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

  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]

  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]

  […] inflammatory protein under study is serum amyloid A (SAA) Other proteins associated with inflammation, such as leukocyte adhesion molecules and fibrinogen are considered to be biomarkers of disease Clinical features Chest pain, shortness of breath, weakness [pathologyoutlines.com]

  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]

  Patients with clogged arteries complain of : severe chest pain, which gets worse with emotional stress or vigorous physical activity irregular heart palpitations shortness of breath nausea dizziness and weakness Diagnosis Clogged arteries can be diagnosed [practo.com]

• Congestive Heart Failure

  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]

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

  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. [symptoma.com]

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

• Dyspnea

  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]

  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]

  It is characterized by a severe and rapid onset of symptoms that may include chest pain, often radiating to the left arm and left side of the neck, dyspnea, sweating, and palpitations. 410 Acute myocardial infarction 410.0 Acute myocardial infarction [icd9data.com]

• Exertional Dyspnea

  dyspnea, fatigue, weakness, and tachycardia.[15] It may lead to heart failure.[15] Anaemia is often a cause of dyspnea. [en.wikipedia.org]

• Heart Disease

  In most instances, ischemic heart disease, i.e., coronary artery disease and/or coronary heart disease, is a result or consequence of arteriosclerosis (hardening of the arteries) and atherosclerosis (fatty deposits within the arteries). [texasheart.org]

  Cold Facts About Hard Arteries About 18 million Americans ages 20 and older have heart disease. More than 800,000 Americans have a heart attack each year. About 650,000 Americans die of heart disease every year. [webmd.com]

  AIM: sudden coronary death (SCD) in older individuals is generally associated with extensive coronary atherosclerosis, although it may be the first manifestation of ischaemic heart disease. [ncbi.nlm.nih.gov]

• Chest Pain

  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]

  If left untreated, coronary artery disease can lead to chest pain (angina), shortness of breath, heart attack and possibly death. [barnesjewish.org]

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

  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]

  Diagnosis is done by Coronary reserve flow (CFR), serum makers and by imaging studies like echocardiography, computed topography, coronary angiography.Risk factors are cigarette smoking, diabetes mellitus, hypertension, sedentary life style. [omicsonline.org]

  Tobacco consumption is a major concern, with almost 40% of the heart patients in India being chain-smokers. 38% of the heart patients suffer from high blood pressure/hypertension, while 30% of them also suffer from diabetes. [practo.com]

  Smoking Stress Menopause Non-compliance with medicines to treat hypertension and high cholesterol. [summitcardiology.com]

• Vascular Disease

  The Indian population is otherwise also vulnerable to coronary vascular disease and the disease also has an earlier onset in our population. [jmidlifehealth.org]

  Definition / general Atherosclerosis is a chronic vascular disease affecting large and medium sized elastic and muscular arteries, characterized by accumulation within the intima of inflammatory cells, smooth muscle cells, lipid, connective tissue Pathophysiology [pathologyoutlines.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]

  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]

  Generalizing beyond the source observational studies is an important issue for vascular disease risk estimation. [doi.org]

• 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]

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

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

  Effect of dietary n-3 polyunsaturated fatty acids on the inducibility of ventricular tachycardia in patients with ischemic cardiomyopathy. Am J Cardiol. 2008;101(6):758-76118328835 PubMed Google Scholar Crossref 9. [doi.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]

• Type A Personality

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

  Explanatory dynamics based on stress and Type A personality are suggested. Austad, S. N. ( 1997 ). Why we age: What science is discovering about the body’s journey through life. New York : John Wiley. Google Scholar Cassandro, V. J. ( 1998 ). [psp.sagepub.com]

  Tobacco (cigarettes, cigars, pipes), but also chewing tobacco, obesity, high blood pressure (hypertension), diabetes, lack of regular exercise, high-fat diet, emotional stress, and type A personality (impatient, aggressive, competitive). [emedicinehealth.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]

  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]

  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]

• LDL Increased

  In dyslipidemia, subendothelial uptake and oxidation of LDL increases; oxidized lipids stimulate production of adhesion molecules and inflammatory cytokines and may be antigenic, inciting a T cell–mediated immune response and inflammation in the arterial [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]

1. Kreiner M, Okeson JP, Michelis V, et al. Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study. J Am Dent Assoc 2007; 138:74.
2. Constant J. The clinical diagnosis of nonanginal chest pain: the differentiation of angina from nonanginal chest pain by history. Clin Cardiol 1983; 6:11.
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.