coronary artery disease
Summary
Atherosclerotic narrowing of the coronary arteries causing myocardial ischemia, the leading cause of death in the United States. Manifests as stable angina, acute coronary syndromes, ischemic cardiomyopathy, and sudden cardiac death.
Detail
Pathogenesis follows the response-to-injury model: endothelial dysfunction, LDL deposition and oxidation, macrophage uptake forming foam cells, fatty streak, fibrous plaque, and complicated plaque with rupture and thrombosis. Major modifiable risk factors are smoking, hypertension, diabetes, hyperlipidemia (high LDL, low HDL), and obesity; non-modifiable include age, male sex, and family history. The LAD is most commonly involved and supplies the anterior wall and anterior 2/3 of the septum. Stable angina reflects fixed >=70% stenosis; ACS reflects plaque rupture with platelet-rich thrombus. Management combines lifestyle, statins, antiplatelets (aspirin), beta-blockers, ACE inhibitors, and revascularization (PCI/CABG) for high-risk anatomy.
Sources
- First Aid for USMLE Step 1 2024
- Pathoma
- Robbins Basic Pathology 10th ed
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