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Coronary Atherosclerosis

Background Knowledge 🧠

Definition

  • 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.

Epidemiology

  • Coronary atherosclerosis is a leading cause of death worldwide.
  • Incidence of coronary atherosclerosis rises with increasing age.

Pathophysiology

  • Endothelial injury β†’ Increased vascularpermeabilityΒ β†’ Lipid accumulation β†’ Monocyte migrationΒ and differentiation into macrophages β†’ Macrophage lipid uptake β†’ Formation of foam cells β†’ Atheroma formation.

Aetiology/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.

Clinical Features πŸŒ‘️

Symptoms

  • Often asymptomatic until significant luminal obstructionΒ or plaque rupture occurs
  • Angina pectoris
  • Shortness of breath
  • Palpitations
  • Fatigue
  • Syncope

Investigations πŸ§ͺ

Initial tests

  • ECG: May show signs of previous myocardial infarction or ischaemia.

  • Cardiac Biomarkers: Elevated in acute coronary syndromes.

Diagnostic tests

  • Coronary Angiography: Gold standard for diagnosing and locating stenoses.

  • Stress Testing: Can assess for inducible ischaemia.

Management πŸ₯Ό

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).

Prognosis

  • Associated with high morbidity and mortality, however, prompt diagnosis and treatment can improve outcomes.

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.

References

Shahjehan, R.D. and Bhutta, B.S. (2023). Coronary artery disease. [online] National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK564304/.

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