuse
• Diets high in animal fat and calories and low in fruits, vegetables, and fiber
• Diets low in polyunsaturated fatty acids
• Diets high in trans fats (Willett et al, 1993)
• Poor stress management
• High blood levels of insulin
• Decreased oxidative radical antioxidant capacity (ORAC) (Fazendas et al, 2000)
• Diabetes mellitus
• Hypertension
• Hypothyroidism In men with angina and no history of Myocardial Infraction, normal resting ECG, and normal BP annual mortality is about 1.4%.
With the presence of systolic hypertension, the rate rises to about 7.5%; with abnormal ECG, the rate is about 8.4%; and if both risk factors are present, annual mortality rate is 12%.

Signs and Symptoms

The most common signs and symptoms for the aspect of CAD most often seen by the clinical practitioner is angina pectoris. Other symptoms include:

• Vague, somewhat troublesome ache or severe, intense precordial crushing sensation
• Most commonly sensation is felt beneath the breastbone or may radiate to the left shoulder and down the inside of the left arm; straight through to the back, into the throat, jaws, and teeth; occasionally down the inside of the right arm. Sometimes upper
abdomen
• Typically precipitated by physical exertion or stress, persists for a few minutes, and subsides with rest or nitroglycerin
• Worse exertion after a meal
• Worse cold weather, walking into the wind, or first contact with cold air after leaving a warm room
• Modest increase in heart rate
• Significant elevation in systolic and diastolic blood pressure, but sometimes hypotension
• Diffuse apical impulse and more distant heart sounds
• Paradoxical second heart sound
• Fourth heart sound

Symptoms

•Shortness of breath
• Chest pain
• Palpitations
• Excessive sweating
• Nausea
• Dizziness
• Pain from the chest to the arms

Diagnosis

• ECG
• Stress Test
• Chest X Ray
• Ultra sound
• Blood Investigations

Advanced diagnostics: Computerized Tomography Scan (CT Scan )
Catheterization and Angiogram

Monitoring Parameters

As well as monitoring levels of LDL cholesterol, triglycerides, and LDL to HDL cholesterol ratios through laboratory values, patients at risk for developing CAD need to be assessed for any coexisting disorders that increase their risk. These include hypertension, hypercholesterolemia, diabetes, and hypothyroidism. Postinfarction management and CAD prevention require monitoring the patient's progress in reversing modifiable risk factors such as smoking. In addition, achievement of appropriate weight to height ratio is important. Studies have shown that increased levels of fitness and physical activity are associated with a lowered incidence of heart disease. It is important to perform a pre-exercise evaluation of the patient with CAD, which consists of history and physical examination to rule out, for example, valvular heart disease, ventricular hypertrophy, dangerous arrhythmias, and exercise-induced asthma. Older or sick patients should be monitored with an exercise stress test. Patients with high cholesterol levels should undergo lipoprotein analysis, body fat estimation, and dietary evaluation. In addition, obese patients should be evaluated for diet, thyroid function, and blood glucose and insulin levels (both fasting and post oral glucose administration).