Phase 2a Clinical Trial of Mitochondrial Protection (Elamipretide) During Stent Revascularization in Patients With Atherosclerotic Renal Artery Stenosis

Coronary Artery Disease

Coronary artery disease (CAD; also atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.

CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.

As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.

A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.

An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).

Inside A Coronary Bypass Surgery

Coronary artery disease, CAD, is a condition where the arteries that supply blood to the heart muscle become clogged and narrow, making it difficult for blood and oxygen to reach the muscles of the heart. Coronary bypass surgery is one treatment option to help restore blood flow, when other surgical procedures may not be recommended.

While coronary bypass surgery does not cure the underlying cause of CAD, it can alleviate symptoms, like chest pain, fatigue, difficulty breathing, and palpitations. It is done using general anesthesia, so you will be asleep during the entire procedure. Your surgeon will make an incision in your chest to access your heart and will use a machine to take over blood flow while your heart is temporarily stopped.

In some cases, minimally invasive procedures are possible, where smaller incisions are used or the heart does not need to be stopped. They will remove a healthy blood vessel from a different part of your body-- commonly from the lower leg, arm, or chest-- and relocate it to your heart. The healthy blood vessel will be attached to the heart above and below a blockage to allow blood to bypass the obstruction and flow more freely.

Once your surgeon confirms that blood is circulating properly, they will drain any fluids and sew the incision closed. Follow up with your doctor if you experience post-surgical complications, such as fever, any redness, pain, or discharge from the incision site. ","publisher":"WebMD Video"} ]]>

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Coronary artery disease, CAD, is a condition where the arteries that supply blood to the heart muscle become clogged and narrow, making it difficult for blood and oxygen to reach the muscles of the heart. Coronary bypass surgery is one treatment option to help restore blood flow, when other surgical procedures may not be recommended.

While coronary bypass surgery does not cure the underlying cause of CAD, it can alleviate symptoms, like chest pain, fatigue, difficulty breathing, and palpitations. It is done using general anesthesia, so you will be asleep during the entire procedure. Your surgeon will make an incision in your chest to access your heart and will use a machine to take over blood flow while your heart is temporarily stopped.

In some cases, minimally invasive procedures are possible, where smaller incisions are used or the heart does not need to be stopped. They will remove a healthy blood vessel from a different part of your body-- commonly from the lower leg, arm, or chest-- and relocate it to your heart. The healthy blood vessel will be attached to the heart above and below a blockage to allow blood to bypass the obstruction and flow more freely.

Once your surgeon confirms that blood is circulating properly, they will drain any fluids and sew the incision closed. Follow up with your doctor if you experience post-surgical complications, such as fever, any redness, pain, or discharge from the incision site.

Dear Doctor: What Are Some Health Concerns For Those Who Have Untreated Sleep Apnea?

DEAR DR. ROACH: Would you please address the dangers of untreated sleep apnea? Also, what do people do when they are unable to tolerate a CPAP (continuous positive airway pressure) machine? I know that surgery is an option, but most times, it can be unsuccessful. -- Anon.

ANSWER: Obstructive sleep apnea (OSA) is very common (15% to 30% of men in the United States and 10% to 15% of women), but there are still many people who aren't diagnosed. Although it is more common in people who are overweight or obese, it can occur in people of any weight. They might have something about the anatomy of their airways that causes their airways to close during sleep.

There are many consequences of untreated OSA, and all of these are more likely with more-severe obstruction. Because people with OSA don't sleep well, they are at a higher risk for motor vehicle accidents. Memory problems and depression are some of the most common neurological and psychiatric complications.

Heart disease, especially in the right side of the heart, is much more likely, and high blood pressure, coronary artery disease, and heart failure are also more likely. Diabetes is more common and independent of the weight effect. For all of these reasons, it's important to make a diagnosis and treat this condition quickly.

CPAP delivered by a mask and a compressor is the usual first-line treatment. It has been shown in several studies to be more effective than most other therapies. It prevents the airway from closing and allows a person to keep breathing during sleep.

However, it is undeniable that many people have trouble adjusting to the mask. Nasal pillow masks tend to be tolerated better. I recommend that my patients try several different types of masks and encourage them to be patient with the device before considering alternatives.

Prior to considering surgery, oral appliances can be considered during a consultation with a person's dentist. A hypoglossal nerve stimulation device can time an electrical impulse to the tongue with inspiration and improve your air flow.

If surgery is considered, the choice of the procedure is determined by a person's anatomy. Overall, the effectiveness of surgery at reducing OSA by at least 50% ranges from 30% to 80% in different studies.

DEAR DR. ROACH: I am 24 years old and have extreme fatigue. Many tests haven't given an answer. I did have a stool test that showed a parasite called Giardia lamblia. Could this be the cause of the fatigue? -- W.A.

ANSWER: Giardia lamblia is an intestinal parasite that is present all over the world. The disease is transmitted by direct exposure to the parasite, such as in contaminated open water, for example. It can be contracted by visitors from the U.S. Who travel to international destinations, and it's a common cause of traveler's diarrhea.

Although some people with Giardia have no symptoms, many people will develop symptoms 7-10 days after exposure. Diarrhea and other gastrointestinal symptoms are common with acute Giardia, with about 66% of people noting weight loss.

Without treatment, acute giardiasis can progress to chronic giardiasis. There is less diarrhea, but the weight loss can be profound -- 10% to 20% of a person's body weight. The fatigue and malaise (a medical term that just means feeling badly) can be overwhelming. Furthermore, the parasite can interfere with the absorption of nutrients, especially vitamin A, vitamin B12 and folic acid.

Fortunately, now that you have a diagnosis, there is effective treatment. Single-dose tinidazole is more than 90% effective, but nitazoxanide and metronidazole are other options.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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