A small discussion on Coronary Artery Disease by Dr Christa Maria Joel MBBS MPH

1. Coronary Heart Disease
(CAD) or Ischaemic
Heart Disease (IHD)
By Dr Christa Maria Joel MBBS
MPH

2. Symptoms
 The most common symptom-
chest pain.
https://commons.wikimedia.org/wiki/File:Heartache-1846050_1920.jpg

3. Etiology of
CAD
 Atherosclerosis: build-up of fat, cholesterol and
other substances on the arterial walls.
https://commons.wikimedia.org/wiki/File:Atherosclerosis,_aorta,_gross_pathology
_PHIL_846_lores.jpg

4. Risk factors for
CAD
Physical inactivity
Stress
Chronic cigarette smoking
Alcohol consumption
Fatty diet
Obesity, hypertension, diabetes mellitus
Family history, elderly age groups, male sex and post-
menopausal women
Blood disorders- hyperlipidemia, hyperhomocysteinemia,
elevated fibrinogen and CRP.

5. Types Of CAD
Acute coronary syndromes
Chronic stable angina
Acute MI
STEMI
NSTEMI
Unstable angina

6. Clinical Picture
Stable angina:
symptoms are non-
progressive due to
fixed plaque.
Unstable angina:
progressive
symptoms due to
ruptured plaque.
MI: myocardial
necrosis due to
plaque rupture and
thrombosis.
Heart failure:
myocardial
dysfunction due to
ischemia.
Arrythmia: altered
cardiac conduction
due to ischemia.
Sudden mortality:
ventricular
arrhythmia, asystole.

7. Diagnosis of CAD
 Proper history taking and examination.
 Various tests can be employed such as:
- ECG: measures the electrical activity of the heart.
- Echocardiogram: evaluates the functioning of the heart.
- Exercise stress test: checks the functioning of the heart.
- Chest X-ray: obtains the overview of the heart and lungs.
- Cardiac catheterization: evaluates the efficiency of the arteries.
- Coronary angiogram: checks for blockages and blood flow.
- Coronary artery calcium scan: checks for calcium accumulation in
the arteries.

8. Treatment for CAD
 Primary prevention: Cardiac rehabilitation-
Promote healthy living through physical activity,
healthy diet, reducing body weight, monitoring
BMI, quitting bad habits such as smoking and
alcohol, and reducing stress through
counselling.
 Secondary prevention: medications to lower
cholesterol (statins), hypertension (ACE
inhibitors, ARB, CCB, Beta-blockers, diuretics),
and arrhythmias (anti-arrhythmic agents).
 Tertiary prevention: cardiac surgery to
improve blood flow in the heart.

9. References
 Kumar, G (2015). Medicine at your
fingertips. Book available by Paras
Publications, India.
 CDC (2021). Coronary Artery Disease.
Heart Disease. Available at:
https://www.cdc.gov/heartdisease/coro
nary_ad.htm

10. Thank you