Cardiology
Coronary Artery Disease
관상동맥질환
Myocardial ischemia from coronary atherosclerosis
- How common
- Leading cause of adult death
- Typical age
- Ages 50+
What is it?
Endothelial injury → LDL deposition → macrophage uptake → foam cells → plaque → coronary stenosis → reduced myocardial O2 supply.
Commonly affected: Coronary arteries (LAD, LCx, RCA), myocardium
How it develops
- Endothelial dysfunctionSmoking, DM, HTN damage endothelium
- Lipid depositionLDL infiltrates and oxidizes in intima
- Plaque formationMacrophages, smooth muscle, collagen accumulate
- Stenosis/ischemia>70% stenosis causes exertional angina
Symptoms
- Exertional anginaChest pressure with exertion/stress
- Radiating painRadiates to L arm, jaw, back
- Relief with restResolves within 5 min of rest
- DyspneaReduced exercise tolerance
- Diaphoresis/nauseaAssociated autonomic symptoms
How it is examined
- Levine signPatient clenches fist over chest
- Cardiac auscultationS4 gallop, MR murmur possible
- Peripheral pulses/bruitsCarotid/abdominal bruits suggest systemic atherosclerosis
Imaging
Resting ECG and stress test for evaluation.
- ST depression
- Positive stress test
Coronary CTA or invasive angiography is standard.
- Stenosis location/severity
- Assess for stent
Non-surgical care
- AntiplateletDaily aspirin 81mg
- StatinHigh-intensity statin (atorvastatin 40-80mg)
- Beta-blockerMetoprolol/bisoprolol reduce O2 demand
- ACE inhibitorVascular protection, reduces mortality
- NitroglycerinSublingual for angina attacks
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed medical therapy, multivessel disease, left main stenosis
Procedures that may be discussed
- PCI with drug-eluting stent
- CABG (left main, DM, 3VD)
- Rotational atherectomy
Outlook
With proper meds, lifestyle, and intervention, 5-yr survival >90%.