Coronary artery disease

Coronary artery disease


The dominant effect of coronary artery disease (CAD) is the loss of oxygen and nutrients to myocardial tissue because of diminished coronary blood flow. This disease is near epidemic in the Western world.

CAD occurs more commonly in men than in women, in whites, and in middle-aged and elderly people. In the past, this disorder rarely affected women who were premenopausal; however, that’s no longer the case. (See Coronary artery disease and menopause, page 232.)


Atherosclerosis is the usual cause of CAD. In this form of arteriosclerosis, fatty, fibrous plaques narrow the lumen of the coronary arteries, reduce the volume of blood that can flow through them, and lead to myocardial ischemia. Plaque formation also predisposes to thrombosis, which can provoke myocardial infarction (MI).

Atherosclerosis usually develops in high-flow, high-pressure arteries, such as those in the heart, brain, kidneys, and aorta, especially at bifurcation points. It has been linked to many risk factors: family history, hypertension, obesity,
smoking, diabetes mellitus, stress, a sedentary lifestyle, and high serum cholesterol and triglyceride levels.

Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow. (See Coronary artery spasm.)

Signs and symptoms

The classic symptom of CAD is angina, the direct result of inadequate flow of oxygen to the myocardium. It’s usually described as a burning, squeezing, or tight feeling in the substernal or precordial chest that may radiate to the left arm, neck, jaw, or shoulder blade. Approximately 50% of women don’t present with the typical symptoms of angina. These women experience vague symptoms such as fatigue, shortness of breath, abdominal pain, nausea, or vomiting.

Typically, the patient clenches his fist over his chest or rubs his left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool extremities. Anginal episodes most commonly follow physical exertion but may also follow emotional excitement, exposure to cold, or a large meal.

Angina has three major forms:

  • Stable angina causes pain that’s predictable in frequency and duration and can be relieved with nitrates and rest.

  • Unstable angina causes pain that increases in frequency and duration. It’s more easily induced.

  • Prinzmetal’s angina causes unpredictable coronary artery spasm.

Severe and prolonged anginal pain generally suggests MI, with potentially fatal arrhythmias and mechanical failure.


The patient history—including the frequency and duration of angina and the presence of associated risk factors—is crucial in evaluating CAD. Additional diagnostic measures include the following:

Jun 16, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Coronary artery disease

Full access? Get Clinical Tree

Get Clinical Tree app for offline access