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About this book

In this concise but authoritative book, the authors take the reader through the epidemiology, risk factors and the basic mechanism of coronary artery disease. In addition, they explain how coronary microvascular dysfunction can lead to angina, even after successful angioplasty following a heart attack. The methods for diagnosis and the options for treatment are explained, ending with a discussion of the evolution of coronary angioplasty from balloon catheters to novel, fully resorbable polymeric drug eluting stents. Enclosed is a list of currently available commercial devices, as well as a listing of experimental products under research and development, so that readers can appreciate the serious nature of this disease and have an understanding of how the medical device sector is attempting to address this major healthcare problem. Globally in 2010, ischemic heart disease was the cause of 13.3% of all deaths. In the US alone, the direct medical costs from coronary artery disease and stroke are currently estimated to be $126 billion per year, and are expected to rise to $309 billion by 2035.

Table of Contents

Frontmatter

Chapter 1. Epidemiology and Risk Factors

Abstract
Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Heart disease and stroke are among the top five leading causes of death. This chapter shows the data that CAD is and will continue to become a global burden of disease and, by 2035, nearly half of the US population will have some form of cardiovascular disease (CVD). The American Heart Association has defined seven key risk factors for heart disease and stroke called “Life’s Simple 7”. These are listed in this chapter along with their global impact.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Chapter 2. Definitions and Basic Mechanism of Coronary Artery Disease (CAD)

Abstract
Coronary artery disease (CAD) also known as coronary heart disease (CHD) is described as the pathologic process affecting the coronary arteries, while atherosclerotic cardiovascular disease (ASCVD or CVD for short) is referred to as the pathological process affecting the entire arterial circulation, not just the coronary arteries. This chapter defines CAD and CHD along with their atherosclerotic pathogenic pathway and all the factors associated with it. The progression of atherosclerosis and its clinical findings are explained at various stages together with a description of the time course of inflammation and atherosclerotic calcification.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Chapter 3. Coronary Microvascular Dysfunction (CMD)

Abstract
Over the past two decades, coronary microvascular dysfunction (CMD) has emerged as an important mechanism of myocardial ischemia. This chapter describes various pathogenic mechanisms of CMD and explains how CMD can result from functional and/or structural alterations to the vessel wall and lead to varying degrees of disruption to normal coronary physiology. Currently ≈20–50% of patients have a predisposition towards ongoing angina despite successful revascularization surgery. The current goal of percutaneous coronary intervention (PCI) or any other revascularization therapy is to relieve the symptoms rather than address the pathology. It will require new research in this area if an improvement in CMD pathology is to be achieved.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Chapter 4. Diagnosis of Coronary Artery Disease (CAD)

Abstract
The evaluation of a patient with known or suspected cardiovascular disease begins with their medical history and a targeted physical examination as well as basic ancillary studies that are sufficient for the physician to understand the aetiology of any chest pain. A history and symptoms of angina are important in order to determine which tools should be used for diagnosis and treatment. This chapter describes the major signs and symptoms associated with cardiac disease. The probability of coronary artery disease (CAD) by age, gender and symptoms are described along with the different types of angina. Invasive and noninvasive techniques that successfully diagnose cardiac disease are also discussed briefly in this chapter. It also includes a comprehensive approach to the diagnosis and treatment of patients with chest pain according to various clinical guidelines. It also lists the established and novel biomarkers for the diagnosis of chronic coronary arterial disease.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Chapter 5. Treatment of Coronary Artery Disease (CAD)

Abstract
The treatment of a particular patient’s coronary artery disease (CAD) will depend on the severity of the symptoms and the patient’s pathological condition. In addition to pain, patients may suffer from other symptoms, such as severe fatigue, dyspnea, abdominal pain, nausea and sweating. And in order to understand cardiac pain, one requires knowledge of the interplay between ischemic, metabolic and neurological mechanisms behind CAD. This chapter presents the alternative therapies for stable ischemic heart disease (SIHD) and for acute coronary syndrome (ACS), such as drug therapy, invasive therapy and minimally invasive therapy. Reference is made to the National Institute for Health and Care Excellence (NICE) 2011 respective guidelines, which recommend medical therapy for chronic stable angina and reperfusion therapy for patients with STEMI.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Chapter 6. Evolution of Angioplasty Devices

Abstract
It is estimated that 600,000 to 1 million cardiac catheterizations (CC) are performed annually in the United States. This figure exceeds the number of coronary artery bypass graft procedures (CABG) performed on an annual basis, and is expected to grow annually by about 1–5% in the United States. This chapter discusses the evolution in design and development of angioplasty devices including a list of currently available commercial products and experimental designs under research and development. This will enable the reader to get a glimpse of how the medical device sector is attempting to address this major healthcare problem whose total medical costs are expected to reach $1.1 trillion by 2035.
Martin W. King, Tushar Bambharoliya, Harshini Ramakrishna, Fan Zhang

Backmatter

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