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.

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.

Treatment for coronary atherosclerosis aims to manage symptoms, slow disease progression, and prevent complications. Lifestyle modifications, such as a heart-healthy diet, regular exercise, and smoking cessation, are foundational. Medications may include statins to lower cholesterol, antiplatelet agents to prevent blood clots, and beta-blockers or ACE inhibitors to manage blood pressure. In some cases, procedures like angioplasty or coronary artery bypass grafting (CABG) may be necessary to restore blood flow.

The prognosis for individuals with coronary atherosclerosis varies based on the severity of the disease, the presence of risk factors, and adherence to treatment. With appropriate management, many patients can lead active lives and reduce their risk of heart attacks and other complications. However, untreated or advanced cases can lead to significant morbidity and mortality.

Coronary atherosclerosis is primarily caused by a combination of genetic and lifestyle factors. High levels of low-density lipoprotein (LDL) cholesterol, high blood pressure, smoking, diabetes, obesity, and a sedentary lifestyle are significant contributors. Family history and age also play a role, with the risk increasing as individuals get older.

Coronary atherosclerosis is a leading cause of morbidity and mortality worldwide. It is more prevalent in industrialized countries, where lifestyle factors such as diet and physical inactivity are common. The condition affects both men and women, although men tend to develop it earlier. The incidence increases with age and is influenced by genetic predisposition and lifestyle choices.

The pathophysiology of coronary atherosclerosis involves the accumulation of lipids, inflammatory cells, and fibrous elements within the arterial walls. This process begins with endothelial injury, often due to high cholesterol or hypertension, leading to the formation of fatty streaks. Over time, these streaks develop into plaques that can narrow the arteries and restrict blood flow. Plaque rupture can result in clot formation, causing acute coronary events.

Preventing coronary atherosclerosis involves addressing modifiable risk factors. This includes maintaining a healthy diet rich in fruits, vegetables, and whole grains, engaging in regular physical activity, avoiding tobacco use, and managing conditions like hypertension and diabetes. Regular health check-ups and monitoring of cholesterol levels can also help in early detection and management.

Coronary atherosclerosis is a common cardiovascular condition characterized by the buildup of plaques in the coronary arteries. It can lead to reduced blood flow to the heart and increase the risk of heart attacks. Early detection and management through lifestyle changes and medication can significantly improve outcomes. Understanding the risk factors and pathophysiology is crucial for prevention and treatment.

If you have been diagnosed with coronary atherosclerosis, it's important to follow your healthcare provider's recommendations. This may include taking prescribed medications, adopting a heart-healthy lifestyle, and attending regular follow-up appointments. Understanding your condition and actively participating in your care can help you manage symptoms and reduce the risk of complications.

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