MVD / Multivessel Disease

What is Multivessel Disease?

The multivessel disease can be simply described as a >70% stenosis in two or more major coronary arteries of 2.5 mm diameter or greater.

Are Multivessel Disease and Coronary Artery Disease The Same?

Multivessel disease (MVD) is considered a form of coronary artery disease (CAD). MVD is a stage of CAD in which too much plaque builds up within two or more major arteries that can lead to major complications.

The multivessel coronary disease affects 40%to 50% of individuals with ST-elevation myocardial infarction (STEMI).

Etiology

The following are some of the most common risk factors for atherosclerosis and coronary artery disease:
●Hypertension
●Hyperlipidemia
●Diabetes
●Age
●Menopause
●Hyperhomocysteinemia
●Family history of heart diseases
●Endothelial nitric oxide synthase mutations
Coronary constriction, in addition to plaque rupture leading to platelet aggregation and thrombus development, plays a crucial role in myocardial infarction.

Epidemiology

Coronary artery disease led to the deaths of 607,000 patients in 2005, and the number is expected to rise to 23.4 million by 2030.
CAD is the main cause of death in developed countries. About 16.8 million Americans are affected by CAD, with 8 million of them having suffered a prior myocardial infarction.

Pathophysiology

The composition of atherosclerotic plaques in dead patients who had suffered a myocardial infarction has been studied. Smooth muscle cells, leukocytes, and foamy cells make up plaques, which have a thin fibrous cover, a big necrotic core, smooth muscle cells, leukocytes, and foamy cells. When a plaque ruptures and circulating thrombotic factors are exposed to exposed endothelial cells, a thrombus forms, which sticks to the artery’s luminal surface and causes an abrupt blockage. It’s made up of platelet aggregates, erythrocytes, and leukocytes, all of which are coated in a fibrin network.
Increased intraluminal pressure, coronary vasospasm, tachycardia, elevated systolic blood pressure, increased blood viscosity, increased sympathetic activity, hypercoagulability, and impaired fibrinolysis are all possible triggers for plaque rupture. Because of structural inflammation, atherosclerotic plaques are prone to rupture, resulting in the formation of a necrotic core with a thin fibrous cover for protection.

History and Physical

BThe severity of the underlying illness, the existence of concomitant disorders that may modify the typical presentation, and the sharpness of the disease all influence the presentation of multivessel disease.
Exertional chest discomfort or shortness of breath with radiation to the left arm and neck are common symptoms in patients with stable multivessel disease.
When three of the following symptoms are present, it is called “typical” chest pain, and when two of the following symptoms are present, it is called “atypical” chest pain: chest pain made worse by emotional or physical stress, chest pain relieved by rest and nitroglycerin, substernal chest pain, pressure, or discomfort.
Patients may experience nausea, diaphoresis, and lightheadedness as well. Patients in their latter years, particularly women and diabetics, may appear with unusual symptoms of epigastric pain.

Evaluation

The risk of a patient having CAD depends on some factors like their age, gender, and whether they have typical angina, atypical angina, or nonanginal chest pain at the time of the test.

A High pretest probability of CAD is defined as a likelihood of CAD that is more than or equal to 75% or 90%.

An intermediate pretest probability of CAD is described as a range of 10% to 25% to 75 percent and 90 percent, respectively, of CAD pretest probability.

A low pretest probability of CAD is defined as a likelihood of CAD that is less than 25% or 10%. There is no need for additional testing.

Differential Diagnosis

The following items help the differential diagnosis of typical and atypical chest pain:

Gastrointestinal
  • GERD
  • Dyspepsia
  • Dysphagia
  • Pancreatitis
Cardiac
  • Acute myocardial infarction (STEMI/NSTEMI)
  • Unstable angina
  • Stable angina
  • Acute pericarditis
  • Aortic dissection
  • Prinzmetal angina
  • Drug use (cocaine, amphetamines)
Musculoskeletal
  • Rib fracture
  • Chronic pain syndromes
  • Costochondritis
  • Trauma
Pulmonary
  • Pleurisy
  • Acute pulmonary embolism
  • Pneumonia
  • Pulmonary contusion
  • Pneumothorax

 

 

Treatment and Management

A healthcare professional will evaluate the severity of the condition and offer the best treatment option for the individual.
People with multivessel coronary artery disease should make major lifestyle changes and seek medical treatment, according to the international guidelines.
There are a lot of different treatment options for multivessel coronary artery disease.

Surgery

Doctors may consider stenting or surgery to allow more blood to reach specific organs in some cases. This is referred to as revascularization in the medical field.

Although revascularization surgery can be beneficial in some cases and may reduce mortality in many people, it is not suited for everyone. Importantly, revascularization surgery is most successful when combined with other medical treatments and lifestyle adjustments.

Lifestyle changes can include:
  • Exercise
  • Smoking cessation
  • Loss of weight or weight maintenance
  • A significant reduction in alcohol consumption
  • lowering salt consumption
Medical treatment may involve the following:
  • Aspirin and other antiplatelet medicines let blood flow more freely through the arteries.
  • Beta-blockers to treat angina symptoms.
  • Statin treatment to lower cholesterol levels and inflammation.

Complications

The multivessel disease has several side effects, including the following:
●Acute coronary syndrome (ACS)
●Acute coronary syndrome (ACS)
●In-stent restenosis
●In-stent thrombosis
●Stent embolization
●Side branch occlusion
●Stent fracture
●Graft failure
●Complications of surgery (bleeding, wound dehiscence, infection, pulmonary complication, stroke, myocardial infarction, arrhythmia, acute kidney injury, transfusion-related reactions)
●Complications of PCI (bleeding, pseudoaneurysm, retroperitoneal hematoma, infection, arterial dissection, distal arterial embolization, coronary perforation, stroke, acute kidney injury, reperfusion injury)

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