Acne Vulgaris definition, causes, aggravating factors, pathogenesis, classification, complications, treatment and management.

Coronary artery disease (CAD) definition 

It is a common heart condition that involves atherosclerotic plaque formation in the vessel lumen.This leads to impairment in blood flow and thus oxygen delivery to the myocardium.

Cornary artery disease(CAD) symptoms 

Coronary artery disease (CAD) is most commonly characterized by chest pain which may radiate to the left arm, lower jaw, neck or to the back (occur at acute attacks of ischemia).

Coronary artery disease (CAD) ICD 10 

• I20 : Angina pectoris
• I21 : Acute myocardial infarction
• I22 : Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• I23 : Certain current complications following ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction (within the 28 day period)
• I24 : Other acute ischemic heart diseases
• I25 : Chronic ischemic heart disease

Coronary artery disease(CAD) risk factors

There is many factors increase the risk of developing CAD which classified into modifiable and non modifiable risk factors :

·        Modifiable risk factors:

Age (risk increase with age), gender (more common in men than women until menopause), family history of CAD.

 

·        Non modifiable risk factors:

Hypertension, diabetes mellitus, cigarette smoking, physical inactivity and metabolic syndrome.

Relationship between atherosclerosis and coronary artery disease(CAD) 

Atherosclerosis of the coronary artery is the main cause of coronary artery disease except for variant angina ( associated with vasospasm of the coronary artery).

Is hypertension related to coronary artery disease(CAD) ?

Yes, hypertension increase the risk of developing coronary artery disease by weakening the intima of blood vessels, which facilitates penetration of LDL to the subintima of blood vessels.

Is diabetes mellitus related to coronary artery disease(CAD) ?

Yes, diabetes mellitus is very strong risk factors for cardiovascular diseases, long term diabetes complications are associated with less intact intima of blood vessels which facilitates penetration of LDL to the subintima of blood vessels.

 

Classification of coronary artery disease (CAD) 

CAD is clinically classified to 2 main classes :

a. Chronic CAD: stable angina.

b. Acute coronary syndrome (ACS): unstable angina, non ST segment elevation myocardial infarction (NSTEMI) & ST segment elevation myocardial infarction (STEMI).

 

What is the relationship between stable angina and myocardial infarction ?

Stable angina is precursor for myocardial infarction, for any reason destabilization (rupture) of atherosclerotic plaques leads to development of unstable angina and subsequent development of myocardial infarction.

Coronary artery disease(CAD) diagnosis

Coronary artery disease is mainly diagnosed by clinical picture.

a. Clinical picture: Heaviness or squeezing chest pain, which may radiates to the left arm, lower jaw and to the neck.  

b. Stress test: By administration of dobutamine, resulting in increased cardiac workload which lead to heart ischemia in CAD patients.

c. Coronary angiography: This method is not routinely used.It could be used in patients who are not responding to therapy.

Coronary artery disease(CAD) treatment and management

Goals of therapy:

1.  Relief the symptoms of acute attacks.
2. Prevent the occurrence of acute coronary syndrome (Primary prevention of ACS).
3. Prevent the recurrence of acute coronary - syndrome (Secondary prevention of ACS).

Non pharmacological therapy

1- Stop smoking.
2- Management of hypertension & diabetes.
3- Weight reduction to normal BMI.
4- Physical activity (active life style).
 

Pharmacological therapy

Pharmacological therapy include drugs used for either relief of symptoms or for primary and secondary prevention of ACS.

•  Antianginal drugs (used for symptomatic relief) :

These drugs are found to have no any benefits on mortality used only for relief of symptoms at acute angina attacks : Organic nitrates, CCBs & beta blockers.

• Drugs used for primary & secondary prevention of ACS :

These drugs are associated with reduced mortality rate : Antiplatelet, Statins, ACEIs & beta blockers.

References 

• Pharmacotherapy principles and practice 4 edition.
• https://pubmed.ncbi.nlm.nih.gov/
• http://www.icd10data.com