Coronary artery disease

Illustration depicting atherosclerosis in a coronary artery
Clogged artery
Micrograph of a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson's trichrome.
Illustration depicting coronary artery disease
Coronary angiogram of a man
Coronary angiogram of a woman
Deaths due to ischaemic heart disease per million persons in 2012

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart.

- Coronary artery disease
Illustration depicting atherosclerosis in a coronary artery

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CPR being administered during a simulation of cardiac arrest

Cardiac arrest

Sudden loss of blood flow throughout the body resulting from the heart not being able to pump blood efficiently.

Sudden loss of blood flow throughout the body resulting from the heart not being able to pump blood efficiently.

CPR being administered during a simulation of cardiac arrest
Conduction of the heart. Changes in this pattern can result from injury to the cardiac muscle and lead to non-conducted beats and ultimately cardiac arrest.
Ventricular fibrillation
Normal vs blocked coronary artery
Short axis view of the heart demonstrating wall thickening in left ventricular hypertrophy
EKG depiction of left ventricular hypertrophy
Medical personnel checking the carotid pulse of a patient
CPR training on a mannequin
An automated external defibrillator stored in a visible orange mural support
Lipid emulsion as used in cardiac arrest due to local anesthetic agents
Illustration of implantable cardioverter defibrillator (ICD)

The most common cause of cardiac arrest is an underlying heart problem like coronary artery disease which decreases the amount of oxygenated blood supplying the heart muscle.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)

Hypertension

Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Long-term medical condition in which the blood pressure in the arteries is persistently elevated.

Automated arm blood pressure meter showing arterial hypertension (shown by a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)
Determinants of mean arterial pressure
Illustration depicting the effects of high blood pressure
Rates of hypertension in adult men in 2014.
Diagram illustrating the main complications of persistent high blood pressure
Image of veins from Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus
Graph showing, prevalence of awareness, treatment and control of hypertension compared between the four studies of NHANES

Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.

A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.

Myocardial infarction

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle.

A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.
Cross section showing anterior left ventricle wall infarction
Diagram showing the blood supply to the heart by the two major blood vessels, the left and right coronary arteries (labelled LCA and RCA). A myocardial infarction (2) has occurred with blockage of a branch of the left coronary artery (1).
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the right coronary artery. Elevation of the ST segment can be seen in leads II, III and aVF.
ECG : AMI with ST elevation in V2-4
Inserting a stent to widen the artery.

Most MIs occur due to coronary artery disease.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.

Heart failure

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body; its signs and symptoms result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood or its ejecting of it during each heart beat.

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body; its signs and symptoms result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood or its ejecting of it during each heart beat.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
Signs and symptoms of severe heart failure
Severe peripheral pitting edema
Kerley B lines in acute cardiac decompensation. The short, horizontal lines can be found everywhere in the right lung.
Model of a normal heart (left); and a weakened heart, with over-stretched muscle and dilation of left ventricle (right); both during diastole
Chest radiograph of a lung with distinct Kerley B lines, as well as an enlarged heart (as shown by an increased cardiothoracic ratio, cephalization of pulmonary veins, and minor pleural effusion as seen for example in the right horizontal fissure. Yet, no obvious lung edema is seen. Overall, this indicates intermediate severity (stage II) heart failure.
Siderophages (one indicated by white arrow) and pulmonary congestion, indicating left congestive heart failure
Ultrasound showing severe systolic heart failure
Congestive heart failure with small bilateral effusions
Kerley B lines

Common causes of heart failure include coronary artery disease, including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause.

ECG of a heart in normal sinus rhythm

Electrocardiography

Process of producing an electrocardiogram , a recording of the heart's electrical activity.

Process of producing an electrocardiogram , a recording of the heart's electrical activity.

