What does it mean?

Coronary Artery Disease (CAD)

• Also known as Ischaemic Heart Disease (IHD)
• It is the narrowing or blockage of the coronary
arteries, usually caused by build-up of
cholesterol & fatty deposits
• It is the most common type of heart disease
 Burden of Disease
• A global killer
– Globally, CAD is the leading cause of death and is predicted to remain
so for the next 20 years.
– Each year, approximately 3.8 million men and 3.4 million women die
from CAD.2 In 2020, it is estimated that this disease will be
responsible for a total of 11.1 million deaths globally.
– Someone suffers a coronary event every 26 seconds, and someone
dies from one every minute in the USA.
– In Europe, between 1 in 5 and 1 in 7 European women die from CAD,
and the disease accounts for between 16% and 25% of all deaths in
European men.
 Atherosclerosis
• Atherosclerosis is a disease in which plaque
builds up inside your arteries.
• Plaque is made up of fat, cholesterol, calcium,
and other substances found in the blood. Over
time, plaque hardens and narrows the arteries.
• Atherosclerosis can affect any artery in the body,
including arteries in the heart, brain, arms, legs,
pelvis, and kidneys. As a result, different diseases
may develop based on which arteries are
affected.
Atherosclerosis
Atherosclerosis Complications
Risk Factors for CAD
 Risk Factors for CAD
Non-Modifiable Modifiable
• Male gender • Cigarette smoking
• Advanced age • High LDL (bad cholesterol)
• Family history of heart disease • High BP >140/90 mmHG
• Race • Uncontrolled diabetes
• Physical inactivity
• Being overweight
• Stress
• Diet high in saturated fat and
cholesterol
• Alcohol intake
 CAD Management

2-Pronged
Approach

Relieve Reduce the Risk

Symptoms of
Cardiovascular
Events
 How is CAD Treated?
• Medicines
– Sometimes lifestyle changes aren’t enough to control your blood
cholesterol levels. For example, you may need statin medications to
control or lower your cholesterol.
– The doctor also may prescribe other medications to:
• Decrease your chance of having a heart attack or dying suddenly
• Lower your blood pressure
• Prevent blood clots, which can lead to heart attack or stroke
• Prevent or delay the need for a stent or surgery
• Reduce heart’s workload and relieve coronary heart disease
symptoms
Take Medications as
Prescribed
 How is CAD Treated?
• Medical Procedures & Surgery
– Percutaneous Coronary Intervention
 Percutaneous coronary intervention, commonly known as
angioplasty, is a nonsurgical procedure that opens blocked or
narrowed coronary arteries. A thin, flexible tube with a balloon or
other device on the end is threaded through a blood vessel to the
narrowed or blocked coronary artery. Once in place, the balloon is
inflated to compress the plaque against the wall of the artery. This
restores blood flow through the artery.
 During the procedure, the doctor may put a small mesh tube
called a stent in the artery. The stent helps prevent blockages in
the artery in the months or years after angioplasty.
 Prevention – Better Than Cure
• Primary prevention

• Secondary prevention

• Targets
 How is CAD Treated?
• Life style changes
– Healthy eating
• When following a heart-healthy diet, you should avoid eating:
 A lot of red meat
 Palm and coconut oils
 Sugary foods and beverages
 Foods that are high in salt and sodium
– Maintaining a healthy weight
– Managing stress
– Physical activity
– Smoking cessation
 Hypertension
was named
'the number one killer'
by
World Health Organization (WHO)

Reference 1 :The World Health Report 2002 http://ish-world.com/public/background-info.htm

 Blood Pressure
Top number (systolic)
-measures the force of blood on arteries
when the heart beats

120/80
Bottom number (diastolic)
- measures force of blood on arteries
between beats

http://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf
 What Is High Blood Pressure?
• Blood pressure that stays elevated
–more than 140/90

http://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf
Reference 7: Reference Card From the Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
 90

In 2000, the estimated number of adults living with high blood

pressure globally was 972 million. This is expected to increase to
1.56 billion by 2025 2

Reference :The World Health Report 2002

http://ish-world.com/public/background-
info.htm

3
94

Reference 2 : International Society of Hypertensionhttp://ish-world.com/public/background-info.htm

Reference 3 : A global brief on Hypertension World Health Day 2013 World Health Organization
 In 2008, worldwide, approximately 40% of adults aged 25 and above
had been diagnosed with hypertension ; the number of people with
the condition rose from 600 million in 1980 to1 billion in 2008.4

Reference 4 : http://ish-world.com/downloads/pdf/global_brief_hypertension.pdf
 60

In 2014, more than 1.9 billion adults, 18 years and older, were overweight.
Of these over 600 million were obese.5

Reference 5 : http://www.who.int/mediacentre/factsheets/fs311/en/
 Hypertension causes a two-to four-fold increase in the risk of
stroke before age 80.6

Reference 6: http://www.ninds.nih.gov/disorders/stroke/preventing_stroke.htm
 What does High Blood Pressure do to my
Body?

