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Coronary Artery Atherosclerosis

Ngày 07/08/2016 03:46 | Lượt xem: 3749

Coronary artery atherosclerosis is the single largest killer of men and women in the United States. 

It is the principal cause of coronary artery disease (CAD), in which atherosclerotic changes are present within the walls of the coronary arteries. See the image below.

Cardiac catheterization and coronary angiography in the left panel shows severe left anterior descending coronary artery stenosis. This lesion was treated with stent placement in the left anterior descending coronary artery, as observed in the right panel.

Signs and symptoms

The signs and symptoms of coronary artery atherosclerosis include the following:

-Chest pain

-Shortness of breath

-Weakness, tiredness, reduced exertional capacity

-Dizziness, palpitations

-Leg swelling

-Weight gain

-Diaphoresis

-Stable angina pectoris

-Intermittent claudication

-Mesenteric angina

-Tachycardia: Common in persons with acute coronary syndrome (ACS) and acute myocardial infarction (AMI)

-High or low blood pressure

-S ₄ gallop: A common early finding

-S ₃ gallop: An indication of reduced left ventricular function

-Heart murmurs

-Tachypnea

-Xanthelasmas

-Livedo reticularis

-Syncope

-Leg edema

-Rales

Diagnosis

Laboratory tests:

-Complete blood count (CBC)

-Chemistry panel

-Lipid profile

-Thyroid function tests: To exclude thyroid disorders

-Blood glucose and hemoglobin A _1C (HbA _1C) measurement: Appropriate in patients with diabetes mellitus

-Myocardial fractional flow reserve (FFR)

-Coronary flow reserve (CFR)

-Lipid studies

-C-reactive protein level

-Serum markers

Imaging studies:

-Echocardiography

-Nuclear imaging

-Computed tomography

-Electron beam CT scanning

-Optical coherence tomography imaging

-Magnetic resonance imaging

-Positron emission tomography

-Coronary angiography

-Doppler velocity probes

-Ultrasonography

Management

The following are used in the management of angina :

-Nitrates

-Beta blockers

-Statins

-Calcium channel blockers

-Ranolazine

Other agents used in the treatment of coronary artery stenosis or to aid in the management of stable coronary artery disease after intervention include the following:

-Angiotensin-converting enzyme inhibitors to reduce blood pressure

-Antiplatelet agents for acute coronary events

-Intravenous glycoprotein IIb/IIIa inhibitors

-Aspirin

-Clopidogrel

-Ticlopidine

-HMG-CoA reductase inhibitors, or statins to lower LDL cholesterol levels

Treatment procedures for coronary artery atherosclerosis include the following:

-Coronary artery bypass grafting (CABG)

-Percutaneous coronary intervention (PCI)

-Partial ileal bypass

In high- and intermediate-risk patients with 3-vessel disease, PCI was associated with significantly higher rates of revascularization and of major adverse cardiac and cerebrovascular events than CABG ; the 2 procedures were equally effective in the treatment of low-risk patients with 3-vessel disease and in low- and intermediate-risk patients with left main CAD.

Source emedicine.com

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