CORONARY ARTERY DISEASE (CAD), ATHEROSCLEROSIS

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Coronary Artery Disease (CAD), Atherosclerosis

Coronary artery disease is a condition in which the heart muscle receives insufficient blood supply through its feeding artery.
There are two main causes of vessel narrowing:

• Atherosclerosis
• Coronary artery spasm

Types of CAD

1.    Silent (asymptomatic) ischemia, diagnosed via ECG and/or Holter monitoring
2.    Prinzmetal’s (variant) angina — vasospastic in nature
3.    Exertional (stable) angina
4.    Acute coronary syndrome (including acute myocardial infarction and unstable angina)

Main symptoms:

Chest pain, pressure, or heaviness behind the sternum, which may radiate to the left arm or lower jaw. Symptoms typically occur after physical exertion or with elevated blood pressure.

Risk Factors for CAD

• Smoking
• Elevated LDL cholesterol
• Arterial hypertension
• Diabetes mellitus
• Obesity
• Low physical activity
• Family history of cardiovascular disease
• Age (men > 45 years, women > 55 years)

Diagnostic Methods

• ECG (electrocardiography)
• Echocardiography
• Treadmill test (exercise stress test)
• Coronary angiography

Among laboratory tests, troponin T is particularly important — it is a key marker of myocardial injury.
In patients with typical cardiac complaints, even if ECG and echocardiography are inconclusive, troponin T must be tested, as myocardial damage may already be in progress.

Arterial Hypertension

Arterial hypertension is a sustained increase in blood pressure above 140/90 mmHg, confirmed at least during two separate clinic visits.
There are European and American classifications of hypertension; the European classification is used in Armenia.

Main Risk Factors

• Heredity
• Obesity
• Age
• Excessive dietary salt intake
• Chronic stress
• Physical inactivity (hypodynamia)

Symptoms of hypertension are varied: headache, dizziness, tinnitus (ringing in the ears)

Causes

    Primary (essential) hypertension — no identifiable underlying cause; accounts for ~90% of all cases
    Secondary hypertension — caused by another condition, such as:
    Renal pathologies (e.g., renovascular stenosis, glomerulonephritis)
    Endocrine disorders (e.g., Conn’s syndrome, pheochromocytoma, hyperthyroidism)
    Certain medications

Complications

• Heart: Myocardial infarction
• Brain: Stroke
• Kidneys: Chronic kidney disease
• Eyes: Retinal damage and vision loss

Treatment Approaches

Treatment includes both non-pharmacological and pharmacological strategies.
Non-pharmacological treatment — a critical component that patients must strictly follow:

• Weight reduction
• Limiting salt intake to 5 g/day (about 1 teaspoon)
• Increasing physical activity
• Quitting smoking and alcohol

Pharmacological treatment involves a wide range of antihypertensive medications, selected by the physician based on the patient’s overall condition and comorbidities.

Cardiology Services at VitaMed Medical Center (Yerevan, Charentsavan, Stepanavan)