Description
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 Unpleasant chest discomfort, commonly substernal and often described as heaviness or squeezing sensation. This discomfort can be felt anywhere from epigastrium to jaw, arm(s), neck, or back. Dyspnea may accompany chest discomfort or occur alone. It can be provoked by exertion or emotional upset, relieved within minutes by rest.
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Symptoms
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| The relationship of symptoms to exertional distress, and relief by cessation of activity is usually characteristic. At rest, it is asymptomatic. |
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Risk Factors of Coronary Artery Disease (CAD)
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Risk factors for CAD have a strong epidemiological correlation with likelihood of developing clinical CAD according to Center of Disease Control (CDC). Multiple risk factors combine to significantly increase CAD risk compared to one factor alone.
- Hyperlipidemia
- Elevated low-density lipoprotein (LDL)
- Low levels of high-density lipoprotein (HDL)
- Elevated triglycerides, possibly
- Cigarette smoking
- Systemic arterial hypertension
- Diabetes Mellitus
- Family history of premature CAD (< 55 yrs of age)
- Male sex
- Post-menopausal females
An HDL level > 60 mg/dL is considered a negative risk factor for CAD as it correlates with lower risk of CAD according to multiple research and American Heart Association. |
Imaging & Diagnosis
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| Typical symptoms that occur especially in the presence of one or more risk factors. Physical exam is often normal and no chest pain is reproducible. Electrocardiogram (ECG) can be normal in absence of prior myocardial infarction. Cardiac stress testing (exercise or pharmacologic), with or without adjunctive nuclear imaging or echocardiography, may be abnormal and provide additional diagnostic information.
In selected cases, coronary angiography may be required for extensive diagnostic search for etiology relating to coronary artery disease (CAD).
Cardiac enzymes (creatine kinase [CK], troponin) can show laboratory evidence of severe ischemia/myocardial infarction (MI). |
Pathology
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 Angina occurs when there is an increase in myocardial demand for oxygen and nutrient substrate that exceeds available supply. Coronary blood supply may be restricted by arterial narrowing secondary to atherosclerotic plaque(s). In some cases, excessive myocardial demand (e.g., left ventricular hypertrophy due to aortic stenosis, thyrotoxicosis, etc) can overtake blood supply through normal coronary arteries, or anemia can also impair oxygen delivery. |
Treatment
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- Aspirin, Beta blockers , Anticoagulants, Nitrates, Calcium Channel blockers
- Reduction of cardiovascular risk factors
- Revascularization with CABG or PCI, if indicated
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Prevention of Coronary Artery Disease
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Primary prevention: promote efforts to lower risk of CAD by risk-factor modification before clinical manifestations of CAD appear, including:
- Hyperglycemic control
- Cessation of cigarette smoking
- Control of systemic arterial hypertension
- Control of excess body weight
- Diet modification
- Behavior modification and stress reduction
- Exercise
- Lipid management
Secondary prevention: promote efforts to lower risk of repeat CAD event in patient who has already developed clinical manifestations of CAD (e.g., angina, myocardial infarction) |
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–Author: Chandru Lalwani, MD, LivingHealthy Clinic, LivingHealthyWorldWide.com
