Coronary+Artery+Disease

Western Diagnosis A. Atheroslerosis in vessels surrounding Ht B. complications are angina pectoris, MI C. angina pectoris: chest discomfort or pressure due to myocardial ischemia brought on by exertion and relieved by rest or sublingual nitroglycerin

Pathophysiology
1. cardiac work and myocardial oxygen demand exceed ability of coronary arteries to supply oxygenated blood

Signs & Symptoms
1. variable discomfort: from a vague ache to an intense crushing sensation 2. substernal 3. radiation to L shoulder and down inside of L arm to fingers 4. also radiates to back, throat, jaw, teeth 5. < physical activity, > rest 6. pattern < if exertion after a meal or in cold weather 7. frequency varies 8. sx characteristic for each individual: any change in pattern is serious and may indicate an impending MI - unstable angina 9. be careful if also GI sx 10. often no sns 11. may have inc HR & BP during attack

Diagnosis
1. clinical, based on classic pattern 2. better with nitro

Testing
1. ECG 2. exercise testing 3. coronary arteriography

Prognosis
1. unstable angina, MI biggest risks 2. age, extent of coronary disease, severity, vent fnc major influences on prognosis 3. L main coronary artery lesions worst 4. # coronary vessels involved: even if 3 but good vent fnc, OK

Treatment
1. Magnesium - 1 gm/d 2. similar to Atherosclerosis 3. Ornish 4. quit cigarette smoking 5. tx inc BP - inc BP, inc cardiac work 6. decrease cholesterol 7. walking 8. IV chelation therapy 9. Chelation therapy 10. drug treatment --sublingual nitro for treatment and prophylaxis --beta blockers --Ca channel blockers --coronary arterial bypass surgery (CABG) --angioplasty

Chinese Herbal Considerations
Chi Shao, Dan Shen