Definition:
Atherosclerosis (arteriosclerosis)is a clinical condition characterized by narrowing of medium and large-sized arteries as a result of lipid accumulation in the body.
Atherosclerosis can cause various clinical conditions depending on the vessel it affects. Coronary artery disease is one of these clinical conditions.
Coronary arteries are vessels that feed the heart muscle. As a result of the narrowing of these vessels, blood flow to the heart muscle decreases. Over time, this narrowing in the coronary arteries may progress and cause complete blockage of the vessel. This condition can cause severe chest pain, shortness of breath and decreased exercise capacity, heart attack and sudden cardiac death.
Heart attack is the cell death in the heart muscle that occurs as a result of inadequate nutrition of the heart due to various reasons. As a result of a heart attack, the heart muscle is seriously affected, depending on the condition of the vascular occlusion.
It may not be seen as typical as chest pain in all patients. In fact, in some patients, the disease progresses insidiously and no symptoms may be observed for years. The progression of the disease and the symptoms seen vary from patient to patient.
Coronary artery disease is the leading cause of death worldwide. Therefore, knowing the risk factors of this disease and carefully examining patients at risk is important for early diagnosis and treatment of coronary artery disease.
Risk Factors
Hyperlipidemia. , hypertension, diabetes, smoking, and the presence of coronary artery disease in the family are typical risk factors for coronary artery disease.
Although the effect of genetic factors on coronary artery disease is not fully understood, especially in first-degree relatives at an early age (<45 in men, in women). <55)Individuals with coronary artery disease are at serious risk.
Hyperlipidemia is an important risk factor for coronary artery disease and it is recommended that every individual over the age of 20 have their lipid levels checked once every 5 years.
Familial hyperlipidemia syndromes associated with coronary artery disease have also been described. Early recognition and treatment of these syndromes and early prevention of coronary artery disease are very important.
Apart from these, there are laboratory data such as homocysteine, lipoprotein a, fibrinogen and C-reactive protein (CRP) used to determine individuals at risk for coronary artery disease. Among these, CRP is a much-studied molecule and is frequently used in the diagnosis of coronary artery disease and response to treatment.
Diagnosis
Individuals with risk factors should be evaluated by a cardiologist once a year for coronary artery disease.
Patients' lipid profiles and electrocardiograms should be examined at every visit. In patients deemed necessary, further examinations such as exercise test, myocardial perfusion scintigraphy and coronary CTA should be performed.
Coronary angiography should be performed for those with highly suspicious findings for coronary artery disease in these tests to confirm the diagnosis and plan the necessary treatment. Coronary angiography is the imaging of coronary arteries by administering contrast material. During the procedure, stenosis in the coronary vessels is detected and the treatment of the patients is planned.
Treatment
Patients with coronary artery disease detected after coronary angiography have various treatment options depending on the severity of the stenosis in their vessels. These are grouped under three headings.
2. Drug treatment
3. Coronary artery intervention (balloon+stent applications)
4. Surgery (Bypass)
Life change: Diagnosis of coronary artery disease Patients who have taken it are advised to definitely quit smoking, stay away from smoking environments, do regular exercise (45 minutes of brisk walking at least three times a week) and be evaluated by a dietitian and follow an appropriate diet.
Drug treatment:Main drugs used for coronary disease; aspirin, clopidogrel, beta blockers, ACE inhibitors, nitrates and calcium channel blockers. These drugs are used in different combinations in suitable patients.
Intervention in coronary arteries: In suitable patients, stenosis in the coronary vessels can be opened by balloon and stent applications. Life changes and drug therapy after the procedure are very important for patients with stent placement to keep the stents open. Patients who undergo this treatment should be under close follow-up of doctors.
Surgery: Those with serious stenosis in all three vessels, those with serious lesions in the left main coronary artery, and diabetic patients are the main candidates for surgery. Suitable patients benefit greatly from this treatment.
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