CAD: Causes, Symptoms & Treatment of Coronary Artery Disease - Essay Sample

Introduction

Coronary artery disease (CAD) is one of the most common heart diseases in the United States (Mack & Gopal, 2016). CAD is a disease of narrowing of coronary vessels that supply blood to the heart muscle. The symptoms of CAD are a result of fatigue of the heart muscle due to inadequate perfusion. The signs and symptoms of this disease include chest pain, shortness of breath, indigestion, heartburn, lightheadedness, sweating, among others (Mack & Gopal, 2016). This paper will analyze the case of 71year old Marylin Banks, who was recently released from the hospital after treatment of chest pains and discomfort.

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Risk Factors for CAD

Marylin's history depicts several risk factors for CAD. She is a non-insulin dependent diabetic. CAD is one of the significant complications of diabetes mellitus. This is because diabetes increases the risk of developing atherosclerosis whose sequelae is narrowing of coronary vessels. The patient also has a family history of coronary heart disease. Her immediate family members, that is, her father and brother had CAD. This increases her risk of developing the disease. She is also advanced in age. The risk for CAD increases with age. Marylin is clinically obese. Her calculated BMI is 34.11, which is miles above the healthy BMI of 18.5 to 24.5 (Mack & Gopal, 2016).

Common Pathophysiology of CAD

Pathogenesis of CAD begins the formation of atheromatous plaques on arterial walls. This starts with endothelial cell injury. This increases the permeability and subsequent entry of lipids into the intima of the artery. There is then the accumulation of lipoproteins on the vascular wall with platelet adhesion. Macrophages are recruited at the site as they engulf the accumulated lipids. The result is intimal thickening with an atheromatous plaque with a lipid core and a fibrous white cap. The lipid core is composed of cholesterol esters and necrotic debris. This process eventually leads to narrowing of the vessel lumen (Mack & Gopal, 2016). The risk of developing atheromatous plaques increases with increased plasma cholesterol. Narrowing of coronary vessels reduces the perfusion of the myocardium. Fatigue of the heart muscle leads to symptoms such as shortness of breath and chest pain that commonly radiates to the left shoulder.

Evaluation of Blood Results

Marylin blood work reveals normal levels of troponin, creatine kinase, myoglobin and B-Type natriuretic peptide. These molecules are indicative of cardiac injury or ischemia. They are indicators of myocardial infarction. This patient is, therefore, not having an ischemic cardiac event. Marylin, however, has elevated levels of cholesterol, LDL and Triglycerides, with low HDL and normal glucose. Her cholesterol 260mg/dl, which is elevated as normal cholesterol for a woman her age is less than 200mg/dl (Adhyaru & Jacobson, 2016). Her LDL level is 189mg/dl, elevated from the normal of less than 100mg/dl. The patient's triglycerides are elevated at 220mg/dl. The normal triglyceride levels are less than 100mg/dl (Adhyaru & Jacobson, 2016). Her levels of these three molecules are predisposing factors to CAD. While her HDL levels are lower than the normal of 50 to 59mh/dl, this lipoprotein is known as the 'good cholesterol'. HDL lowers body cholesterol levels by returning it to the liver for breakdown. Marylin's blood glucose is normal despite her being diabetic. This means that her diabetes is well managed on metformin.

C - Reactive Protein In CAD

C-reactive protein (CRP) is a marker of acute inflammation. Scientists have identified relations between inflammation and development of CAD. CRP has been isolated from atheromatous plaques. It mediates the polarization of M1 macrophages, which eventually inhibits angiogenesis and promotes t-lymphocyte mediated endothelial destruction. The sequelae of this prolonged and persistent inflammation are continuous thickening of the arterial intima. This leads to narrowing of the vessels and increased size of myocardial infarcts.

Heart Disease As an 'Old Man's Disease'

The incidence of heart disease increases with age. This is because risk factors for heart disease become more prevalent with age. These include elevated plasma cholesterol as well as advanced age itself. However, this does not restrict heart disease to only the older population. Younger people with predisposing factors to heart disease are just as likely to develop heart disease as older people. This includes obese people in all age groups.

Evaluation of EKG and Stress Test

Marylin has a normal EKG at rest. This shows a well-perfused heart at rest. She has a normal rhythm and conduction. The stress test at 5 minutes showed a prolonged QT interval. In normal individuals, QT intervals are shortened during exercise. This is due to the inhibition of parasympathetic stimulation and inhibition of sympathetic stimulation (Adhyaru & Jacobson, 2016). The patient's prolonged QT interval is indicative of CAD. Coronary angiography revealed a 50 per cent blockage of the coronary artery. This confirms the diagnosis of CAD and explains her symptoms of shortness of breath and chest pains radiating to the left shoulder.

Reason for Increased Dose of Atorvastatin Calcium

Marylin's cholesterol, LDL and triglycerides were persistently low despite being on atorvastatin calcium 40mg PO daily. Increased dose of this drug to 80mg PO daily was targeted towards a further decrease of these three molecules in the blood as well as increasing the levels of HDL.

Purpose of Medications

Atorvastatin Calcium

This drug belongs to the statin group of lipid-lowering agents. Its purpose is to lower cholesterol production by the liver as well as increase HDL levels (Mihan, 2016).

Metformin HclThis drug belongs to the biguanide class of glucose-lowering antidiabetic agents. Its function is to lower blood glucose levels by decreasing insulin resistance.

Metroprolol Titrate

This is a beta blocker used in hypertensive patients to lower blood pressure.

Nitroglycerin

This is a nitrate used in CAD patients to prevent angina. It works by relaxing the arterial muscle and hence widening of the vessel lumen increasing blood flow to the heart (Mihan, 2016).

Lifestyle Changes

I would advise Marylin to be more physically active to lose some weight. She should also avoid foods high in cholesterol such as eggs and other fatty meat products, as well as saturated oils such as palm oil and palm kernel oil (Adhyaru & Jacobson, 2016). I would also recommend regular medical checkups to keep her blood pressure and cholesterol levels in check.

References

Adhyaru & Jacobson (2016). New Cholesterol Guidelines For The Management Of Atherosclerotic Cardiovascular Disease Risk: A Comparison Of The 2013 American College Of Cardiology/American Heart Association Cholesterol Guidelines With The 2014 National Lipid Association Recommendations For Patient-Centered Management Of Dyslipidemia. Endocrinology and Metabolism Clinics, 45(1), 17-37.

Mack & Gopal. (2016). Epidemiology, Traditional And Novel Risk Factors In Coronary Artery Disease. Heart Failure Clinics, 12(1), 1-10.

Mihan juhas. (2016). Treatment of Ischaemic Heart Disease: Coronary Heart Disease (CAD). Department Of Pharmacology, Masaryk University School of Medicine. Bryno, Czech Republic.