CORONARY HEART DISEASE (CAD)

Coronary artery disease is caused by the buildup of cholesterol deposits in walls of the coronary arteries. This is called plaque and may result in the narrowing or occlusion of the artery. Coronary artery disease can lead to angina, acute coronary syndrome (e.g. myocardial infarction or heart attack).

TREATMENT OPTIONS

Treatments for coronary artery disease (CAD) aim to improve blood and oxygen supply to the heart and also reduce the risk of the condition and its speed of progression.

Improving the blood and oxygen supply to the heart:

• Medication
• Percutaneous coronary intervention (PCI also known as angioplasty)
• Coronary artery bypass grafting (CABG)

CHEST PAIN EVALUATION

Patients with chest pain are a diagnostic challenge given the wide array of possible causes, including a potentially life-threatening condition. Some patients (e.g diabetics) may present without classic chest pain but have symptoms of breathlessness, weakness, nausea and vomiting, palpitations, or fainting.

TREATMENT OPTIONS

A detailed history (including family history) and physical examination are needed to aid in the initial assessment. Depending on the clinical evaluation, relevant blood tests, X rays, ECG, echocardiogram, invasive coronary angiogram, CT cardiac and stress testing may be done to reach an accurate diagnosis.

CARDIOGENIC SHOCK

Cardiogenic shock is a medical emergency. It is a condition where the heart is unable to pump enough blood to meet the demands of the body. If prolonged, this can result in organ and tissue damage. Signs may include low urine output, cool arms/legs, reduced level of consciousness. Cardiogenic shock is most often caused by a massive heart attack. However, not all heart attacks result in cardiogenic shock.

TREATMENT OPTIONS

Fluids and plasma, given through an IV, and medications to treat cardiogenic shock, work to increase your heart’s pumping ability. You might be given medications to improve your heart function, until other treatments start to work. Depending on the cause, invasive procedures may be done to such as coronary angioplasty, insertion of a balloon pump in your aorta to support the heart, or even implantation of a mechanical circulatory support to improve blood flow and supply oxygen to the body, such as extracorporeal membrane oxygenation (ECMO). Surgery may be indicated in some cases, and in rare cases, even a heart transplant or mechanical heart.

ACUTE CORONARY SYNDROME

Acute coronary syndrome (ACS) is used to describe a range of conditions brought on by a sudden, reduced blood flow to the heart. ACS encompasses three types of coronary artery disease:

• Non-ST-segment elevation myocardial infarction or heart attack (NSTEMI)
• ST-segment elevation myocardial infarction or heart attack (STEMI)
• Unstable angina.