Coronary artery disease

Coronary artery disease (CAD) is the leading cause of death in the UK. Almost 100,000 people die of CAD every year in the UK. About 2.6 million people have coronary artery disease; most of them - 2.0 million - are symptomatic with angina, chest pain due to narrowings and blockages in coronary arteries. Coronary artery disease is more common in men and in the elderly. CAD, cerebrovascular disease and peripheral vascular disease are together called cardiovascular disease.

Heart pumping function

Normal heart is about the size of the fist. Heart beats 60-90 times per minute to pump the blood to the whole body and therefore act as an engine driving the circulation. The right side of the heart pumps the blood poor in oxygen into the lungs. The oxygenated blood then enters the left side of the heart from where it is pumped to the whole body via arteries. Oxygen is extracted from the blood and used up by body organs. The deoxygenated blood finally returns via veins to the right sided heart chambers and is again pumped to the lungs.

Heart itself needs oxygen to function properly like any other organ. Blood rich in oxygen gets to the heart muscle tissue via coronary arteries, a network of small vessels on the surface of the heart.

Mechanism and prevention

Atherosclerosis is the build up of fatty substancies - atheroma - in the walls of the coronary arteries. Atherosclerosis narrows the coronary arteries which results in reduced blood and oxygen supply to the heart. Lack of oxygen in the heart (myocardial ischaemia) then causes chest pain called angina. Stable atheroma leads to stable angina on exertion or stress. Complete and sudden blockage of coronary arteries causes myocardial infarction (heart attack).

Healthy lifestyle is one of the most important ways to prevent coronary artery disease. There are several risk factors that can't be modified (age, gender, genetic disposition) but many others that can be reduced or eliminated. A balanced diet, regular physical activity, healthy weight, no smoking, alcohol consumption within recommended limits can prevent not only coronary artery disease but also reduce the risk of stroke and peripheral vascular disease.

Treatment

CAD can be managed with combination of lifestyle measures, medication and if appropriate, with revascularization, an invasive procedure to improve blood supply to the heart muscle. Correct treatment of CAD improves symptoms and prognosis, reduces risk of heart attack and heart failure and prolongs life.

Some of the medicines used in CAD are aspirin, beta-blockers, calcium channel blockers, ACE-I, nitrates, nicorandil and statins.

Two main invasive procedures for revascularization in CAD are:

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