Diseases of Heart - Coronary Artery Disease

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DISEASES OF HEART CORONARY ARTERY DISEASE
WHAT IS IT? The hearts muscles get its blood
supply through coronary arteries. When blocks
develop in these arteries heart is deprived of
essential blood circulation. The block or
stenosis is caused by a disease process called
Atherosclerosis, which is deposition of lipid
rich material in the vessel walls. Depending on
the severity of the blocks the symptoms vary
from absence of symptoms to severe myocardial
infarction (Heart attack).
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SYMPTOMS
Angina or chest pain is the commonest presenting
symptom. This is generally felt as a heaviness or
uneasiness in the centre of chest. It is usually
brought out by effort and relieved by rest.
Angina lasts for short periods and seldom lasts
for more than 20 minutes. Nitrates (medicines
taken to relax coronary arteries) have the
ability to relieve angina very quickly (Almost
instantaneously if kept under the tongue ie.,
sublingual). Angina is felt usually in the centre
of chest (Left sided chest pains re usually not
angina). Typically angina appears as chest
discomfort. It may radiate to neck, jaws, left
shoulder or left arm. Rarely it can present as
back pain, headache or even abdominal pain.
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If you suffer from repeated burning sensation in
your upper abdomen and not relieved by usual
medicines, a detailed check up is required.
Angina presenting as stomach burn has misled
even doctors to make wrong judgements. Beware of
gas trouble which is recurrent and not relieved
by usual medicati ons! ANGINA can present as
stoma. Heart attack or Myocardial Infarction
(MI) is another form of presentation. While
angina is almost completely reversible, MI
threatens permanent myocardial damage. This
happens when there is sudden complete occlusion
in the coronary arteries. Usually this occlusion
occurs at pre-existing stenotic lesions. The
common cause is a plaque rupture (separation of
the atheromatous plaque and clot formation
underneath). The myocardium supplied by the
particular coronary artery is under threat of
permanent damage. The pain of MI is more severe
and lasts longer. Patient may vomit and sweat. It
is often described as a feeling of Impending
death. This condition is severe and can be
fatal at times. It calls for urgent attention.
Patient needs urgent hospitalisation and
treatment.
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HOW TO DIAGNOSE? When the physician sees a
patient with symptoms of CAD, a thorough
assessment is made. A detailed history of risk
factors, previous events, procedures,
medications and family history is obtained. A
careful physical examination is the next step.
Generally, ECG and few blood tests may be done
along with the first visit. If symptoms are
suggestive of CAD, further investigations are
required. This may include ECHO, TMT and
Coronary Angiogram depending on the type and
severity of symptoms.
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TREATMENT Of all the patients with CAD, nearly
three fourth requires only medicines. Rest of
the symptomatic patients may require some form of
invasive treatment depending on the findings of
the CAG.
Common treatments are of two types PTCA
(Percutaneous Transluminal Coronary Angioplasty)
or ANGIOPLASTY and CABG or Bypass Operation. The
requirement and suitability of each modality of
treatment is decided by the treating specialist.
Copyright ? 2017 Heart and Aorta. All rights
reserved.