Essay On Coronary Artery Disease

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Introduction
Coronary artery disease (CAD) is caused by reduced blood flow in the coronary arteries. This subsequently leads to reduced oxygenation to the myocardium, resulting in transient ischemia or angina. CAD may cause permanent damage to myocardial cells or infarction. The left ventricle of the heart is most susceptible to CAD.
The causes of CAD include atherosclerosis, congenital defects, coronary artery spasm, dissecting aneurysm, infectious vasculitis and syphilis. Atherosclerosis and vasospasm are the most prevalent causes of CAD, with atherosclerosis being the most common.

Pathophysiology
Atherosclerosis
Atherosclerosis is the hardening of the arteries. It occurs when fat, cholesterol and other substances build up in the walls of the arteries and form plaques. It primarily affects the intima of the arterial wall. The process of atherosclerosis begins when the body attempts to heal any irritation, damage or injury to the endothelial lining. CAD progresses though three developments, which are, the fatty streak, the fibrous plaque, and the complicated lesion.
(1) The Fatty Streak
Fatty streaks contain atherogenic lipoproteins and macrophage foam cells. The streak is caused by the development of fatty, lipid-rich lesions that result from macrophages adhering to the vessel’s intact endothelial surface. The streaks usually form between the endothelium and internal elastic lamina of the vessel. The macrophages engulf the lipids, produce a fibrous tissue and stimulate calcium deposition, leading to a thickening of the intimal layer. The smooth muscle cells then migrate to the intima and become lipid laden. Lesions at this stage do no obstruct the artery. However, the continuous cycle results in the transformation of the fat...

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...as the other end is attached to the coronary artery distal to the arterial stenosis. On the other hand, LIMA is carefully dissected away from the chest wall. The distal end of the LIMA is anastamosed to the left anterior descending artery (LAD) whereas the proximal end remains attached to the left subclavian artery. Most CABG procedures use LIMA to bypass the LAD because it has a greater long-term patency than an SVG. The use of LIMA is also associated with a greater rate of long-term survival. At the end of the procedure, the heart is restarted and the sternum is closed and held together with wires.
After the procedure, patients will typically need 1 to several days of intensive care unit management and then up to a week more of further care. Patients with poor exercise capacity before the procedure usually take longer to recover and recover good functional status.

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