CORONARY ARTERY DISEASE

Definition:
atherosclerosis (hardening of the arteries)It is a clinical picture that progresses with narrowing of these vessels as a result of lipid accumulation in medium and large-scale arteries in the body.

Atherosclerosis can cause various clinical conditions depending on the vessel it affects. Coronary artery disease is one of these clinical pictures.

Coronary arteries are the vessels that feed the heart muscle. As a result of the narrowing of these vessels, the blood flow to the heart muscle decreases. Over time, this narrowing of the coronary vessels may progress and cause complete occlusion of the vessel. This can cause severe chest pain, shortness of breath, and decreased effort capacity, heart attack, and sudden cardiac death.
A heart attack is cell death in the heart muscle that occurs as a result of malnutrition of the heart for various reasons. As a result of a heart attack, the heart muscle is affected very seriously, depending on the state of vascular occlusion.

It may not be as typical as chest pain in all patients. In some patients, the disease progresses insidiously and no symptoms can be seen for years. The progression of the disease and the observed findings vary from patient to patient.

Coronary artery disease ranks first among deaths worldwide. Therefore, it is important to know the risk factors of this disease and to carefully examine the patients at risk for the early diagnosis and treatment of coronary artery disease.

Risk factors

Hyperlipidemia, hypertension, diabetes, smoking, family history of coronary artery disease 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, <55 in women)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 should 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 is very important to prevent coronary artery disease in the early period.

Apart from these, there are laboratory data such as homocysteine, lipoprotein a, fibrinogen and C-reactive protein (CRP), which are used to identify individuals at risk for coronary artery disease. Among them, CRP is a molecule that has been studied extensively and is frequently used in the diagnosis of coronary artery disease and in response to treatment.

Diagnosis

Individuals with risk factors should be evaluated for coronary artery disease by a cardiologist once a year.
The lipid profiles and electrocardiograms of the patients should be reviewed at each visit. Further tests such as exercise test, myocardial perfusion scintigraphy and coronary CTA should be performed in patients deemed necessary.
Coronary angiography should be performed in order to confirm the diagnosis and plan the necessary treatment for those with highly suspicious findings in terms of coronary artery disease in these tests. Coronary angiography is the imaging of coronary artery vessels with contrast material. During the procedure, stenosis in the coronary vessels is detected and the treatment of the patients is planned.

Treatment
Patients diagnosed with coronary artery disease after coronary angiography have various treatment options depending on the severity of the stenosis in their vessels. These are grouped under three headings.
1. Life change
2. Drug therapy
3. Intervention in coronary arteries (balloon + stent applications)
4. Surgery (Bypass)

Life change: Patients diagnosed with coronary artery disease should definitely quit smoking, stay away from smoking environments, and exercise regularly. (45 minutes brisk walking at least three times a week)It is recommended that they be evaluated by a dietitian and make an appropriate diet.
Medication: The 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 appropriate patients.

Intervention in coronary arteries: In suitable patients, stenosis in coronary vessels can be opened with balloon and stent applications. Post-procedure life changes and drug therapy in patients with stent placement are very important to keep the stents open. Patients undergoing this treatment should be under close monitoring of doctors.

Surgical: Patients with severe stenosis in all three vessels, severe lesions in the left main coronary, and diabetic patients are the main candidates for surgery. Appropriate patients benefit greatly from this treatment.
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