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CAD & Your Health

Many patients with CAD may never experience symptoms, but a large number do. The main complications associated with CAD are:

  1. Acute coronary syndrome: Acute coronary syndrome (ACS) refers to a number of conditions in which blood flow to the heart is decreased, resulting in symptoms. These symptoms may manifest as unstable angina pectoris or myocardial infarction (heart attack).
  2. Stable angina pectoris: Stable angina refers to chest pain or discomfort, usually a squeezing or pressure-like sensation, which occurs with exertion and is relieved by rest, and is due to the presence of atherosclerosis causing narrowing coronary arteries. Stable angina may also be precipitated by emotional stress, cold weather, or large meals. Stable anginal pain may spread, or radiate, to the jaw, shoulder, or arm, usually on the left side, and typically lasts for only a few minutes. Stable anginal pain is also relieved by medications that dilate the coronary arteries, such as nitroglycerin.
  3. Unstable angina pectoris: Unlike stable angina, unstable angina is often unpredictable and may be severe, and occurs with minimal exertion or rest, and may even occur during sleep. Unstable anginal pain often lasts longer and is more intense than pain associated with stable angina. Stable angina may also become unstable when symptoms begin to occur more frequently, last longer, or are triggered more easily than they were previously. Unstable angina heralds a serious situation and may be a precursor to a heart attack.
  4. Myocardial infarction: Myocardial infarction (MI) refers to a condition in which blood flow through the coronary arteries to the heart is blocked or disrupted, depriving the heart of necessary oxygen and nutrients. This situation results in damage to heart muscle, and, if prolonged, heart muscle death. Usually, MI is the result of CAD, but MI can occasionally occur in the absence of significant CAD, such as when the coronary arteries undergo severe spasm or with congenital disorders of the positions of the coronary arteries (called coronary artery anomalies

An acute coronary syndrome may be diagnosed when one or more of thefollowing are present within 24 hours of arrival at the hospital of a patient with symptoms that suggest CAD:
  1. Characteristic ECG (electrocardiogram, also known as EKG) changes: an electrocardiogram is a device that records the electrical activity of the heart for a period of time. Occasionally certain patterns may be seen that suggest decreased blood flow to heart muscle or frank damage to heart muscle;
  2. Known previous CAD, by history of previous clinical events (angina, MI, etc.) or evidence of CAD on testing (stress tests, cardiac catheterization, nuclear medicine perfusion imaging or CT scanning; or:
  3. Increases in cardiac enzymes that tend to "leak" into the circulation when heart muscle is damaged.
Every year, CAD contributes to MI's in 1.5 million Americans, and up to one-third of these patients will die. Patients who survive their MI may have a poor prognosis because of the death of a significant amount of heart muscle. In fact, patients who survive their MI's may have a 1.5 — 15 times increased risk of dying compared to the rest of the population. Among MI survivors, a significant number will have another MI within 6 years.
  1. Heart failure: The heart muscle does not pump effectively in patients with heart failure. This heart muscle dysfunction is often the result of long-term decreased blood flow to heart muscle or death of a large amount of cardiac muscle when a coronary artery is severely narrowed or blocked entirely. When heart failure occurs, blood backs up in the lungs and produces cough, shortness of breath, and decreased exercise tolerance. Lower extremity swelling is also common.
  2. Arrhythmias: Similar to heart failure, cardiac arrhythmias may result from CAD when blood flow to the regions of the heart that produce and carry the heart's electrical activity is disrupted. The tissue that produces and conducts electrical activity within the heart is responsible for coordinating the contraction of the heart. When this tissue is disrupted, the heartbeat may become irregular and poorly coordinated, which may produce heart failure. Additionally, if the heart is not pumping blood effectively, it is not supplying itself with needed oxygen and nutrients, which will exacerbate the entire situation.