CORONARY DISEASE


Coronary disease means a disease of blood vessels of the heart, which is most often due to the atherosclerosis process.

The process of atherosclerosis leads to narrowing of coronary arteries and, consequently, to reduced supply of the heart muscle by blood or oxygen, which is manifested in various clinical forms of coronary disease (stable and unstable angina pectoris, myocardial infarction, cardiac failure)

There are two coronary arteries in the body: left (LCA) and right coronary artery (RCA). The initial segment of the left coronary artery is the main tree (LM), and two branches are separated from it: the circumflex artery (Cx) and the anterior descending branchof the left  coronary artery (LAD). Coronary arterie s are separated from the aortic roots and provide a large number of smaller branches that feed the whole heart. Clinically significant narrowing of the blood vessels of the heart reduces the lumen of the blood vessel more than 50%.

Risk Factors:

  • Male sex
  • older than 55 (men) and 65 years (women)
  • elevated cholesterol levels (above 5 mmol / L) and triglycerides (above 3 mmol / L) in the blood
  • elevated arterial pressure (above 140/90 mmHg)
  • diabetes
  • smoking
  • family preference for cardiovascular diseases
  • Excessive body weight
  • physical inactivity
  • stress

Symptoms:

  • It progresses slowly, often without symptoms.
  • Chest pains that can occur in the body burden, but also at rest (often the first sign)
  • Pain in the form of tightness, pressure and lack of air in the chest, and it can spread into the hands, especially left, shoulders, back or jaw, it can be accompanied by nausea, vomiting and severe sweating.

Diagnosis:

  • Clinical cardiac examination
  • Ergometry – load test
  • Ultrasound of the heart
  • Holter ECG
  • Coronarography (invasive diagnostic method)
  • MSCT coronarography (non-invasive, radiological diagnostic method)

Treatment:

  • Medication therapy (nitroglycerin, beta blockers, ACE inhibitors, Ca channel blockers, statins, antithrombotic therapy, etc.)
  • Invasive therapy – Percutaneous coronary intervention (PCI) of coronary arteries with or without stent
  • Surgical treatment – Surgical myocardial revascularization

Prevention:

  • reduce the intake of fat and alcohol, salt intake at the recommended limits
  • maintain normal body weight
  • regular physical activity appropriate to the degree of cardiac damage
  • Smoking cessation
  • reduce the impact of stress

 

Forms of coronary disease

Stable Angina Pectoris

It occurs during physical activity when the needs of the cardiac muscle (myocardium)for oxygen  are increased, and myocardial oxygen supply due to narrowing of the coronary arteries is insufficient.

In case of insufficient supply of oxygen to myocardium, pain behind the chest bone (anginous pain) occurs, which usually has the traits of dull pain, tightness or burning. Pain often spreads to the left or right hand, neck, jaw, accompanied by a sense of lack of air, fatigue. Sometimes anginous pains do not have to be reported at all, but other complications  equivalent to angina pectoris occur: fatigue and/or lack of air during a physical effort.

Difficulties stop several minutes after the load interruption.

Unstable Angina Pectoris

Unstable angina pectoris is characterized by chest pains that occur at smaller physical effort or inaction. It occurs due to erosion or rupture of the atherosclerotic plaque on the blood vessel, resulting in a decrease in lumen of the blood vessel. The symptoms of the discomfort are the same as for stable angina pectoris, but the patient is more limited in his activities. Unstable angina pectoris often precedes myocardial infarction.

Myocardial infarction

It is caused by the reduction or cessation of blood flow through a critically narrowed or clogged blood vessel, due to the formation of a clot, resulting in the dying of a part of the heart muscle that is supplied through that artery.

Myocardial infarction is manifested by: severe pain in the chests of prolonged duration (over 20 minutes) that can spread in the left or right hand, neck, jaw, followed by wheezing, fatigue, sweating, vomiting. In case of prolonged chest pain, it should be immediately reported to the emergency department to refer to further adequate treatment.


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