The clinical manifestations of coronary artery disease show a wide range of variation, with some individuals being completely asymptomatic, whilst others may develop stable or unstable angina pectoris. A large number of people may present with myocardial infarction (MI), whereas congestive heart failure and cardiomyopathies are not unusual outcomes. Patients may even present with sudden cardiac death.

The predominant symptom seen in coronary artery disease patients is chest pain (stable angina) that is retrosternal in location and commonly radiates to the left arm and neck [1] [2]. Often associated with shortness of breath, this pain is aggravated by activity and rapidly relieved by rest/nitrates [3] [4].

Unstable angina is characterized by severe and more frequent episodes of chest pain. Chest pain may also be evident on rest.

MI patients often report a protracted course of anginal pain associated with increased sweating. Intermittent claudication, mesenteric angina, transient ischemic attacks and strokes are some of the other common ways in which coronary artery disease presents.

On examination, tachycardia, tachypnea and an irregular pulse may be present. Hypertension or hypotension may be found in these patients. Signs suggestive of congestive cardiac failure may be seen such as limb edema, pulmonary congestion, diaphoresis, abdominal swelling, etc [5]. Murmurs and extra sounds (the third and fourth heart sounds) may also be present. Other signs include central obesity, xanthelasmas, livedo reticularis or diagonal ear creases.

• Weakness

  The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default), R (Regulatory Action), NR (Not Rated). [southerncross.co.nz]

  Weak associations were observed between NBL1-Ab level and apnea-hypopnea index, age, mean SpO2 and arousal index, whereas significantly higher NBL1-Ab levels were observed in OSA patients with a history of CAD than in those without a history of CAD. [ncbi.nlm.nih.gov]

  Lightheadedness or sudden weakness. Fast or irregular heartbeat. If you experience these symptoms, take them seriously, and call 911 immediately. Our goal is to quickly determine what’s causing your symptoms. [mercy.net]

  Other symptoms of coronary artery disease may include shortness of breath, weakness, fatigue and pain radiating in the arms, shoulders, jaw, neck, and/or back. [barnesjewish.org]

  Symptoms include: Heaviness, tightness, pressure or pain in the chest behind the breastbone Pain spreading to the arms, shoulders, jaw, neck or back Shortness of breath Weakness and fatigue Diagnosis In addition to a complete medical history and physical [lifebridgehealth.org]

• Congestive Heart Failure

  For example, heart failure (congestive heart failure) may be diagnosed if your heart cannot deliver adequate amounts of oxygen to the body. [uabmedicine.org]

  We report the case of a 51-year-old female, in whom coronary artery disease such as occlusion of septal perforators was manifested, on the occasion of hospitalization with congestive heart failure. [ncbi.nlm.nih.gov]

  Signs suggestive of congestive cardiac failure may be seen such as limb edema, pulmonary congestion, diaphoresis, abdominal swelling, etc. Murmurs and extra sounds (the third and fourth heart sounds) may also be present. [symptoma.com]

  heart failure and CV death prior to RA diagnosis and during the first few years of the disease. [doi.org]

• Dyspnea

  Shortness of breath Other names Dyspnea, dyspnoea, breathlessness, difficulty of breathing, respiratory distress Pronunciation Dyspnea: /dɪspˈniːə/ Specialty Pulmonology Shortness of breath (SOB), also known as dyspnea, is a feeling of not being able [en.wikipedia.org]

  Although women have more frequent chest pain than men, atypical symptoms such as nausea, dyspnea, and fatigue make it difficult to determine their risk of coronary artery disease (CAD) before testing. [ncbi.nlm.nih.gov]

  […] acute renal failure, significant dissection, perforation, vascular complications requiring intervention, bleeding event within 72 hours, and emergent CABG for failed PCI. 3 Tracked via the Seattle Angina Questionnaire (SAQ-7) 4 Tracked via the Rose Dyspnea [ichom.org]

• Exertional Dyspnea

  Distinct sensations include effort/work, chest tightness, and air hunger (the feeling of not enough oxygen).[1] Dyspnea is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations[2] or light exertion. [en.wikipedia.org]

