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Brief Analysis and Review of “Coronary Artery Disease” (CAD)

a. Introduction of disease

Coronary artery disease (CAD), also referred to as coronary heart disease (CHD), is

associated with the attenuation or inside thickening of blood vessels or coronary arteries

supplying blood into the heart of the patient (Shahjehan & Bhutta, 2022). Due to this problem,

the patient tends to experience shortness of breath and angina while engaging in physical activity

or exercise since the heart does not receive enough blood. Hence, less oxygen is supplied to the

brain. In extreme cases, these arteries get blocked, leading to heart attacks (Shahjehan & Bhutta,

2022). The disease develops when the coronary arteries’ lumen develops plaques, which then

reduces oxygen and blood flow to the myocardium of the heart. It forms part of the main

cardiovascular illnesses taking almost 18 million people's lives each year (WHO, 2022). Out of

this population, most of them are older people over 70 years of age since they are the most likely

to be affected by immunity weakness. Also, their former lifestyle when they were young dictates

their health.

b. Etiology and risk factors

Various etiology and risk factors are causing CAD, with all of them lying in two main

groups; “non-modifiable” and “modifiable factors”. Modifiable factors include; tobacco use,

lipid levels, obesity and psychosocial elements. On the other hand, the unchangeable factors

include; genetics, family history, age, and gender of the patient. Beginning with the modifiable

factors, smoking tobacco and other substances remain the top causes of CAD since the inhaled

chemical particles from the cigarette tend to stick to the arteries supplying blood to the heart,

impeding the blood flow (WHO, 2022). Other causes include eating unhealthy meals and intake

of foods with lots of fats as they are the ones that tend to cause cholesterol or lipids to clog along
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the heart walls and also the key arteries. Under nonmodifiable factors, it is common to find a

CAD patient to come from a family where members died of the same disease or other

cardiovascular diseases (WHO, 2022). Males are generally at a higher risk of developing CAD

and other cardiovascular illnesses than women due to their lifestyles of drinking and smoking

more than women.

c. Pathophysiological processes

Atherosclerotic plaque development along the coronary arteries is the main cause of CAD. The

plaque is usually made up of fatty materials that begin as small streaks but accumulate as the

person ages. This process begins with foam cells, otherwise referred to as lipid-laden

macrophages, being deposited in the subendothelial space that occurs during a vascular insult

that causes the intima layer to break (Shahjehan & Bhutta, 2022). The formation of the foam

cells is usually a result of oxidized “low-density lipoprotein” (LDL) particles being taken up by

the macrophages, which grow along the endothelial layer of the arteries over time. The

population of the foam cells then increases from the smooth cells initiated by the cytokines

resulting from T cells being activated during the deposition as a method of facilitating the

pathologic process. The smooth cells also increase the take-up of oxidized LDL particles,

increasing the thickening of the inner walls of the arteries (Shahjehan & Bhutta, 2022). Over

time, these macrophages grow into hemodynamically important lesions, which start causing

angina, especially during increased demand for oxygen, such as during exercises or physical

activities.

d. Clinical manifestations and complications

There are different ways through which CAD presents itself clinically such as; it begins as an

“acute coronary syndrome” (ACS) or “stable ischemic heart disease” (SIHD), whereby patients
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feel little pain after engaging in work the whole day or vigorous physical activities like playing

with their children or walking for long distance. As time goes on and the patient does not receive

any treatment, this issue advances to form complications such as congestive heart failure (CHF)

that are highly associated with issues of extreme chest pains or angina when engaged in even

small physical activity and, at times shortness of breath (Shahjehan & Bhutta, 2022). When the

arteries are over 90% blocked, the patients might even start experiencing angina and pains in

other parts of the body, like the jaw and neck, while at rest. Other manifestations of CAD

include; peripheral edema, jugular venous distention, and acute distress, among others

(Shahjehan & Bhutta, 2022).

e. Diagnostics

To investigate the patient's situation, diagnostics will involve Electrocardiogram (EKG) tests

which utilize ten leads placed on the patient’s skin on the chest at specified areas to measure the

cardiac conduction system’s electrical activity. Echocardiography or ultrasound of the heart is the

second test to help study key heart parts such as chamber sizes, infective or autoimmune lesions,

stenosis, valvular regurgitation, and wall motion (Shahjehan & Bhutta, 2022). This goes hand in

hand with the Chest X-ray test, which helps to study left lateral decubitus and to stand

posteroanterior (PA). Stress test which is often used to prove the presence of CAD. Artificial

exposure of the heart to stress helps to identify if the patient develops certain abnormal EKG

changes in “ST segments” or CAD symptoms like angina and dyspnea. Other tests include

bloodwork and cardiac catheterization that introduce factors like “Cardiac enzymes”, CK and

troponin to provide details regarding an “acute ischemic event” (Shahjehan & Bhutta, 2022).

f. Interview
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 What is the age of the individual being interviewed? What is the relationship of the

individual to you?

The individual interviewed was 78 years old and is a family friend of my parents.

 How long have they had the disorder?

The individual claimed to have developed the issue for over half a decade.

 What clinical manifestations of the disorder does the individual experience? How

does it compare to what you discovered in your resources?

The individual claims to have extreme chest pains while moving around his farm and

after feeding his animals, and at times when sleeping at night, he experiences shortness of

breath and angina. These symptoms did not deviate from those indicated in the sources at

all.

 What complications of the disorder does the individual experience? How does this

compare to what you discovered in your resources?

The complications the individual faces include acute coronary syndrome (ACS). These

symptoms are accurate since, in the research, I learned how CAD manifests itself as ACS.

 What other medical conditions/disorders has the individual been diagnosed with?

Do their other medical conditions have any effect on the chosen disorder?

The other illness the patient has is type 2 diabetes, which affects his CAD condition

because it increases his risk of succumbing to the illness.

 How does the disease affect the individual’s daily living/activities?

The disease reduces the patient's time with his family since he is scheduled to have

several medical appointments per week. Taking many meds also affects the patient's life
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since most of his retirement income is spent on medication and not taking care of his

family.

 How does the disease/disorder affect the individual’s outlook on life?

The illness affects the patient as he feels like a burden to his family, who have to take

care of him in most cases. The patient also feels hopeless but is trying to be optimistic

that the medications will work and will be able to see his future grandkids grow.

 What did you learn from interviewing the individual?

I learned from the interview that engaging in sports and high-energy physical activities

when young is important. I also learned that it is better to learn how to avoid drugs and

alcohol as young as I am so that I can avoid such illnesses in the future.

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References

Shahjehan, R. D., & Bhutta, B. S. (2022). Coronary artery disease. In StatPearls [Internet].

StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK564304/

World Health Organization (2022). Cardiovascular diseases.

https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1