Coronary Artery Disease

Coronary artery disease, also called coronary heart disease, or simply, heart disease, is the No. 1 killer in
America, affecting more than 13 million Americans.
Heart disease is a result of plaque buildup in your arteries, which blocks blood flow and heightens the risk
for heart attack and stroke.

What Is Coronary Artery Disease?

Heart disease is a result of plaque buildup in your coronary arteries -- a condition called atherosclerosis -that leads to blockages. The arteries, which start out smooth and elastic, become narrow and rigid, restricting
blood flow to the heart. The heart becomes starved of oxygen and the vital nutrients it needs to pump
properly.
From a young age, cholesterol-laden plaque can start to deposit in the blood vessel walls. As you get older,
the plaque burden builds up, inflaming the blood vessel walls and raising the risk of blood clots and heart
attack. The plaques release chemicals that promote the process of healing but make the inner walls of the
blood vessel sticky. Then, other substances, such as inflammatory cells, lipoproteins, and calcium that travel
in your bloodstream start sticking to the inside of the vessel walls.
Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get
blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to
supply enough oxygen-rich blood to the heart muscle.
In some cases, a blood clot may totally block the blood supply to the heart muscle, causing heart attack. If a
blood vessel to the brain is blocked, usually from a blood clot, an ischemic stroke can result. If a blood
vessel within the brain bursts, most likely as a result of uncontrolled hypertension (high blood pressure), a
hemorrhagic stroke can result.

Angina - or angina pectoris (Latin for squeezing of the chest) - is chest pain, discomfort, or tightness
that occurs when an area of the heart muscle is receiving decreased blood oxygen supply. It is not a disease
itself, but rather a symptom of coronary artery disease, the most common type of heart disease.
The lack of oxygen rich blood to the heart is usually a result of narrower coronary arteries due to plaque
buildup, a condition called atherosclerosis. Narrow arteries increase the risk of pain, coronary artery disease,
heart attack, and death.
Angina may manifest itself in the form of an angina attack, pain or discomfort in the chest that typically lasts
from 1 to 15 minutes. The condition is classified by the pattern of attacks into stable, unstable, and variant
angina.

Stable (or chronic) angina is brought on when the heart is working harder than usual, such as
during exercise. It has a regular pattern and can be predicted to happen over months or even years.
Symptoms are relieved by rest or medication.

Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less
common and more serious as it is not relieved by rest or medicine. This version can signal a future
heart attack within a short time - hours or weeks.

Variant (Prinzmetal's) angina and microvascular (smallest vessels) angina are rare and can occur
at rest without any underlying coronary artery disease. This angina is usually due to abnormal
narrowing or relaxation (spasm) of the blood vessels, reducing blood flow to the heart. It is relieved
by medicine.

Angina risk factors

Those at an increased risk of coronary artery disease are also at an increased risk of angina. Risk factors
include:

Unhealthy cholesterol levels

Hypertension (high blood pressure)
Tobacco smoking
Diabetes
Being overweight or obese

Metabolic syndrome
Sedentary lifestyle
Being over 45 for men and over 55 for women
Family history of early heart disease.

 Causes of angina
Atherosclerosis - a buildup of plaque around the artery wall - is the most common cause of angina.
Angina is most frequently the result of underlying coronary artery disease. The coronary arteries supply the
heart with oxygen rich blood. When cholesterol aggregates on the artery wall and hard plaques form, the
artery narrows.
It is increasingly difficult for oxygen rich blood to reach the heart muscle as these arteries become too
narrow. In addition, damage to the arteries from other factors (such as smoking and high levels of fat or
sugar in the blood) can cause plaque to build up where the arteries are damaged. These plaques narrow the
arteries or may break off and form blood clots that block the arteries.

Symptoms of angina
Angina is usually felt as a squeezing, pressure, heaviness, tightening, squeezing, burning or aching across
the chest, usually starting behind the breastbone. This pain often spreads to the neck, jaw, arms, shoulders,
throat, back, or even the teeth.
Patients may also complain of symptoms that include indigestion, heartburn, weakness, sweating, nausea,
cramping, and shortness of breath.
Stable angina usually is unsurprising, lasts a short period of time, and may feel like gas or indigestion.
Unstable angina occurs at rest, is surprising, last longer, and may worsen over time. Variant angina occurs at
rest and is usually severe.

Heart Failure:

Cardiac Arrest:
Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is a sudden stop in effective
blood circulation due to the failure of the heart to contract effectively or at all.[1] Medical personnel may
refer to an unexpected cardiac arrest as a sudden cardiac arrest (SCA).

A cardiac arrest is different from (but may be caused by) a myocardial infarction (also known as a heart
attack), where blood flow to the muscle of the heart is impaired.[2] It is different from congestive heart
failure, where circulation is substandard, but the heart is still pumping sufficient blood to sustain life.
Arrested blood circulation prevents delivery of oxygen and glucose to the body. Lack of oxygen and glucose
to the brain causes loss of consciousness, which then results in abnormal or absent breathing. Brain injury is
likely to happen if cardiac arrest goes untreated for more than five minutes.[3][4][5] For the best chance of
survival and neurological recovery immediate treatment is important.[6]
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early.
Unexpected cardiac arrest can lead to death within minutes: this is called sudden cardiac death (SCD).[1] The
treatment for cardiac arrest is immediate defibrillation if a "shockable" rhythm is present, while
cardiopulmonary resuscitation (CPR) is used to provide circulatory support and/or to induce a "shockable"
rhythm.
A number of heart conditions and non-heart-related events can cause cardiac arrest; the most common cause
is coronary artery disease.

Heart Attack
The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries
provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become
narrow and blood cannot flow as well as they should. Fatty matter, calcium, proteins, and inflammatory cells
build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside
and soft and mushy on the inside.
When the plaque is hard, the outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood
that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the
artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells
occurs, causing permanent damage. This is a heart attack.
While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During a coronary
spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle
(ischemia). It may occur at rest, and can even occur in people without significant coronary artery disease.
Each coronary artery supplies blood to a region of heart muscle. The amount of damage to the heart muscle
depends on the size of the area supplied by the blocked artery and the time between injury and treatment.
Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. Just like a skin
wound, the heart's wound heals and a scar will form in the damaged area. But, the new scar tissue does not
contract. So, the heart's pumping ability is lessened after a heart attack. The amount of lost pumping ability
depends on the size and location of the scar.

Heart Attack Symptoms

Symptoms of a heart attack include:
Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
Discomfort radiating to the back, jaw, throat, or arm

 Fullness, indigestion, or choking feeling (may feel like heartburn)

Sweating, nausea, vomiting, or dizziness
Extreme weakness, anxiety, or shortness of breath
Rapid or irregular heartbeats
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or nitroglycerin under
the tongue.
Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent
MI can occur in anyone, but it is more common among people with diabetes.