• Heart Disease

  Some examples of cardiovascular diseases include ischemic heart disease, heart valve disease, cardiomyopathies, peripheral artery disease, congenital heart disease, and vascular disease of the kidneys. This study is located in Bethesda, Maryland. [nhlbi.nih.gov]

• Chest Pain

  Often associated with shortness of breath, this pain is aggravated by activity and rapidly relieved by rest/nitrates. Unstable angina is characterized by severe and more frequent episodes of chest pain. Chest pain may also be evident on rest. [symptoma.com]

  She had long-lasting excruciating chest pain after dipyridamole infusion. [doi.org]

  Symptoms Chest pain is the most common complaint in heart attack. Unlike angina, pain does not subside on resting. However, the symptoms may be different. [summitcardiology.com]

  Such an association presenting with chest pain mimicking an infarct aneurysm with angina or a takotsubo cardiomyopathy with chest pain is difficult to differentiate clinically. [ncbi.nlm.nih.gov]

• Hypertension

  Serum levels and gene polymorphism of IL-22 were investigated in hypertensive patients with no CAD (H-Tens), hypertensive patients with CAD (CAD + H-Tens); 3), CAD patients with no hypertension (CAD); and non-hypertensive with no CAD subjects as a control [ncbi.nlm.nih.gov]

  Relationship Between Hypertension and CAD 1.1. Epidemiology of Hypertension and CAD Hypertension is a major independent risk factor for CAD for all age/race/sex groups. [doi.org]

• Vascular Disease

  Show More Learn More Diagnosing Heart Disease Eating Right for Your Heart FAQ: Heart-healthy Diets FAQ: Heart Transplant Heart and Vascular Disease Prevention Tips Heart and Vascular Disease: The Facts Heart and Vascular Disease: The Risks Heart Disease [ucsfhealth.org]

  (IHD) due to coronary vascular disease is mainly caused due to atherosclerosis. [jmidlifehealth.org]

  Abstract Favorites PDF Get Content & Permissions CABG Are two internal thoracic grafts better than one in patients with peripheral vascular disease? Nadav, Teich; Pevni, Dmitry; Mohr, Rephael; More Coronary Artery Disease. 30(1):67-73, January 2019. [journals.lww.com]

  Convert to ICD-10-CM : 429.2 converts approximately to: 2015/16 ICD-10-CM I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris Approximate Synonyms Arteriosclerotic cardiovascular disease Arteriosclerotic vascular disease [icd9data.com]

  Because the underlying atherosclerosis causal to CAD is a systemic disease, patients with CAD often have ischaemic vascular disease affecting two or more vascular beds (known as polyvascular disease). Coronary syndromes are a spectrum of conditions. [thrombosisadviser.com]

• Tachycardia

  On examination, tachycardia, tachypnea and an irregular pulse may be present. Hypertension or hypotension may be found in these patients. [symptoma.com]

  研究成果 : ジャーナルへの寄稿 › 記事 Catheter ablation for verapamil-sensitive fascicular ventricular tachycardia guided by precise mapping using a multi-spline duodecapolar catheter with small electrodes and close spacings Takase, S., Mukai, Y., Honda, N., Chishaki [kyushu-u.pure.elsevier.com]

  States of tachycardia increase oxygen demand significantly. which explains why anginal symptoms are frequently exertional. [healio.com]

  AHA = American Heart Association; ECMO = extracorporeal membrane oxygenation; PCI = percutaneous coronary intervention; VT = ventricular tachycardia. [onlinejacc.org]

• Increased Sweating

  MI patients often report a protracted course of anginal pain associated with increased sweating. [symptoma.com]

  sweating Lifesaving heart attack care If one of your coronary arteries becomes significantly blocked by plaque, it cuts off blood and oxygen to the heart muscle. [muhealth.org]

