Coronary Artery Disease

Classification

Definitions

• Coronary Artery Disease: encompasses all diseases of coronary arteries

• Ischaemic heart disease describes ischaemic coronary disease. The majority of coronary artery disease is ischaemic, therefore these terms are often used interchanegably

• Acute coronary syndrome includes myocardial infarction and unstable angina (but not angina)

• Myocardial infarction refers to the death of cardiac myoctes from infarction in STEMIs and NSTEMIs

• Coronary artery dissection can cause the acute coronary syndrome

• Coronary artery spasm usually causes ischaemia (reversible tissue hypoxia) than infarction (irreversible hypoxic necrosis)

Coronary Artery Disease (CAD)

• Ischaemic Heart Disease (IHD)

  • Angina

  • Acute Coronary Syndrome

    • Unstable Angina

    • Myocardial Infarction

      • STEMI

      • NSTEMI

    • Coronary Artery Dissection

• Coronary Artery Spasm

• Non ischaemic coronary artery disease

  • Kawasaki Disease

Outline

Background 

Diagnosis

Diagnostic criteria: 

History:

Examination:

Ix

• ECG

Ischaemia Territories

1. Left anterior descending artery: Anterior leads V1-V4

2. Right coronary artery: Right sided leads II, III, aVF

3. Circumflex artery: Lateral leads V5-V6, I, aVL

4. Posterior artery: Anterior & posterior V1-V3 (ST depression), V7-V9 (ST elevation)

Right coronary

• Distal vs proximal: 

  • • • More proximal lesion produces wider ST elevation, in e.g. V1-V3-

      • Distal lesion produces only II, III, aVF

Posterior artery

• Differentiate posterior STEMI from anterior NSTEMI

  • • • Dominant R waves

      • Confirmation from V7-9 STE

• 90% from RCA, 10% from circumflex

Differentials

Management

Coronary Artery Dissection

Cause of myocardial infarction in pregnancy. 

Coronary Artery Vasospasm

Presentation

• Male < 40yrs

• Central crushing chest pain

• Cocaine habit

Investigations

• ECG: NSTEMI changes- e.g. TWI

Management

• GTN IV or other nitrates

• Calcium channel blockers

References

1. Shahjehan RD, Sharma S, Bhutta BS. Coronary Artery Disease. [Updated 2024 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564304/

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Written in 2024