Coronary Atherosclerosis

Arteriosclerosis is a cardiovascular disease, Thickening and loss of elasticity of the coronary arteries leads to a progressive insuffiency of the artheries,plaque builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart. When blood flow to your heart is reduced or blocked, it can lead to chest pain and heart attack. CAD also is called heart disease, and it's the leading cause of death in the United States.

Arteriosclerosis is a disease in which the fatty materials is deposited on the wall of the artery, normally walls on the artery was smooth allowing blood to flow blood un-pleted ,however if damaged occurs to interlining ,Fat ,cholesterol platelets other substances may accumulate in damaged section of the arterial wall, eventually the tissue buildup up and plaque is formed narrowing the lumen of the artery ,when narrowing is severe there is risk vessel becoming blocked completely ,If the thrombus formed is diseased segment

Coronary Bypass Surgery

Coronary bypass surgery is a common procedure used to divert blood around blocked arteries in the heart. Coronary bypass surgery remains one of the gold standard surgical treatments for coronary artery disease.

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Just like all the other organs in your body, your heart needs blood and oxygen to do its job. Coronary arteries snake across the surface of your heart, delivering a constant supply of much-needed blood and oxygen to the heart muscle. When one or more of these arteries becomes narrowed or blocked, blood and oxygen are reduced and heart muscle is damaged.Coronary bypass surgery uses a healthy blood vessel harvested from your leg, arm, chest or abdomen and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area.

If lifestyle changes and medication haven't relieved your symptoms or if your narrowed coronary arteries put you at imminent risk of a heart attack, you and your doctor will need to consider whether coronary bypass surgery or another artery-opening procedure such as angioplasty is right for you.

Bypass surgery is an option if:

• You have debilitating chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during light exercise or at rest. Sometimes angioplasty and stent placement will bring relief in this situation, but for some, bypass is the best option.
  
• You have more than one diseased coronary artery and the heart's main pump — the left ventricle — is functioning poorly.
  
• Your left main coronary artery is severely narrowed or blocked. This artery feeds blood to the left ventricle.
  
• You have an artery blockage for which angioplasty isn't appropriate, you've had a previous angioplasty or stent placement hasn't been successful, or you've had angioplasty but the artery has narrowed again (restenosis).
  
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Coronary bypass surgery doesn't cure the underlying disease process called atherosclerosis or coronary artery disease. Even if you have bypass surgery, lifestyle changes are still necessary and an integral part of treatment after surgery. Lifestyle changes — especially smoking cessation — are crucial to reduce the chance of future blockages and heart attacks, even after successful bypass surgery. In addition, you will likely need to make other lifestyle changes, such as reducing certain types of fat in your diet, increasing physical activity, and controlling high blood pressure, diabetes and other risk factors for heart disease. Medications are routine after heart surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart function as well as possible.

Genetics of Heart Disease

The major reason heart disease seems to plague certain families is genetics. We all inherit many characteristics from our mothers and fathers. Many characteristics are beneficial but some are harmful. In the case of coronary heart disease, specific traits have been identified that substantially increase the risk of developing heart disease. Genetic information is stored in your cells on long sugar chains called deoxyribonucleic acid (DNA). This DNA is a template for all your characteristics. The genetic information is stored on 23 pairs of chromosomes (46 total). A chromosome is a very long chain of DNA that has many genes on it. Two of these are termed "X linked" since women have two X chromosomes and men have one X and one Y. A gene is a section of a chromosome that contains the instructions on how to make a specific product, such as Lp(a). When a child is conceived, it receives one of the paired genes from each parent. During preparation for procreation, special cells are made that have only one set of chromosomes during a process termed meiosis. The inheritance of a gene from a particular parent is generally a 50% chance situation due to separation and recombination of genes during meiosis. The inheritance of genetic traits can be described in three general ways. A dominant form of inheritance indicates the genetic trait is apparent when only one gene dose is inherited. A recessive form of inheritance indicates that two gene doses are required to express the trait. An X-linked trait indicates that the genetic manifestation is located on the X chromosome. The expression of genetic traits can be impacted by environmental factors .

Genetic epidemiology of coronary heart disease: Past, present, and future : proceedings of a workshop held in St. Louis, Missouri, August 10-12, 1983 (Progress in clinical and biological research)Nutrition, Genetics, and Heart Disease (Pennington Center Nutrition Series)

Angioplasty Animation

Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. These obstructions are often caused by atherosclerosis. The term angioplasty is a portmanteau of the words angio (from the Latin/Greek word meaning "vessel") and plasticos (Greek: "fit for moulding"). Angioplasty has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist.

Coronary angioplasty


Peripheral angioplasty

Peripheral angioplasty refers to the use of mechanical widening in opening blood vessels other than the coronary arteries. It is often called percutaneous transluminal angioplasty or PTA for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.

Renal artery angioplasty

Atherosclerotic obstruction of the renal artery can be treated with angioplasty of the renal artery (percutaneous transluminal renal angioplasty, PTRA). Renal artery stenosis can lead to hypertension and loss of renal function.

Carotid angioplasty

Generally, carotid artery stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy

Hypertrophic Obstructive Cardiomyopathy Animation

Hypertrophic Obstructive Cardiomyopathy (HOCM) or idiopathic hypertrophic subaortic stenosis (IHSS) is characterized by an abnormal arrangement of the myocardial cells, which instead of lying in parallel rows, form whorl-like patterns. It most commonly affects the interventricular septum, but may also involve the entire myocardium or occur in isolated areas undetectable except by detailed histopathologic examination.

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Alcohol septal ablation, introduced by Ulrich Sigwart in 1994, is a percutaneous technique that involves injection of alcohol into one or more septal branches of the left anterior descending artery. This is a technique with results similar to the surgical septal myectomy procedure but is less invasive, since it does not involve general anaesthesia and opening of the chest wall and pericardium (which are done in a septal myomectomy). In a select population with symptoms secondary to a high outflow tract gradient, alcohol septal ablation can reduce the symptoms of HCM. In addition, older individuals and those with other medical problems, for whom surgical myectomy would pose increased procedural risk, would likely benefit from the lesser invasive septal ablation procedure..

When performed properly, an alcohol septal ablation induces a controlled heart attack, in which the portion of the interventricular septum that involves the left ventricular outflow tract is infarcted and will contract into a scar. Which patients are best served by surgical myectomy, alcohol septal ablation, or medical therapy is an important topic and one which is intensely debated in medical scientific circles