CORONARY ARTERY DISEASE

Coronary artery disease (CAD), also known as coronary heart disease (CHD) or coronary
atherosclerosis, involves the progressive narrowing of the arteries that nourish the heart muscle.
Often there are no symptoms, but if one or more of these arteries become severely narrowed,
angina may develop during exercise, stress, or other times when the heart muscle is not getting
enough blood.

Cause

The narrowing is due to a buildup of fatty plaque (atherosclerosis) along the artery walls. These
deposits are composed mostly of cholesterol, other lipids, and fibrous tissue, such as collagen.
Coronary disease appears to be a lifelong process in some people, beginning at an early age
and progressing slowly until the vessels become so occluded that the heart muscle no longer
gets adequate nourishment.

Diagnosis

A coronary artery must be narrowed to less than 30% of its original size before there is a serious
reduction in the blood flow to the heart muscle served by that vessel. Generally, about 5% of the
total cardiac output of blood goes through the coronary arteries; thus there is adequate coronary
blood flow to meet normal demands at rest even if the vessels are 70 to 90% occluded. If the
coronary arteries are seriously blocked, however, blood flow may not be adequate for any
increased demand, such as that of exercise or an emotional upset. If the heart muscle cannot
get enough oxygena state known as myocardial ischemiasymptoms such as chest pain
(angina) or shortness of breath may result.

A presumptive diagnosis of coronary disease is based on a review of symptoms, health history,

an electrocardiogram, and an exercise stress test, perhaps with a thallium scan. A more
definitive diagnosis requires cardiac catheterization and angiography.

During an exercise stress test, the patient is hooked up to an electrocardiographic monitor (an
ECG or EKG machine) and then asked to walk on a treadmill, peddle a stationary bicycle, or
climb steps. The ECG monitor will show whether the heart muscle is getting enough blood. An
exercise test also detects silent ischemia, a condition with no symptoms in which heart muscle
does not get enough blood.

If severe narrowing is suspected, a coronary angiogram may be needed. This examination

entails threading a catheter through a blood vessel into the heart, and then injecting a dye into
the coronary arteries to make them visible on x-rays.

Treatment

Various medications constitute the first-line treatment of coronary artery disease. These include:

Beta-Blocking Drugs: These agents act by blocking the effect of the sympathetic nervous
system on the heart, slowing heart rate, decreasing blood pressure, and thereby reducing the
oxygen demand of the heart. Studies have found that these drugs also can reduce the chances
of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart
attack and continued for 2 years.

Calcium-Channel-Blocking Drugs: All muscles need varying amounts of calcium in order to

contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery
walls, spasms can be prevented. Some calcium-channel-blocking drugs also decrease the
work-load of the heart and some lower the heart rate as well.

Surgical Treatment
Coronary artery bypass surgery

This operation, once considered a difficult achievement, is now almost routine in many medical
centers. Indeed, there is a good deal of controversy over whether it is now being used
unnecessarily to treat coronary disease that could be controlled just as effectively by more
conservative, less costly medical therapies.

Studies have conclusively demonstrated that the operation prolongs life in patients who have a
severely blocked left main coronary artery. It is also indicated in most cases in which three
major arteries are diseased. In general, it is recommended for people with disabling angina that
cannot be controlled by conventional therapy and who are also good candidates for surgery.

It should be noted that not all people with severe coronary disease are suitable candidates for
surgery, and also that the operation is not always successful in achieving its intended goals. As
with any surgical procedure, the operation involves some risk

Although bypass surgery greatly improves the way most patients feel, it is not a cure for heart
disease. Unless other preventive steps are taken, the processes that caused the artery disease
will continue.

Angioplasty

A relatively recentand increasingly populartreatment for atherosclerotic arterial diseases is

transluminal angioplasty, also referred to as balloon angioplasty. Used to treat severely blocked
coronary arteries as well as arteries diseased with atherosclerotic plaque in other parts of the
body, this technique involves threading a catheter with an inflatable balloonlike tip through the
artery to the area of blockage. The balloon is inflated, flattening the fatty deposits and widening
the arterial channel, allowing more blood to reach the heart muscle.

Angioplasty offers several obvious advantages:

The operation is performed under local anesthesia.

Although invasive, it does not involve surgery or the use of a heart-lung machine.
It is not as costly as coronary bypass surgery, nor does it involve more than 1 or 2 days
of hospitalization under ordinary circumstances.

Unfortunately, it is not appropriate for all types of coronary artery disease, nor does it work in all
people. For example, studies show that women are not as likely as men to benefit from the
operation; they also have a higher mortality rate from the procedure. Some studies have put the
success rate at about 60 percent; people who undergo an unsuccessful angioplasty still may
require coronary bypass surgery.

A. Responder las siguientes preguntas:

1. Escribe en espaol la definicin de Enfermedad Coronaria.

2. A qu se debe el estrechamiento de las arterias?
3. Por qu razn suele haber un flujo sanguneo adecuado an cuando los vasos
estn ocluidos entre un 70 a un 90%?
4. A qu se denomina isquemia miocrdica y cules son sus sntomas?
5. En qu se basa el diagnstico presuntivo?
6. Cundo es necesario un angiograma y en que consiste?
7. Cmo actan los beta bloqueantes?
8. Cul es el fundamento del uso de los bloqueadores de los canales de calcio
para el tratamiento de la enfermedad?
9. En que casos se indica la realizacin de bypass coronario?
 10. Qu ventajas ofrece la angioplastia?

b. Interpretar los siguientes prrafos:

1. Often there are no symptoms, but if one or more of these arteries become severely narrowed,
angina may develop during exercise, stress, or other times when the heart muscle is not getting
enough blood.

2. A coronary artery must be narrowed to less than 30% of its original size before there is a
serious reduction in the blood flow to the heart muscle served by that vessel.

3. If the coronary arteries are seriously blocked, however, blood flow may not be adequate for
any increased demand, such as that of exercise or an emotional upset.

4. This operation, once considered a difficult achievement, is now almost routine in many
medical centers. Indeed, there is a good deal of controversy over whether it is now being used
unnecessarily to treat coronary disease that could be controlled just as effectively by more
conservative, less costly medical therapies.

5. It should be noted that not all people with severe coronary disease are suitable candidates for
surgery, and also that the operation is not always successful in achieving its intended goals. As
with any surgical procedure, the operation involves some risk

6. Although bypass surgery greatly improves the way most patients feel, it is not a cure for heart
disease. Unless other preventive steps are taken, the processes that caused the artery disease
will continue.

C. Completar los siguientes prrafos:

1. Un tratamiento relativamente reciente..

.
.

2. Usado para tratar

esta tcnica implica.

3. Desafortunadamente.
..
...