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CORONARY ARTERY DISEASE

PRESENTED BY Sunil Yadav BDS FINAL YR

 INTRODUCTION
It accounts for approx. 30 to 50% of all cases of CVD. It is caused by build up of plaque on the of the coronary artery. Coronary artery disease typically begins when the inside wall of the coronary arteries are damaged because of another health problem such as: High cholesterol High B.P. Diabetes Smoking Over time plaque build up narrows the coronary arteries & can lead to ischemia If plaque apart & makes a clot that blocks an artery, this can cause M.I. & Heart attack.

CLINICAL FEATURES Angina pectoris(is often referred to as chest pain ) It is also described as chest discomfort , heaviness , tightness, pressure aching , numbness ,fullness or squeezing. Pain or discomfort in other areas of the upper body including the arms ,left shoulder ,back neck jaw or stomach. Difficulty breathing or shortness of breath. Fullness indigestion or choking feeling. Nausea or vomiting. Light headedness, dizziness, extreme weakness or anxiety. Rapid or irregular heart beats. .

INVESTIGATION OF CAD
B.P. :High B.P. increases the risk for heart disease. Cholesterol :A good rule is to follow that any total cholesterol reading below 200 is good and anything over 240 indicates that the risk for developing coronary disease. In addition the LDL cholesterol should measure below 130 & HDL cholesterol should ranges from 35 to 40 . C-Reactive protein test :High CRP level increases the risk for H .D. Coronary Ca- scan: This test uses a special kind of X-ray to check for build up of Ca in the heart arteries. Electrocardiogram : The presence of Q waves on the ECG may suggest prior MI, although these are not invariably present & often only nonspecific changes of the ST wave are observed.

 Other tests may include:.

Cardiac perfusion scan: This test shows if patients have enough blood flow to the heart. Echocardiogram and stress echocardiogram. This test uses ultrasound to see areas of poor blood flow in the heart. It can also check how well the heart is working after a heart attack. The test can help the doctor find out how much blood the heart is pumping during each heartbeat (ejection fraction). Coronary angiogram. This is an X-ray test that creates pictures of the blood flow through the coronary arteries. It allows the doctor to see any blockage or narrowing of the artery. It's done using a soft, thin tube (catheter) that is put in a blood vessel in the arm or groin and gently moved into the heart.
CT angiogram. CT (computed tomography) angiograms use X-rays to get detailed pictures of the heart and its blood vessels.

TREATMENT
Initial treatment Lifestyle changes : It is the first step for anyone with coronary artery disease. But sometimes lifestyle changes are not enough. Taking medicines properly can help to prevent heart attacks or strokes. Lifestyle changes include quitting smoking, eating a heart-healthy diet, and getting regular exercise. These healthy habits can slow or even stop the disease and improve the quality and length of the life.

Eat a heart-healthy diet: Eat more fruits, vegetables, whole grains, and other high-fiber foods. Choose foods that are low in saturated fat, trans fat, and cholesterol. Limit salt. Eat more foods that are high in omega-3 fatty acids, such as fish. Start an exercise program. Try walking, swimming, biking, or jogging for at least 30 minutes on most, if not all, days of the week. In people with heart disease, exercise can help lower the chance of a heart attack.

CAD MEDICATION
Aspirin and other antiplatelet medicines : prevent blood clots in the coronary arteries. This decreases the risk of heart attack and stroke. Aspirin: 75 -100mg OD. Ticlopidine :250mg BD with meal.
Beta-blockers : Slow the heart rate and lowers the blood pressure to reduce the amount of work the heart has to do. They also reduce angina. Propranolol :40-480 mg/day Metoprolol :100-400 mg/day Atenolol :25-100 mg/day

Statins : Lowers the cholesterol and may reduce the risk of a future heart attack. Lova statin : 10-40 mg/day Simvastatin : 520 mg/day Atorvastatin : 10-40 mg/day Nitrates(nitroglycerin and long-acting nitrates) : Relieves chest pain and other symptoms of angina. Monotrate : 20-40 mg/day Cardilate :15-60 mg/day

Calcium channel blockers : Slows the heart rate and lowers the blood pressure to reduce the heart's workload. They also help widen (dilate) the coronary arteries and reduce angina. Verapamil: 40-160 mg TDS Ditiazem: 30-60 mg TDS Nifedipine: 5-20mg BD Angiotensin-converting enzyme (ACE) inhibitors : Lowers the blood pressure and reduces the strain on the heart. They may also reduce the risk for a future heart attack or heart failure. Captopril : 25 150 mg /day Enalapril : 2.5 40 mg /day Ramipril : 1.25-10 mg/day Anticoagulants(Blood thinners) : May also be used after an angioplasty, atherectomy, or bypass surgery Enoxaparim : 20 mg Raviparum : 0.25 ml S.C (O.D) X 5-10 days

CONCLUSION We can slow or even prevent CAD by taking steps toward a healthier lifestyle. More people are adopting healthy habits such as eating right , exercising more and not smoking. Doing these things can also help reduce risk factors such as high cholesterol & high B.P.

THANKS