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Coronary Artery Disease

The coronary arteries are the arteries that supply oxygen rich blood to the heart itself. When one of these arteries becomes completely blocked the result is myocardial infarction or heart attack. When the arteries are not completely blocked but have partial blockages, the result can be myocardial ischemia or angina felt as exertional chest pain. However, people can experience the symptoms of coronary artery disease in different manifestations and sometimes the first sign of coronary artery disease is a heart attack. Heart disease is a leading cause of death in the United States. Furthermore, it is a major contributor to poor quality of life. Risk factors for CAD include age, heredity, male gender, high cholesterol, high blood pressure, diabetes, obesity, smoking and physical inactivity. The diagnosis of CAD can be challenging as the disease can manifest with variable symptoms and in some cases can be silent. Diagnosis of CAD starts with a thorough history and physical exam. Testing usually includes an electrocardiogram (EKG) and a stress test. Management of CAD centers around risk factor modification and symptom management. Smoking cessation, diet and exercise are starting points but blood pressure control with medications such as beta blockers and ACE inhibitors as well as cholesterol lowering with medications such as statins. Aspirin is sometimes used as well based on risk factors. In some cases, patients may need a procedure to better characterize the blockage and at that time, stents can be placed to open the blockages if needed. In some patients with very high risk disease, surgery known as coronary bypass grafting is needed.

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Wilson JF. In The Clinic: Stable Ischemic Heart Disease. Ann Intern Med. 2017 Jan 7; 160 (1)