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ID: 132
Category: Heart condition
CreatedBy: 1
UpdatedBy: 1
createdon: 05 Feb 2023
updatedon: 05 Apr 2023

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Author: Khoa Tran
Published Feb 05, 2023
Updated Apr 05, 2023

Table of contents

Coronary Artery Disease

Etymology and Pronunciation

Coronary (kuh-raw-nuh-ree)
corona - Latin for "crown". The term was first used to describe the pattern of blood vessels on the surface of the heart, which resembles a crown or wreath.

History of Coronary Artery Disease

Heart-related conditions have been recognized and documented since ancient times. For instance, in 1500 BCE, the "Edwin Smith Papyrus" recorded symptoms and treatments for heart ailments. Similarly, in 400 BCE, the Greek physician Hippocrates wrote about chest pain and heart disease in his medical texts.

However, it was not until the 19th century that the modern understanding of CAD began to emerge. In 1819, the French physician René Laennec invented the stethoscope, which allowed doctors to listen to the heart and detect abnormalities.

In 1856, the German pathologist Rudolf Virchow described the build-up of plaque in the arteries, which he called atherosclerosis. He used microscopy to examine the structure of the arterial wall and the plaques that were forming within it. He observed that the plaques consisted of cholesterol, calcium, and other substances, and that they were causing the arterial wall to thicken and become less flexible. 

Around the same time, the British physician William Jenner identified a link between angina and the narrowing of the coronary arteries. He observed that patients with this condition often had a distinctive pattern of chest pain that was related to physical activity. He hypothesized that this pain was caused by a narrowing of the coronary arteries, which supply blood to the heart muscle. He used his stethoscope to listen for any abnormalities in the heart sounds of these patients and to monitor their heart rate and blood pressure.

In the early 20th century, advances in technology allowed doctors to better diagnose and treat CAD. In 1929, the German physician Werner Forssmann performed the first cardiac catheterization, a procedure that involves inserting a thin tube into the heart to measure its function.

In the 1950s and 60s, researchers began to study the role of cholesterol in the development of CAD. They discovered that high levels of cholesterol in the blood could lead to the formation of plaque in the arteries, which could eventually lead to a heart attack.

In the 1970s, a team of researchers led by Dr. Robert F. Furchgott discovered the role of nitric oxide in the regulation of blood vessels. This discovery led to the development of new medications to treat CAD, such as nitroglycerin and sildenafil (Viagra).

Modern Understanding of Coronary Artery Disease

Coronary Artery Disease (CAD) is a heart disease that affects the coronary arteries, which are the blood vessels that supply the heart with oxygen and nutrients. It is also known as Coronary Heart Disease or Arteriosclerosis. The disease occurs when the arteries become narrow and clogged with fatty deposits called atherosclerotic plaques. These plaques can limit or block the flow of blood to the heart muscle, causing chest pain or angina. In severe cases, the lack of blood flow to the heart can lead to a heart attack, also known as Myocardial Infarction.

Symptoms of CAD can include chest pain, angina, shortness of breath, fatigue, and dizziness. There are two types of angina: stable and unstable. Stable angina occurs when the chest pain is predictable and relieved by rest or nitroglycerin, while unstable angina is more severe and can lead to a heart attack. Silent ischemia is a type of CAD in which the individual experiences no symptoms, but the heart muscle is still not receiving enough blood.

Diagnosis of CAD typically involves a cardiac catheterization, which is a procedure in which a thin, flexible tube is inserted into the coronary arteries to detect any blockages or stenosis. In some cases, Percutaneous Coronary Intervention (PCI) may be recommended to open or remove the blockages in the coronary arteries.

Causes of Coronary Artery Disease

Coronary artery disease (CAD) is caused by the gradual buildup of plaque in the coronary arteries, which are the blood vessels that supply the heart with oxygen and nutrients. Plaque is made up of cholesterol, fat, and other substances, and it can accumulate on the inner walls of the arteries, causing them to narrow or become blocked. This can reduce blood flow to the heart muscle, leading to chest pain (angina) and increasing the risk of a heart attack.

There are several risk factors that can contribute to the development of CAD, including:

- High blood pressure: This can damage the lining of the arteries and promote the formation of plaque.
- High levels of cholesterol and triglycerides in the blood: These substances can accumulate on the inner walls of the arteries and contribute to the formation of plaque.
- Smoking: Nicotine and other chemicals in cigarettes can damage the arteries and promote the buildup of plaque.
- Diabetes: This condition can damage the blood vessels and increase the risk of plaque buildup.
- Obesity: Excess weight can increase the risk of high blood pressure, high cholesterol, and diabetes, all of which are risk factors for CAD.
- Physical inactivity: Lack of exercise can contribute to the development of risk factors for CAD, such as high blood pressure and high cholesterol.
- Family history of CAD: Having a close relative with CAD increases the risk of developing the condition.
- Age: The risk of CAD increases with age, particularly after age 45 for men and age 55 for women.

Other factors that may contribute to the development of CAD include stress, poor diet, alcohol consumption, and certain medical conditions such as chronic kidney disease and sleep apnea.

Treatments for Coronary Artery Disease

The treatment of coronary artery disease (CAD) typically depends on the severity of the condition, the symptoms experienced by the patient, and the presence of other medical conditions. Some of the common treatments for CAD include:

- Lifestyle changes: Adopting a healthy lifestyle is crucial for managing CAD. This includes regular exercise, a healthy diet, quitting smoking, and managing stress.
- Medications: Various medications can be prescribed to help manage CAD, such as aspirin, cholesterol-lowering drugs, blood pressure medications, and nitroglycerin.
- Angioplasty and stenting: In this procedure, a thin tube is inserted through an artery in the groin or wrist and guided to the blocked artery. A small balloon is inflated to widen the artery, and a stent (a tiny wire mesh tube) is placed in the artery to keep it open.
- Coronary artery bypass grafting (CABG): In this procedure, a surgeon creates a new route for blood to flow around the blocked or narrowed artery by grafting a healthy blood vessel from another part of the body.
- Lifestyle interventions and cardiac rehabilitation: After a heart attack or other cardiac event, patients may benefit from a structured program of lifestyle interventions and cardiac rehabilitation, which can help them recover and reduce the risk of future cardiac events.

It's important to note that the treatment plan for CAD will be tailored to the individual patient's needs and may involve a combination of these approaches. In addition, patients with CAD may require ongoing monitoring and management of their condition to prevent complications and improve quality of life.

Symptoms

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Irregular heartbeat
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Chest pain
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Shortness of breath
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Fatigue
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Nausea

Confirmation Tests

- Echocardiogram
- Electrocardiogram (ECG)
- Angiogram
- CT scan
- Exercise stress test
- Nuclear stress test

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