Coronary artery disease

 CORONARY ARTERY DISEASE (CAD)

The commonest form of coronary artery disease is narrowing of the vessel lumen by atherosclerotic plaque(s).The most frequent symptom of CAD is chest pain (angina pectoris) due to myocardial ischemia.

Coronary Arteries

 There are two main coronary arteries which branch to supply the entire heart. They are named the left and right coronary arteries,and arise from the left and right aortic sinuses within the aorta.

Branches of Left coronary artery are:

1. Left anterior descending artery (LAD) or anterior

interventricular artery

2. Left marginal artery (LMA)

3. Left circumflex artery (Cx)

Branches of Right coronary artery are:

1. Right Marginal artery

2. Posterior interventricular artery


MYOCARDIAL ISCHEMIA

Ischemia results in immediate changes which can be detected by echo:

Abnormalities of wall motion (hypokinetic, akinetic, dyskinetic)

Abnormalities of wall Thickening Abnormalities of overall LV function (e.g. EF) These can be detected by 2-D echo but M-mode is also extremely good because it is very sensitive to wall motion and thickening abnormalities. 


The changes reverse if ischemia is reversed, e.g. by rest, antianginal medication, percutaneous transluminal coronary

angioplasty, thrombolysis or coronary artery bypass grafting.

 If the myocardium has its blood supply occluded for more than 1

hour, permanent changes occur which include MI and scarring.


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