Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD)

• Estimated to affect more than 16 million people in the United States.
• Nearly 8 million have had a myocardial infarction (MI).
• The most frequent cause of death of Americans in 2005.¹ 
• CAD is the result of atherosclerosis – the formation of plaques throughout the arterial system.² 
• Symptoms of atherosclerosis may vary depending on the location and degree of vessel stenosis.
• May be asymptomatic or cause angina pectoris, MI, heart failure, arrhythmias, or sudden death.³ 
• CAD is the most common cause of heart failure.⁴ 
• Angina pectoris symptoms include sternal discomfort, heaviness, or a pressure-like sensation that may radiate to the jaw, shoulder, back, or arm.
• May be caused by exertion, a heavy meal, or emotional stress.⁵ 
• Risk factors include smoking, hypertension, diabetes, hyperlipidemia, and a family history of MI.^6 7 
• Treatment: Aspirin, ACE inhibitor, high dose statins, nitrates, beta-blockers, and calcium antagonists.⁸ 
• Symptom relief: nitroglycerine, Monoket (isosorbide mononitrate), or nifedipine.
• Revascularization – relief of ischemia, improve QoL and exercise capacity, reduce the amount of drugs for symptoms, and improve prognosis.⁹ 
  • “Revascularization exerts favourable effects on symptoms, quality of life, exercise capacity, and survival, particularly in those with extensive CAD and documented moderate-to-severe ischaemia.”⁹ 
  • Percutaneous Coronary Intervention (PCI, Angioplasty with Stent) – target lesion elimination by use of a catheter to place a stent to open up blood vessels narrowed by atherosclerosis¹⁰ 
  • CABG – to bypass narrowed vessels

Stable vs Unstable Angina¹¹ 

• Stable (most common) – angina has a regular pattern
• Unstable – irregular pattern and symptoms of angina that do not resolve with rest or medicine. May be a sign of MI.
• Variant – angina occurs during rest.

1. Lloyd-Jones D, Adams R, Carnethon M, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published correction appears in Circulation. 2009;119(3):e182] Circulation 2009;119(3):480-486[↩]
2. Abrams J. Clinical practice. Chronic stable angina, N Engl J Med, 2005, vol. 352 (pg. 2524-2533[↩]
3. Abrams J. Clinical practice. Chronic stable angina, N Engl J Med, 2005, vol. 352 (pg. 2524-2533) [↩]
4. Fox KF, Cowie MR, Wood DA, Coats AJ, Poole-Wilson PA, Sutton GC. New perspectives on heart failure due to myocardial ischaemia, Eur Heart J, 1999, vol. 20 (pg. 256-262) [↩]
5. Cassar, A., Holmes Jr, D. R., Rihal, C. S., & Gersh, B. J. (2009, December). Chronic coronary artery disease: diagnosis and management. In Mayo Clinic Proceedings (Vol. 84, No. 12, pp. 1130-1146). Elsevier.[↩]
6. Pryor DB, Shaw L, Harrell FE, Jr, et al. Estimating the likelihood of severe coronary artery disease. Am J Med. 1991;90(5):553-562[↩]
7. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score [published correction appears in JAMA. 2007;297(13):1433] JAMA 2007;297(6):611-619[↩]
8. M, Osterspey A, Tamargo J, Zamorano JL. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology, Eur Heart J, 2006, vol. 27 (pg. 1341-1381) [↩]
9. Simoons, M. L., & Windecker, S. (2010). Chronic stable coronary artery disease: drugs vs. revascularization. European heart journal, 31(5), 530-541.[↩][↩]
10. Heart and Stroke Canada. (n.d.). Percutaneous coronary intervention (PCI or angioplasty with stent). Retrieved from https://www.heartandstroke.ca/heart-disease/treatments/surgery-and-other-procedures/percutaneous-coronary-intervention[↩]
11. Medline Plus. (n.d.). Angina. Retrieved from https://medlineplus.gov/angina.html[↩]