Non Obstructive Coronary Artery Disease
Non Obstructive Coronary Artery Disease Throughout this series, we will also introduce you to Acibadem Healthcare Group, a leading healthcare organization renowned for its expertise in cardiac health. With a multidisciplinary team of specialists and state-of-the-art facilities, Acibadem Healthcare Group is dedicated to providing comprehensive care for individuals with N-O CAD.
Join us as we delve into the world of non obstructive coronary artery disease and uncover actionable information that can empower you to prioritize your heart health and make informed decisions about your care.
Understanding Non Obstructive Coronary Artery Disease
Non obstructive coronary artery disease (N-O CAD) is a condition that affects the arteries supplying blood to the heart. Unlike obstructive coronary artery disease, where there is a significant blockage in the arteries, N-O CAD involves less severe narrowing or no blockage at all. Despite the absence of obstructive lesions, N-O CAD can still lead to significant cardiovascular complications if left untreated.
Causes and Risk Factors:
The exact cause of N-O CAD is not fully understood, but it is believed that a combination of factors contributes to its development. These factors may include:
- Endothelial dysfunction
- Inflammation
- Microvascular abnormalities
- Metabolic disturbances
Additionally, certain risk factors can increase the likelihood of developing N-O CAD, including:
- High blood pressure
- High cholesterol levels
- Diabetes
- Smoking
- Obesity
- Sedentary lifestyle
- Family history of coronary artery disease
Potential Complications:
Although N-O CAD may not cause complete blockage of the coronary arteries, it can still lead to serious complications. Some of the potential complications associated with N-O CAD include:
- Angina (chest pain or discomfort)
- Heart attack
- Heart failure
- Arrhythmias (abnormal heart rhythms)
Maintaining Heart Health:
To reduce the risk of developing N-O CAD, it is essential to prioritize heart health. This can be achieved through various lifestyle modifications, such as:
- Following a heart-healthy diet that is rich in fruits, vegetables, lean proteins, and whole grains.
- Engaging in regular physical activity, aiming for at least 150 minutes per week of moderate-intensity exercise.
- Quitting smoking and avoiding exposure to secondhand smoke.
- Managing stress through techniques like meditation, deep breathing exercises, or engaging in hobbies and activities that promote relaxation.
- Maintaining a healthy weight and managing any existing chronic conditions, like hypertension or diabetes, under the guidance of a healthcare professional.
By taking proactive steps to prioritize heart health, individuals can reduce their risk of developing non obstructive coronary artery disease and maintain optimal cardiac well-being.
Symptoms of Non Obstructive Coronary Artery Disease
Non obstructive coronary artery disease (N-O CAD) can present with a range of symptoms that may differ from those of obstructive coronary artery disease. These symptoms can impact daily life and serve as indicators for when individuals should seek medical attention. Understanding the common symptoms associated with N-O CAD is crucial for timely diagnosis and appropriate management.
Common Symptoms of N-O CAD
While N-O CAD does not involve significant blockages in the major coronary arteries, it can still cause discomfort and affect heart health. The following symptoms are commonly experienced by individuals with N-O CAD:
- Chest discomfort or pain: Non-specific chest discomfort or a mild burning sensation may be present, often resembling angina. The pain may occur during physical exertion or emotional stress and tends to subside with rest.
- Shortness of breath: Difficulty in breathing or breathlessness, especially during activities that require exertion.
- Fatigue: Unexplained tiredness or lack of energy, even after sufficient rest and sleep.
- Palpitations: Irregular or rapid heartbeats, often accompanied by a sensation of the heart pounding or fluttering.
Distinguishing N-O CAD from Obstructive CAD
It is important to note that the symptoms experienced in N-O CAD can overlap with obstructive coronary artery disease. However, N-O CAD is characterized by a lack of significant blockages in the major coronary arteries. These differences can help in differentiating between the two conditions:
Non Obstructive Coronary Artery Disease (N-O CAD) | Obstructive Coronary Artery Disease |
---|---|
Minor or no significant blockages in the coronary arteries | Significant blockages in the coronary arteries |
Potential microvascular dysfunction and endothelial dysfunction | Blockages leading to reduced blood flow to the heart |
Symptoms often triggered by emotional or physical stress | Symptoms typically triggered by exertion or physical activity |
The table above summarizes the key differences between N-O CAD and obstructive CAD, highlighting the distinct characteristics and implications for heart health.
Recognizing the symptoms of N-O CAD and understanding how they differ from obstructive CAD can aid in the early detection and appropriate management of this condition. If you experience any of these symptoms, it is important to consult a healthcare professional for a comprehensive evaluation and personalized treatment plan.
Diagnosis of Non Obstructive Coronary Artery Disease
In order to accurately diagnose non obstructive coronary artery disease (N-O CAD) and differentiate it from other cardiovascular conditions, various tests and procedures are utilized. These diagnostic measures help healthcare professionals assess the patient’s cardiac health and determine the most appropriate course of treatment. Acibadem Healthcare Group, renowned for its expertise in cardiac care, offers advanced diagnostic capabilities to ensure accurate diagnosis of N-O CAD.
