Coronary Artery Disease

Coronary Artery Disease

  • Atherosclerosis
    • Begins as soft deposits of fat that harden with age
    • Referred to as “hardening of arteries”
    • Atheromas (fatty deposits) prefer coronary arteries
  • Etiology and pathophysiology
    • Atherosclerosis is major cause of CAD
      • Characterized by lipid deposits within intima of artery
      • Endothelial injury and inflammation play a major role in development
    • C-reactive protein (CRP)
      • Nonspecific marker of inflammation
      • Increased in many patients with CAD
      • Chronic exposure to CRP linked with unstable plaques and oxidation of LDL cholesterol
    • Collateral circulation
      • Arterial anastomoses (or connections) within coronary circulation
      • Increased with chronic ischemia
      • May be inadequate with rapid-onset CAD
  • Developmental stages
    • Chronic Endothelial Injury due to
      • Hypertension
      • Tobacco use
      • Hyperlipidemia
      • Hyperhomocysteinemia
      • Diabetes
      • Infections
      • Toxins
    • The stages of atherosclerosis development are
      • Fatty streak
        • Lipids accumulate and migrate into smooth muscle cells
      • Fibrous plaque
        • Collagen covers the fatty streak
        • Vessel lumen is narrowed
        • Blood flow is reduced
        • Fissures can develop
      • Complicated lesion
        • Plaque rupture
        • Thrombus formation
        • Further narrowing or total occlusion of vessel