CORONARY ARTERY DISEASE (CAD)By- Dr. Armaan Singh

Coronary artery disease (CAD) also known as atherosclerotic heart disease, atherosclerotic cardiovascular disease, coronary heart disease,

or ischemic heart disease (IHD), is the most common type of heart disease and cause of heart attacks. The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the lumen of arteries and reduces blood flow to the heart.While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. Symptoms of stable ischaemic heart disease include angina(characteristic chest pain on exertion) and decreased exercise tolerance.

Signs and symptoms• Angina (chest pain) that occurs regularly with activity, after heavy meals, or at other predictable times is termed stable angina and is associated with high gradenarrowings of the heart arteries. The symptoms of angina are often treated with betablocker therapy such as metoprolol or atenolol. Nitrate preparations such asnitroglycerin, which come in short-acting and long-acting forms, are also effective in relieving symptoms but are not known to reduce the chances of future heart attacks. Many other more effective treatments, especially of the underlying atheromatous disease, have been developed.

• Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may precede myocardial infarction. In adults who go to the emergency with an unclear cause of pain, about 30% have pain due to coronary artery disease.

INVESTIGATIONS:-• Baseline electrocardiography (ECG)•  Exercise ECG – Stress test, Exercise radioisotope test (nuclear stress test.

• Myocardial scintigraphy), Echocardiography (including stress echocardiography)

• Coronary angiography.•  Intravascular ultrasound.•  Magnetic resonance imaging (MRI)The diagnosis of coronary disease underlying particular symptoms depends largely on the nature of the symptoms.

• The first investigation is an electrocardiogram (ECG/EKG), both for "stable" angina and acute coronary syndrome. An X-ray of the chest and blood tests may be performed.

PREVENTION INVOLVES:•  EXERCISE.•  DECREASING OBESITY.•  TREATING HYPERTENSION.•  A HEALTHY DIET.•  DECREASING CHOLESTEROL LEVELS. AND STOPPING SMOKING. • MEDICATIONS AND EXERCISE ARE ROUGHLY EQUALLY EFFECTIVE.

PREVENTION INVOLVES:•  EXERCISE.•  DECREASING OBESITY.•  TREATING HYPERTENSION.•  A HEALTHY DIET.•  DECREASING CHOLESTEROL LEVELS. AND STOPPING SMOKING. • MEDICATIONS AND EXERCISE ARE ROUGHLY EQUALLY EFFECTIVE.