Tests for Non Obstructive Coronary Artery Disease
When evaluating a patient for N-O CAD, healthcare providers may employ the following tests and diagnostic procedures:
- Echocardiogram: This non-invasive procedure uses ultrasound to create images of the heart, providing valuable information about its structure and function.
- Coronary angiography: This test involves injecting a contrast dye into the coronary arteries and visualizing them using X-ray imaging. It helps detect any blockages or abnormalities in blood flow.
- Cardiac MRI: Magnetic resonance imaging (MRI) of the heart produces detailed images of its structure and function, aiding in the diagnosis of N-O CAD.
- Exercise stress test: This test involves monitoring the patient’s heart during physical exercise to evaluate its response to exertion. It can help identify any signs of N-O CAD.
- Coronary computed tomography angiography (CTA): Using computed tomography (CT) scanning technology, this test provides detailed images of the coronary arteries, allowing for the detection of any blockages or abnormalities.
These tests, among others, allow healthcare professionals to make an accurate and timely diagnosis of N-O CAD, ensuring that appropriate treatment measures can be initiated.
Diagnostic Tests for N-O CAD | Description |
---|---|
Echocardiogram | Non-invasive ultrasound imaging of the heart to assess structure and function. |
Coronary angiography | Injecting a contrast dye into coronary arteries and using X-ray imaging to visualize blockages or abnormalities. |
Cardiac MRI | Magnetic resonance imaging of the heart to produce detailed images and aid in diagnosis. |
Exercise stress test | Monitoring the heart during physical exercise to evaluate its response and detect signs of N-O CAD. |
Coronary CTA | Computed tomography scanning to provide detailed images of the coronary arteries and identify blockages or abnormalities. |
Acibadem Healthcare Group’s commitment to cutting-edge technology and specialized expertise in cardiovascular care ensures that patients receive the most accurate and reliable diagnosis for N-O CAD. This enables healthcare professionals to tailor personalized treatment plans for each individual, optimizing their cardiac health outcomes.
Treatment Options for Non Obstructive Coronary Artery Disease
When it comes to managing non obstructive coronary artery disease (N-O CAD), there are various treatment options available to help individuals improve their heart health and alleviate symptoms. These treatment options encompass both lifestyle modifications and medical interventions, providing patients with a comprehensive approach to their cardiac care.
Lifestyle Modifications
One of the key aspects of managing N-O CAD is making certain lifestyle changes that promote a healthy heart. These modifications may include:
- Engaging in regular physical exercise, such as brisk walking, cycling, or swimming to improve cardiovascular fitness and strengthen the heart.
- Maintaining a balanced and nutritious diet that is low in saturated fats, cholesterol, and sodium, which can contribute to heart disease.
- Quitting smoking and avoiding exposure to secondhand smoke, both of which can harm the blood vessels and increase the risk of heart problems.
- Managing stress levels through relaxation techniques like deep breathing, meditation, or yoga, as stress can negatively impact cardiac health.
Medical Interventions
In addition to lifestyle modifications, medical interventions may be necessary to manage N-O CAD effectively. These interventions can help address underlying causes and alleviate symptoms. Some common medical treatments for N-O CAD include:
- Medications – Prescription medications, such as statins to lower cholesterol levels, aspirin to reduce the risk of blood clots, and blood pressure medications to control hypertension, may be prescribed to manage N-O CAD.
- Cardiac Rehabilitation – This structured program combines exercise, education, and counseling to help patients recover from heart-related conditions and improve overall cardiac health.
- Minimally Invasive Procedures – In some cases, minimally invasive procedures, such as angioplasty and stenting, may be performed to improve blood flow to the heart.
It is important to note that the most suitable treatment approach for N-O CAD varies based on individual circumstances, and healthcare professionals at Acibadem Healthcare Group can provide personalized guidance and recommendations.
Treatment Option | Description |
---|---|
Lifestyle Modifications | Includes regular exercise, adopting a healthy diet, quitting smoking, and managing stress. |
Medications | Prescription drugs such as statins, aspirin, and blood pressure medications may be used to manage N-O CAD. |
Cardiac Rehabilitation | A structured program combining exercise, education, and counseling to support recovery and improve cardiac health. |
Minimally Invasive Procedures | Procedures like angioplasty and stenting may be performed to improve blood flow to the heart. |
Coronary Microvascular Dysfunction and Non Obstructive Coronary Artery Disease
Non obstructive coronary artery disease (N-O CAD) can be linked to a condition known as coronary microvascular dysfunction (CMD). CMD refers to abnormalities in the small blood vessels of the heart that can affect cardiac health. Understanding the connection between CMD and N-O CAD is crucial for accurate diagnosis and effective treatment.
CMD can contribute to the development and progression of N-O CAD. When the small blood vessels in the heart are not functioning properly, it can lead to reduced blood flow to the heart muscle, even in the absence of significant blockages in the larger coronary arteries. This can result in symptoms similar to those of obstructive CAD, such as chest pain (angina) and shortness of breath.