Hypertension

Hemorrhage
Heart Attack
stroke
Heart Failure

Peripheral
vascular
disease
Kidney Failure
CHD = coronary heart disease
CHF = congestive heart failure
LVH = left ventricular hypertrophy JNC V. Arch Intern Med 1993;153:154–183
 Hypertension

• Ten Commandments for Blood

Pressure Control
7
Keep your appointments with the doctor
8 Follow your doctors advice about exercise
9 Make certain family members have their
blood pressure checked regularly
10
Live a normal life in every other way!
 Hypertension
• Ten Commandments for Blood
Pressure Control
4
Eat a low-fat diet
5 Don’t smoke cigarettes Or use tobacco
products
6
Take your medicine exactly as prescribed
• Don’t forget to take pills even for a single day
 Hypertension

• Ten Commandments for Blood

Pressure Control
7
Keep your appointments with the doctor
8 Follow your doctors advice about exercise
9 Make certain family members have their
blood pressure checked regularly
10
Live a normal life in every other way!
 How I measure my BP at Home?

• Home Blood Pressure

Monitoring
– Mercury sphygmomanometer
• Standard for BP monitoring
• No calibration
• May be bulky
• Need a second person to use machine
• May be difficult for hearing impaired or
patients with arthritis
 Hypertension

• Home Blood Pressure

Monitoring
– Aneroid equipment
• Inexpensive, lightweight and portable
• Two person operation/need stethoscope
• Delicate mechanism, easily damaged
• Needs calibration with mercury
sphygmomanometer
 Hypertension

• Home Blood Pressure

Monitoring
– Automatic equipment
• Contained in one unit
• Portable with easy-to-read digital display
• Expensive, fragile
• Must be calibrated
• Requires careful cuff placement
 Conclusion

• Hypertension is a very controllable disease,

with drastic consequences if left uncontrolled.
 What are Coronary Arteries?
• Coronary arteries are the blood vessels that
carry blood to the heart muscle.
 What is CAD?
• Coronary artery disease is the narrowing or
blockage of the coronary arteries, usually
caused by atherosclerosis.
– Atherosclerosis (sometimes called "hardening" or "clogging" of the
arteries) is the buildup of cholesterol and fatty deposits (called
plaques) on the inner walls of the arteries.
– These plaques can restrict blood flow to the heart muscle by physically
clogging the artery or by causing abnormal artery tone and function.
– Without an adequate blood supply, the heart becomes starved of
oxygen and the vital nutrients it needs to work properly.
– This can cause chest pain called angina. If blood supply to a portion of
the heart muscle is cut off entirely, or if the energy demands of the
heart become much greater than its blood supply, a heart
attack (injury to the heart muscle) may occur.
 Atherosclerosis
• As already mentioned, atherosclerosis is a
disease in which plaque builds up inside your
arteries.
• Plaque is made up of fat, cholesterol, calcium,
and other substances found in the blood. Over
time, plaque hardens and narrows the arteries.
• Atherosclerosis can affect any artery in the body,
including arteries in the heart, brain, arms, legs,
pelvis, and kidneys. As a result, different diseases
may develop based on which arteries are
Atherosclerosis
Atherosclerosis Complications
What Causes the Coronary Arteries
to Narrow?
• The coronary arteries are shaped like hollow
tubes through which blood can flow freely.
• The muscular walls of the coronary arteries
are normally smooth and elastic and are lined
with a layer of cells called the endothelium.
• The endothelium provides a physical barrier
between the blood stream and the coronary
artery walls, while regulating the function of
the artery by releasing chemical signals in
response to various stimuli.
What Causes the Coronary Arteries
to Narrow?
• The coronary arteries are shaped like hollow
tubes through which blood can flow freely.
• The muscular walls of the coronary arteries
are normally smooth and elastic and are lined
with a layer of cells called the endothelium.
• The endothelium provides a physical barrier
between the blood stream and the coronary
artery walls, while regulating the function of
the artery by releasing chemical signals in
response to various stimuli.
 What Causes the Coronary Arteries
to Narrow?
• Coronary artery disease starts when at a young
age.
• Before the teen years, the blood vessel walls
begin to show streaks of fat.
• As you get older, the fat builds up, causing slight
injury to your blood vessel walls.
• Other substances traveling through your blood
stream, such as inflammatory cells, cellular
waste products, proteins and calcium begin to
stick to the vessel walls. The fat and other
What Causes the Coronary Arteries
to Narrow?
What Causes the Coronary Arteries
to Narrow?
• Over time, the inside of the arteries develop
plaques of different sizes. Many of the plaque
deposits are soft on the inside with a hard
fibrous "cap" covering the outside. If the hard
surface cracks or tears, the soft, fatty inside is
exposed.
• Platelets (disc-shaped particles in the blood
that aid clotting) come to the area, and blood
clots form around the plaque.
• The endothelium can also become irritated
 What Causes the Coronary Arteries
to Narrow?
• Sometimes, the
blood clot breaks
apart, and blood
supply is restored.
In other cases, the
blood clot
(coronary
thrombus) may
suddenly block the
blood supply to
the heart muscle
 Clinical Presentation
• Pain or pressure in the chest, arm,
jaw, shoulder, or neck
• A feeling of tightness, heaviness,
squeezing or burning in the chest
• Shortness of breath
• Sweating
• Fatigue
• Reduced exertional capacity
• A significant number of people with
underlying CAD and ischemia will
experience no symptoms.
• Others will show only very subtle
signs such as decreased endurance
or energy.
• As a result, CAD is often a silent
disease which progresses
undetected until the first effects of
ischemia appear

