Disease Description (Causes and Symptoms)
- Definition: A group of diseases in which the myocardium receives insufficient oxygen and nutrients due to impaired blood flow in the coronary arteries (ischemic heart disease). Clinically, this includes stable angina, unstable angina, and acute myocardial infarction (AMI).
- Main cause: Narrowing and thrombus formation caused by atherosclerosis (plaque formation) in the coronary arteries.
- Pathophysiology (summary):
- When the lumen of a coronary artery becomes substantially narrowed (usually by approximately 70% or more), blood flow to the myocardium becomes insufficient during exercise or stress, resulting in angina.
- When a coronary artery becomes completely or suddenly occluded, the myocardium supplied by that artery loses its blood supply, resulting in necrosis (myocardial infarction). According to the provided material, permanent necrosis of the myocardium may occur if the coronary artery is not recanalized within approximately 6 hours after occlusion.
- Ischemic myocardium has increased electrical instability and may cause arrhythmias (such as ventricular fibrillation) and sudden death. The dangerous period of acute myocardial infarction is known to be between 3 days and 1 week after onset.
- Main symptoms:
- Chest pain (center or left side of the chest) — pressure, tightness, or burning sensation lasting several minutes to several tens of minutes
- Radiating pain (to the neck, jaw, left arm, etc.), shortness of breath, cold sweats, vomiting, fatigue
- Some patients, particularly older adults and people with diabetes, may have asymptomatic ischemia (silent ischemia)
Treatment Methods
- Acute phase (unstable angina and acute myocardial infarction):
- Emergency treatment: Oxygen (if necessary), aspirin (initially), nitrates (oral/sublingual/injection for relief of chest pain), analgesics (if necessary), etc.
- Antithrombotic therapy: Aspirin + a P2Y12 inhibitor (such as clopidogrel, prasugrel, or ticagrelor), with an anticoagulant if necessary
- Reperfusion therapy:
- Percutaneous coronary intervention (PCI, stent placement): Performed as an emergency priority when possible (within the recommended time for each institution)
- Thrombolysis (when emergency PCI is unavailable)
- Medications to protect myocardial function and reduce complications: Beta-blockers, ACE inhibitors/ARBs, and high-intensity statins
- Chronic phase (stable coronary artery disease):
- Medication: Antiplatelet agents (such as aspirin), statins (to correct hyperlipidemia), beta-blockers, calcium channel blockers, and nitrates (for symptom control), and ACE inhibitors/ARBs (to protect cardiac function)
- When reperfusion is indicated: Selective PCI or coronary artery bypass grafting (CABG)
- Cardiac rehabilitation: Gradual exercise programs and education to improve risk factors
- Lifestyle management and precautions:
- Stop smoking, strictly manage blood pressure, blood glucose, and lipid levels, control weight, eat a balanced diet (low in sodium and saturated fat), and engage in regular aerobic exercise (as directed by a physician)
- Take medications as prescribed (particularly antiplatelet agents and statins)
- Immediate emergency department visit is recommended if chest pain occurs (especially if the pain persists or worsens)
- Complications (caution):
- Heart failure, decreased cardiac performance (reduced left ventricular function), mechanical complications such as ventricular aneurysm and myocardial rupture, and various arrhythmias (including sudden death due to ventricular fibrillation)
- Prognosis:
- Varies according to the extent of coronary artery occlusion and myocardial necrosis. Prognosis can be improved through early reperfusion and appropriate treatment. The acute phase (3 days to 1 week after onset) carries a high risk of complications.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare and confirm:
- List of all medications currently being taken (including prescription drugs, OTC medications, and supplements)
- Previous medical certificates and surgical records (including whether coronary artery procedures or surgery were performed), and previous test results (electrocardiogram, echocardiogram, coronary angiography, and blood tests)
- Record of symptom changes: Time of onset, duration, frequency, triggers (exercise, meals, and stress), and characteristics of the chest pain (pressure/burning sensation/radiation sites)
- Lifestyle information: Smoking, alcohol consumption, amount of exercise, and whether hypertension, diabetes, or hyperlipidemia is present
- Contact information for a caregiver who can be reached in an emergency
- Information to tell the medical staff in advance during the outpatient visit:
- Changes in recent chest pain attacks (increased frequency or changes in frequency or pattern)
- New symptoms such as fainting, tachycardia, or shortness of breath
- Whether anticoagulants or antiplatelet agents are being taken (important before a procedure)
General Example Questions to Ask the Doctor
- What are the main side effects of this medication (or combination of medications)? What precautions should I take when taking it?
- What is my prognosis? To what extent is my cardiac function (left ventricular contractility) preserved?
- When can I resume daily activities (driving, exercise, and returning to work)? What activities should I avoid?
- What should I do if a situation occurs in which I need to stop taking my medication (such as bleeding)?
Examples of Disease-Specific Questions
- What is the degree and location of narrowing in my coronary arteries? Do I need stent placement or coronary artery bypass grafting (CABG)?
- When this chest pain (or myocardial infarction) occurred, was the available time for reperfusion (PCI/thrombolysis) adhered to, and how much of the remaining myocardium could be saved?