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Coronary Artery Disease

     Coronary Artery Disease or Ischemic heart disease is a condition in which there is oxygen deprivation to the muscles of the heart as a result of decreased blood flow and perfusion and is accompanied by inadequate removal of the products of metabolism (Zevitz, 2006). This is the most common form of heart disease and a leading cause of premature death in the developed countries (Zevitz, 2006). The hallmark feature of this condition is imbalance between the supply and demand of oxygen of the myocardium which can occur either due to increased myocardial oxygen demand or decreased myocardial oxygen supply or both. It can manifest as one of these: anginal discomfort, ST-segment deviation on ECG, decreased uptake of technetium 99 or thallium 201 in images of myocardial perfusion and ventricular function impairment (Zevitz, 2006).

Ischemia to the myocardium results from disease in the coronary arteries. The disease is most often due to formation of atheroma and its consequences like thrombosis.

     There are many risk factors for the development of coronary artery disease. Advanced age is one of the most important risk factors. Men are at increased risk of development of IHD than women (Zevitz, 2006). However, the risk is same after menopausal age in women. Family history of coronary artery disease increases the risk of ischemic heart ailment. This is either due to genetic factors or due to similar diet, eating habits, lifestyle and smoking. Other risk factors are hyperlipidemia, hypercholesterolemia and hyperfibrinogenemia

     Coronary artery disease can manifest as angina, myocardial infarction, heart failure, arrhythmias or sudden death. There are many tests to detect and evaluate coronary artery disease. The most useful test is stress ECG and ECHO. Once there is suspicion of coronary artery disease in the test or in an ECG, then angiogram and myocardial perfusion scintigraphy tests are done to ascertain the site of lesion and prognosticate ischemia (Zevitz, 2006).

     Goals of treatment in coronary artery disease are relief of symptoms, slow the progression of the disease and decrease the possibility of future events like myocardial infarction and death. General measures which need to be taken include quitting of smoking, regular physical activity, control of weight and control of other risk factors like diabetes mellitus, hypertension and hyperlipidemia. For relief of symptoms, nitroglycerine, betablockers and angiotensin-converting enzyme inhibitors are useful. Platelet inhibitors, antilipidemic drugs and antihypertensives prevent development of complications (Zevitz, 2006).

Reference

Zevitz, M. E. (2006). Myocardial ischemia. Emedicine from WebMD. Retrieved on July 27 2009 from http://emedicine.medscape.com/article/156065-overview

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