Symptoms of angina are the most common presentation

of CAD.
 How is CAD Diagnosed?
ECG Stress Echocardiography
Testing

Chest X Blood Tests Coronary Angiography

Ray and
Cardiac Catheterization
 What is Cardiac Catheterization?
• Cardiac catheterization is a medical procedure
used to diagnose and treat some heart
conditions.
• A long, thin, flexible tube called a catheter is
put into a blood vessel in your arm, groin
(upper thigh), or neck and threaded to your
heart. Through the catheter, your doctor can
do diagnostic tests and treatments on your
heart.
• The doctor may put a special type of dye in
 Coronary Artery Disease (CAD)
• Also known as Ischaemic Heart Disease (IHD)
• It is the narrowing or blockage of the coronary
arteries, usually caused by build-up of
cholesterol & fatty deposits
• It is the most common type of heart disease
 What are Coronary Arteries?
• Coronary arteries are the blood vessels that
carry blood to the heart muscle.
 What is CAD?
• Coronary artery disease is the narrowing or
blockage of the coronary arteries, usually
caused by atherosclerosis.
– Atherosclerosis (sometimes called "hardening" or "clogging" of the
arteries) is the buildup of cholesterol and fatty deposits (called
plaques) on the inner walls of the arteries.
– These plaques can restrict blood flow to the heart muscle by physically
clogging the artery or by causing abnormal artery tone and function.
– Without an adequate blood supply, the heart becomes starved of
oxygen and the vital nutrients it needs to work properly.
– This can cause chest pain called angina. If blood supply to a portion of
the heart muscle is cut off entirely, or if the energy demands of the
heart become much greater than its blood supply, a heart
attack (injury to the heart muscle) may occur.
 How is CAD Treated?
 https://youtu.be/gvRtP3wl_AY
 How is CAD Treated?
• Medical Procedures & Surgery
– Coronary Artery Bypass Grafting
 CABG is a type of surgery in which arteries or veins from other
areas of the body are used to bypass (that is, go around) the
narrowed coronary arteries.
 CABG can improve blood flow to your heart, relieve chest pain,
and possibly prevent a heart attack.
 CABG also may be an option if there are blockages in the heart
that can't be treated with PCI. In this situation, CABG may work
better than other types of treatment.
 How is CAD Treated?
• https://youtu.be/gyBPtLrKfk4
 How is CAD Treated?
• Cardiac Rehabilitation
– Education, counseling, and training.
– Exercise training.
 Burden of Disease
• An international epidemic
– Due to this increasing incidence across the world CAD has been
described as an epidemic.

• High Cost burden

– In addition to its mortality burden, CAD is a leading cause of morbidity
and loss of quality of life. This makes CAD a major public health
problem which exerts heavy economic costs.
 Summary
• CAD is the most common cause of heart
disease, usually caused by atherosclerosis.
• It has multiple risk factors including gender,
age, uncontrolled BP/cholesterol/sugar,
smoking, stress etc.
• Most common presentation is with symptoms
of angina.
• Treatment includes lifestyle modifications,
medicines and medical procedures & surgery.
• It is a major public health problem with