• Alopecia

  […] effects[edit] Adverse drug reactions associated with the use of beta blockers include: nausea, diarrhea, bronchospasm, dyspnea, cold extremities, exacerbation of Raynaud's syndrome, bradycardia, hypotension, heart failure, heart block, fatigue, dizziness, alopecia [en.wikipedia.org]

• Type A Personality

  Explanatory dynamics based on stress and Type A personality are suggested. [web.archive.org]

  Personality, Type A behavior, and coronary heart disease: The role of emotional expression. Journal of Personality and Social Psychology, 53, 783 - 792. Google Scholar | Crossref | Medline | ISI Friedman, H. S., & Booth-Kewley, S. ( 1987b ). [psp.sagepub.com]

Coronary artery disease requires emergency management and must be strongly suspected in patients presenting with any of the symptoms mentioned.

An electrocardiogram (ECG) is the most important investigation to be performed for such individuals within 10 minutes of presentation. ST segment elevations ≥ 1 mm present in 2 or more contiguous leads is strongly suggestive of an ST-segment elevation MI (STEMI) [6] [7]. Pathologic Q waves may develop over time. With a specificity of 90%, serial ECG measurements may help confirm the diagnosis or may even guide the treatment strategy. A pulse oximetry and chest radiography may aid in diagnosis.

Detection of serum cardiac markers suggestive of myocardial necrosis are highly suggestive of MI. Troponins I and T are the markers of choice and show a high sensitivity and specificity (can detect levels as low as 1 pg/ml) at detecting STEMI [8]. Other serum cardiac markers that may be helpful include myoglobin and creatine kinase-MB.

A diagnostic coronary angiography combined with percutaneous coronary intervention (PCI) procedures has proven to be life-saving for people with MI. Patients with STEMI may benefit from PCI (angioplasty, placement of stents) when they present within 3 hours of onset of angina. Long term outcomes for unstable angina and NSTEMI patients are also improved by delayed (within 24-48 hours) coronary angiography.

Routine investigations aren’t of much help in coronary artery disease; however, a fasting lipid profile must be done in all such patients. Cardiac stress testing, echocardiography and/or cardiac nuclear imaging studies may also be beneficial in these individuals.

• Hypertriglyceridemia

  Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents [acc.org]

  Health-care providers should identify for patients the importance of physical activity as primary or adjunctive therapy for such medical conditions as hypertension, hypertriglyceridemia, glucose intolerance, and obesity. [web.archive.org]

  The role of hypertriglyceridemia in atherogenesis is complex, although it may have a small independent effect (2). Hypertension may lead to vascular inflammation via angiotensin II–mediated mechanisms. [merckmanuals.com]

  Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol. 1996 ; 77 :1179–1184. Crossref Medline Google Scholar 20 Rosengren A, Wilhemsen L, Eriksson E, et al. [doi.org]

• LDL Increased

  PCSK9 inhibitors are monoclonal antibodies that keep PCSK9 from attaching to LDL receptors, leading to increased recycling of these receptors to the plasma membrane leading to further clearance of plasma LDL cholesterol to the liver. [merckmanuals.com]

• T Wave Inversion

  Diagnosis of MI required documentation of two or more of: (a) typical ischemic chest pain, pulmonary oedema, syncope or shock; (b) development of pathological Q-waves and/or appearance or disappearance of localized ST-elevation followed by T-wave inversion [doi.org]

  The ECG can show ST segment shifts and/or T-wave inversions as signs of heart ischemia or injury. However, there are electrically silent areas in the standard monitors. [emedicine.com]

• Ischemic Changes

  No ischemic changes on the electrocardiogram were noted for either patient. Patient 1 had an exercise stress test that was negative for any inducible ischemia whereas patient 2 had no obstructive lesion seen on coronary angiography. [ncbi.nlm.nih.gov]

  The VA Cooperative Study included 686 CAD patients with stable angina, electrocardiographic signs of previous infarction or ischemic changes in exercise, and at least one major coronary artery with ≥ 50% stenosis. [dx.doi.org]

