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Coronary artery disease
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==Pathophysiology== [[File:RCA atherosclerosis.jpg|thumb|[[Micrograph]] of a [[coronary artery]] with the most common form of coronary artery disease ([[atherosclerosis]]) and marked [[lumen (anatomy)|luminal]] narrowing. [[Masson's trichrome]].]] Limitation of blood flow to the heart causes [[ischemia]] (cell starvation secondary to a lack of oxygen) of the heart's [[myocardium|muscle cells]]. The heart's muscle cells may die from lack of [[oxygen]] and this is called a [[myocardial infarction]] (commonly referred to as a heart attack). It leads to damage, death, and eventual scarring of the heart muscle without regrowth of heart muscle cells. Chronic high-grade [[stenosis|narrowing]] of the coronary arteries can induce transient [[ischemia]] which leads to the induction of a [[ventricular arrhythmia]], which may terminate into a dangerous heart rhythm known as [[ventricular fibrillation]], which often leads to death.<ref name="AmbroseSingh2015">{{cite journal | vauthors = Ambrose JA, Singh M | title = Pathophysiology of coronary artery disease leading to acute coronary syndromes | journal = F1000Prime Reports | volume = 7 | pages = 08 | year = 2015 | pmid = 25705391 | pmc = 4311268 | doi = 10.12703/P7-08 | doi-access = free }}</ref> Typically, coronary artery disease occurs when part of the smooth, elastic lining inside a [[coronary artery]] (the arteries that supply blood to the heart muscle) develops [[atherosclerosis]]. With atherosclerosis, the artery's lining becomes hardened, stiffened, and accumulates deposits of calcium, fatty lipids, and abnormal inflammatory [[Cell (biology)|cells]] β to form a [[Atheromatous plaque|plaque]]. Calcium phosphate (hydroxyapatite) deposits in the muscular layer of the blood vessels appear to play a significant role in stiffening the arteries and inducing the early phase of coronary [[arteriosclerosis]]. This can be seen in a so-called metastatic mechanism of [[calciphylaxis]] as it occurs in [[chronic kidney disease]] and [[hemodialysis]].{{citation needed|date=June 2021}} Although these people have kidney dysfunction, almost fifty percent of them die due to coronary artery disease. Plaques can be thought of as large "pimples" that protrude into the channel of an artery, causing partial obstruction to blood flow. People with coronary artery disease might have just one or two [[Atheromatous plaque|plaques]] or might have dozens distributed throughout their [[coronary arteries]]. {{anchor|CTO}}A more severe form is ''chronic total occlusion'' (CTO) when a coronary artery is completely obstructed for more than 3 months.<ref name="Aziz2005">{{cite journal | vauthors = Aziz S, Ramsdale DR | title = Chronic total occlusions β a stiff challenge requiring a major breakthrough: is there light at the end of the tunnel? | journal = Heart | volume = 91 | issue = Suppl 3 | pages = iii42β48 | date = June 2005 | pmid = 15919653 | pmc = 1876352 | doi = 10.1136/hrt.2004.058495 }}</ref> [[Microvascular angina]] is a type of [[angina pectoris]] in which chest pain and chest discomfort occur without signs of blockages in the larger [[coronary arteries]] of their hearts when an [[angiogram]] (coronary angiogram) is being performed.<ref>{{cite journal | vauthors = Lanza GA | title = Cardiac syndrome X: a critical overview and future perspectives | journal = Heart | volume = 93 | issue = 2 | pages = 159β66 | date = February 2007 | pmid = 16399854 | pmc = 1861371 | doi = 10.1136/hrt.2005.067330 }}</ref><ref name="Aldiwani">{{cite journal |vauthors=Aldiwani H, Mahdai S, Alhatemi G, Bairey Merz CN |title=Microvascular Angina: Diagnosis and Management |journal=Eur Cardiol |volume=16 |issue= |pages=e46 |date=February 2021 |pmid=34950242 |pmc=8674627 |doi=10.15420/ecr.2021.15 |url=}}</ref> The exact cause of microvascular angina is unknown. Explanations include [[microvascular dysfunction]] or [[Pericardium#Serous|epicardial]] atherosclerosis.<ref>{{cite journal | vauthors = Jones E, Eteiba W, Merz NB | title = Cardiac syndrome X and microvascular coronary dysfunction | journal = Trends in Cardiovascular Medicine | volume = 22 | issue = 6 | pages = 161β68 | date = August 2012 | pmid = 23026403 | pmc = 3490207 | doi = 10.1016/j.tcm.2012.07.014 }}</ref><ref>{{cite journal | vauthors = Petersen JW, Pepine CJ | title = Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014? | journal = Trends in Cardiovascular Medicine | volume = 25 | issue = 2 | pages = 98β103 | date = February 2015 | pmid = 25454903 | pmc = 4336803 | doi = 10.1016/j.tcm.2014.09.013 }}</ref> For reasons that are not well understood, females are more likely than males to have it; however, [[hormone]]s and other risk factors unique to females may play a role.<ref>{{cite journal | vauthors = Kaski JC | title = Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X) | journal = Circulation | volume = 109 | issue = 5 | pages = 568β72 | date = February 2004 | pmid = 14769677 | doi = 10.1161/01.CIR.0000116601.58103.62 | s2cid = 18216111 | doi-access = free }}</ref>
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