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Coronary atherosclerosis

Definition
  • Coronary Atherosclerosis: A chronic inflammatory disease characterised by the accumulation of lipids, cells, and fibrous elements in the large- and medium-sized arteries, especially the coronary arteries.
Etiology/Risk Factors
  • Non-modifiable: Age, male gender, family history of premature coronary artery disease.
  • Modifiable: Hypertension, dyslipidaemia, diabetes mellitus, smoking, obesity, physical inactivity, and poor diet.
  • Others: Chronic kidney disease, inflammatory conditions (e.g., rheumatoid arthritis), and psychosocial stress.
Pathophysiology
  • Endothelial injury ā†’ increased vascular permeability ā†’ lipid accumulation ā†’ monocyte migration and differentiation into macrophages ā†’ macrophage lipid uptake ā†’ formation of foam cells ā†’ atheroma formation.
Clinical Features
  • Often asymptomatic until significant luminal obstruction or plaque rupture occurs.
  • Symptoms: Angina pectoris, shortness of breath, palpitations, fatigue, or syncope.
Investigations
  • ECG: May show signs of previous myocardial infarction or ischaemia.
  • Cardiac Biomarkers: Elevated in acute coronary syndromes.
  • Coronary Angiography: Gold standard for diagnosing and locating stenoses.
  • Stress Testing: Can assess for inducible ischaemia.
Management
  • Lifestyle Modifications: Smoking cessation, dietary improvements, increased physical activity.
  • Pharmacotherapy: Antiplatelets (e.g., aspirin), statins, antihypertensives, and glycaemic control in diabetics.
  • Interventions: Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG).
Complications
  • Myocardial infarction.
  • Chronic stable angina.
  • Heart failure.
  • Cardiac arrhythmias.
  • Sudden cardiac death.
Key Points
  • Coronary atherosclerosis is the leading cause of death worldwide.
  • Prevention and risk factor modification are pivotal in disease management.
  • Early detection and intervention can significantly improve outcomes.

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