  Noninvasive testing, such as rest echocardiography revealing multiple regional wall motion abnormalities or electrocardiography with diffuse ischemic changes in multiple territories, may reflect CAD with a large ischemic burden and justify diagnostic [circ.ahajournals.org]

Their efforts have led to advances in the treatment of coronary artery disease. [nyulangone.org]

Our doctors help patients make heart-healthy lifestyle changes after treatment to maintain their health. Our doctors conduct cutting edge research, including genomic studies, to find causes and new treatments for atherosclerosis. [yalemedicine.org]

The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. [ncbi.nlm.nih.gov]

Results: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. [doi.org]

Treatment “Treatments work better early on,” says Martin, which is why early identification and intervention are so important. Depending on your health status and goals, there are three key approaches to treating heart disease: Lifestyle changes. [hopkinsmedicine.org]

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. [ncbi.nlm.nih.gov]

But there is large evidence gap in these high-risk patients' prognosis-related factors, limiting the improvement of care quality. [clinicaltrials.gov]

[…] barrier to macromolecules and leukocyte adhesion molecules on the surface endothelial cells are activated to promote the infiltration of macrophages into the subendothelium Diagrams / tables Images hosted on other servers: Risk factors for atherosclerosis Etiology [pathologyoutlines.com]

However, categorizing the patients by etiologic stroke subtype allowed a good approximation of the relative prevalence of coronary atherosclerosis between each stroke subtype. [ahajournals.org]

This is a controversial topic, as no clear etiology has been seen. [healio.com]

Early EMS transport exclusion criteria included: 1) cardiac arrest of noncardiac etiology (e.g., blunt or penetrating traumatic arrest, burn-related, exsanguination, hanging, known overdose); 2) contraindications to mechanical CPR; 3) known pregnancy; [onlinejacc.org]

283 (2007). https://doi.org/10.1038/ncpcardio0878 Download citation Received: 04 March 2006 Accepted: 12 January 2007 Issue Date: May 2007 DOI: https://doi.org/10.1038/ncpcardio0878 Further reading Guanidino compound ratios are associated with stroke etiology [nature.com]

Prospective Urban Rural Epidemiology (PURE) Study Investigators. [doi.org]

In this review, we summarize the epidemiologic significance of ACS and CAD in patients with CKD, discuss the diagnosis of ACS in this patient population, and review the therapeutic interventions in patients with CKD. [ncbi.nlm.nih.gov]

IHD as a Complex Pathophysiological Process The pathophysiological events that occur at the coronary atherosclerotic plaque have been of great interest for the past few decades. [onlinejacc.org]

The purpose of this review is to provide an overview of the pathophysiological, analytical, and clinical characteristics of MPO and to summarize the state of art about the possible clinical use of MPO as a marker for diagnosis and risk stratification [ncbi.nlm.nih.gov]

Preventive Services Task Force (USPSTF) for aspirin for the primary prevention of cardiovascular events, as well as the supporting scientific evidence. [doi.org]

Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer [Putting Prevention into Practice] 10/15/2016 Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: Recommendation Statement [U.S. [aafp.org]

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3. Kearney MT, Charlesworth A, Cowley AJ, MacDonald IA. William Heberden revisited: postprandial angina-interval between food and exercise and meal composition are important determinants of time to onset of ischemia and maximal exercise tolerance. J Am Coll Cardiol 1997; 29:302.
4. Schiffer F, Hartley LH, Schulman CL, Abelmann WH. Evidence for emotionally-induced coronary arterial spasm in patients with angina pectoris. Br Heart J 1980; 44:62.
5. Cook DG, Shaper AG. Breathlessness, angina pectoris and coronary artery disease. Am J Cardiol 1989; 63:921.
6. Goldberger AL. Myocardial Infraction: Electrocardiographic Differential Diagnosis, 4th, Mosby Yeark Book, St. Louis 1991.
7. Goldberger AL. Clinical Electrocardiography: A Simplified Approach, 6th, Mosby, St. Louis 1999.
8. Macrae AR, Kavsak PA, Lustig V, et al. Assessing the requirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies. Clin Chem 2006; 52:812.