chapter 24

Coronary Artery Disease (CAD)

Definition of CAD:
- Coronary artery disease (CAD) refers to a condition where there is damage or disease in the arteries that supply blood to the heart.
- Etiology:
- CAD is primarily caused by atherosclerosis, which is the buildup of fats, cholesterol, and other substances in and on the artery walls.
- Arteriosclerosis is an interchangeable term but references the hardening of the arteries; both terms are synonymous with CAD.
- Major causes include hyperlipidemia (high levels of fats in the blood), hypertension, smoking, and other lifestyle factors.
Risk Factors for CAD:
- Major risk factors contributing to CAD include:
- Modifiable Risk Factors:
  - Diet
  - Exercise
  - Tobacco use
  - Alcohol consumption
  - Stress
- Non-modifiable Risk Factors:
  - Age
  - Genetics (Family history of heart disease)
  - Gender
Implications:
- The awareness of risk factors points to preventive measures through lifestyle changes, which can begin early in life (i.e., from childhood).

Dietary Recommendations:
- A heart-healthy diet is essential for managing CAD.
- DASH Diet (Dietary Approaches to Stop Hypertension):
- Focuses on reducing sodium intake while emphasizing fruits, vegetables, whole grains, and low-fat dairy.
- Examples of healthy foods include:
- Avocados (healthy fats)
- Fatty fish (such as salmon for omega-3 fatty acids)
- Lean meats like venison over red meats.
- More whole grains, fruits, and vegetables.
Nutrition Strategies:
- Highlight importance of MyPlate for balanced meal planning.
- Focus on low-sodium canned vegetables or fresh, and understanding serving sizes:
- Protein intake should be about the size of the palm of one’s hand per meal.
Lifestyle Modifications:
- Avoidance of alcohol and tobacco as they lead to blood vessel constriction and overall cardiovascular risk.
- Emphasize the importance of daily physical activity to raise HDL (good cholesterol) levels and lower LDL (bad cholesterol) levels.
- Exercise Recommendations:
- Aim for at least 30 minutes of moderate exercise that elevates heart rate (e.g., walking briskly, using an exercise bike).

Healthcare providers use a range of diagnostic tests that can include:
- Blood tests to check cholesterol (LDL, HDL, triglycerides) and other lipid levels.
- EKGs or echocardiograms for assessing heart function.
- Stress tests to determine how the heart performs under exertion.

Definition:
- A myocardial infarction occurs when blood flow to a part of the heart is blocked for long enough that part of the heart muscle is damaged.
Signs and Symptoms:
- Chest pain or discomfort, which can radiate to the arms, neck, back, jaw, or stomach.
- Other symptoms may include shortness of breath, sweating (diaphoresis), cool and clammy skin, pale or cyanotic complexion.
Evaluation:
- Immediate medical evaluation is critical for chest pain. Patients should receive sublingual nitroglycerin, oxygen, and aspirin.
- For myocardial infarction, key labs include troponin levels (specific for heart damage).
Intervention Methods:
- PCI (Percutaneous Coronary Intervention) or catheterization to open blockages (via angioplasty and stenting).
- In the event of unstable angina or full MI, thrombolytic medications may be administered.
- CABG (Coronary Artery Bypass Grafting) may be considered if multiple blockages are present (using grafts such as from the saphenous vein).

Definition:
- Angina pectoris refers to chest pain or discomfort caused by reduced blood flow to the heart muscle.
Types:
- Stable Angina:
- Predictable chest pain that happens with exertion and resolves with rest.
- Unstable Angina:
- Occurs unexpectedly and may happen at rest. It requires medical evaluation as it can precede a heart attack.
Vasospastic Angina:
- Caused by spasm of coronary arteries, leading to temporary reduction in blood flow.
Management:
- Management includes lifestyle modifications and pharmacological treatment aimed at controlling symptoms and reducing the frequency of angina episodes.