I. Introduction

Coronary arteries supply blood flow to the muscle of the heart. Atherosclerosis results in vessel narrowing or even occlusion and myocardial ischemia. Risk factors for atherosclerosis include aging, hypertension, diabetes mellitus, smoking, high blood cholesterol, obesity, stress and lack of exercise.

II. Symptoms

The chest discomfort is effort-related, located at the retrosternal or precordial area, may radiate to the left shoulder or jaw and lasts for 3–5 minutes. It may be associated with cold sweating, too.

    Chest discomfort

III. Management

Stop activities and take a rest. You can take nitroglycerin tablet (NTG) sublingually once every five minutes, with up to maximal 3 times. Seek medical help immediately.

IV. Examination and treatment

2. Diet

Take low-fat, low-cholesterol foods, such as lean meat, chicken, and fish. Use vegetable oil instead of animal-fat oil.

Recommended cooking methods:

• Soup can be stored in the refrigerator. Remove the oil on the upper layer to reduce the fatty content.
• Use steamed stewed, roasted, or water-boiled method for preparing food. Avoid frying or fried food and eating low-salt diet to prevent hypertension.
• Eat more fruits and vegetables to avoid constipation.
• Eat low-calorie diet and avoid snacks.

3. Take medicine on time to control blood pressure below 130/80 mmHg. Maintaining fasting blood glucose below 80-130 mg/dl, after meal glucose below 140 mg/dl.

                    Keep blood pressure                   Fasting blood glucose

                        130/80 mmHg                              below 80-130 mg/dl

5. Quit smoking is a powerful preventive measure for CAD.

6. Avoid emotional stress and job strain.

7. Have nitroglycerin tablets in the pocket at any time.

8. Moderate exercise: avoid strenuous and competitive exercise; you can do walking, tai chi or jogging.

                     Walking                                      Tai chi                                             Jogging

• Take your pulse rate before and after exercise.
• If you have any discomfort after exercise, take a rest immediately.
• Take physical exercise in warm weather; avoid doing it in the extremely cold or hot environment.
• Avoid doing the Valsalva maneuver; avoid lifting heavy loads.

            Avoid lifting heavy loads

VI. Reference

1. Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Jr, Nnacheta, L. C., Rao, S. V., … Zwischenberger, B. A. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: Executive summary: A report of the American College of Cardiology/American heart association joint committee on clinical practice guidelines. Circulation, 145(3), e4–e17. https://doi.org/10.1161/CIR.0000000000001039
2. Jia, S., Liu, Y., & Yuan, J. (2020). Evidence in guidelines for treatment of coronary artery disease. Advances in Experimental Medicine and Biology, 1177, 37–73. https://doi.org/10.1007/978-981-15-2517-9_2
3. Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology, 234(10), 16812–16823. https://doi.org/10.1002/jcp.28350