ECG of a heart in normal sinus rhythm
Normal 12-lead ECG
A 12-lead ECG of a 26-year-old male with an incomplete right bundle branch block (RBBB)
A patient undergoing an ECG
An EKG electrode
Proper placement of the limb electrodes. The limb electrodes can be far down on the limbs or close to the hips/shoulders as long as they are placed symmetrically.
Placement of the precordial electrodes
The limb leads and augmented limb leads (Wilson's central terminal is used as the negative pole for the latter in this representation)
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Diagram showing the contiguous leads in the same color in the standard 12-lead layout
QRS is upright in a lead when its axis is aligned with that lead's vector
Schematic representation of a normal ECG
Measuring time and voltage with ECG graph paper
Animation of a normal ECG wave
Formation of limb waveforms during a pulse
An early commercial ECG device (1911)
ECG from 1957
Use of real time monitoring of the heart in an intensive care unit in a German hospital (2015), the monitoring screen above the patient displaying an electrocardiogram and various values of parameters of the heart like heart rate and blood pressure

Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including cardiac rhythm disturbances (such as atrial fibrillation and ventricular tachycardia ), inadequate coronary artery blood flow (such as myocardial ischemia and myocardial infarction ), and electrolyte disturbances (such as hypokalemia and hyperkalemia ).

Vascular ischemia of the toes with characteristic cyanosis

Ischemia

Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Restriction in blood supply to any tissues, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism .

Vascular ischemia of the toes with characteristic cyanosis
Native records of contractile activity of the left ventricle of isolated rat heart perfused under Langendorff technique. Curve A - contractile function of the heart is greatly depressed after ischemia-reperfusion. Curve B - a set of short ischemic episodes (ischemic preconditioning) before prolonged ischemia provides functional recovery of contractile activity of the heart at reperfusion.

In most Western countries, Ischemic heart disease is the most common cause of death in both men and women, and a major cause of hospital admissions.

A color photograph of two bags of thawed fresh frozen plasma: The bag on the left was obtained from a donor with hypercholesterolemia, and contains altered serum lipid levels, while the bag obtained from a normal donor contains regular serum lipid levels.

Hypercholesterolemia

Presence of high levels of cholesterol in the blood.

Presence of high levels of cholesterol in the blood.

A color photograph of two bags of thawed fresh frozen plasma: The bag on the left was obtained from a donor with hypercholesterolemia, and contains altered serum lipid levels, while the bag obtained from a normal donor contains regular serum lipid levels.
Xanthelasma palpebrarum, yellowish patches consisting of cholesterol deposits above the eyelids. These are more common in people with familial hypercholesterolemia.
Formula structure of cholesterol

All the lipoproteins carry cholesterol, but elevated levels of the lipoproteins other than HDL (termed non-HDL cholesterol), particularly LDL-cholesterol, are associated with an increased risk of atherosclerosis and coronary heart disease.

X-ray image of the chest showing the internal anatomy of the rib cage, lungs and heart as well as the inferior thoracic border–made up of the diaphragm.

Heartburn

Burning sensation in the central chest or upper central abdomen.

Burning sensation in the central chest or upper central abdomen.

X-ray image of the chest showing the internal anatomy of the rib cage, lungs and heart as well as the inferior thoracic border–made up of the diaphragm.

One article estimates that ischemic heart disease may appear to be GERD in 0.6% of people.

Coronary arteries (labeled in red text) and other major landmarks (in blue text)

Coronary arteries

The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle.

The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle.

Coronary arteries (labeled in red text) and other major landmarks (in blue text)
atherosclerosis
heart attack

Coronary artery disease (CAD) or ischemic heart disease (IHD) are the terms used to describe narrowing of the coronary arteries.

Potential location of pain from a heart attack

Chest pain

Pain or discomfort in the chest, typically the front of the chest.

Pain or discomfort in the chest, typically the front of the chest.

Potential location of pain from a heart attack
A blockage of coronary arteries can lead to a heart attack
Gastroesophageal reflux disease is a common cause of chest pain in adults

In adults the most common causes of chest pain include: gastrointestinal (42%), coronary artery disease (31%), musculoskeletal (28%), pericarditis (4%) and pulmonary embolism (2%).