Diagnosing CMD-related N-O CAD can be challenging due to the absence of visible blockages in the major coronary arteries. However, specialized diagnostic techniques, such as invasive coronary reactivity testing and cardiac magnetic resonance imaging, can help identify and evaluate CMD. These tests measure the blood flow response in the small blood vessels of the heart, providing valuable insights into the presence and severity of CMD.
Treatment for CMD-related N-O CAD focuses on improving blood flow and alleviating symptoms. Lifestyle modifications, such as adopting a heart-healthy diet, engaging in regular exercise, and managing stress, play a crucial role in managing CMD. Medications, such as calcium channel blockers and nitroglycerin, may also be prescribed to improve blood flow and relieve symptoms.
Acibadem Healthcare Group specializes in the diagnosis and treatment of CMD-related N-O CAD. With a multidisciplinary approach and state-of-the-art facilities, Acibadem Healthcare Group’s cardiac care experts are equipped to provide comprehensive care for individuals with CMD-related N-O CAD. Through advanced diagnostic techniques and personalized treatment plans, Acibadem Healthcare Group aims to improve cardiac health and enhance overall well-being.
Coronary Microvascular Dysfunction and Non Obstructive Coronary Artery Disease: A Comparison
Coronary Microvascular Dysfunction (CMD) | Non Obstructive Coronary Artery Disease (N-O CAD) |
---|---|
Abnormalities in the small blood vessels of the heart | Presence of plaque or blockages in the coronary arteries |
Reduced blood flow to the heart muscle | Reduced blood flow due to plaque or blockages |
Can cause chest pain (angina) and shortness of breath | Can cause similar symptoms to obstructive CAD |
Diagnosis through coronary reactivity testing and cardiac imaging | Diagnosis through angiography and non-invasive imaging tests |
Treatment includes lifestyle modifications and medications | Treatment includes lifestyle modifications, medications, and invasive procedures if necessary |
Managing Non Obstructive Coronary Artery Disease for Long-Term Cardiovascular Health
In order to maintain optimal cardiovascular health and effectively manage non obstructive coronary artery disease (N-O CAD) in the long term, it is important to make certain lifestyle modifications. These modifications include adopting a heart-healthy diet, engaging in regular exercise, and implementing stress management techniques.
1. Heart-Healthy Diet:
Emphasize a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit the intake of saturated and trans fats, cholesterol, and sodium. Incorporate heart-healthy foods such as salmon, walnuts, olive oil, and avocados into your meals.
2. Regular Exercise:
Engage in moderate-intensity aerobic exercises such as brisk walking, cycling, swimming, or dancing for at least 150 minutes per week. Additionally, incorporate strength training exercises to improve overall fitness and muscle strength.
3. Stress Management:
Chronic stress can have a negative impact on heart health. Explore stress management techniques such as deep breathing exercises, meditation, yoga, or engaging in hobbies or activities that promote relaxation. Incorporating stress-reducing activities into your daily routine can help improve cardiovascular health.
4. Ongoing Care and Regular Check-ups:
Regular monitoring and follow-up with your healthcare provider is crucial for managing N-O CAD. They can assess your condition, adjust treatment plans if necessary, and provide guidance on lifestyle modifications. Regular check-ups can help detect any changes in your condition and ensure that you are on the right track towards maintaining long-term cardiovascular health.
By implementing these strategies and maintaining regular communication with your healthcare provider, you can effectively manage non obstructive coronary artery disease and improve your overall heart health in the long term.
Understanding the Impact of Non Obstructive Coronary Artery Disease on Mental Health
Living with non obstructive coronary artery disease (N-O CAD) can have significant emotional and mental health effects. Managing a chronic cardiovascular condition like N-O CAD can lead to potential psychological challenges such as anxiety and depression. It’s important to recognize and address these mental health aspects alongside the physical symptoms of N-O CAD.
Individuals with N-O CAD may experience feelings of uncertainty, stress, and fear in relation to their heart health. The knowledge that they have a cardiovascular disease, albeit non-obstructive, may contribute to heightened emotional distress. This can stem from concerns about future health complications, limitations in daily activities, and the need for ongoing medical care.
Acibadem Healthcare Group, a leading healthcare organization specializing in cardiac health, understands the holistic nature of N-O CAD care. They take a comprehensive approach to cardiac care, recognizing the importance of mental well-being alongside physical interventions. Acibadem Healthcare Group offers dedicated mental health support services to individuals with N-O CAD, ensuring that patients receive the emotional and psychological guidance they need throughout their cardiac healthcare journey.
Supporting Mental Well-being Alongside Cardiac Care
Managing the mental health impact of N-O CAD is crucial for overall well-being. Acibadem Healthcare Group integrates mental health support into their cardiac care programs, recognizing the interconnectedness of mental and physical health.
Through a multidisciplinary approach, Acibadem Healthcare Group provides access to psychologists and counselors who specialize in working with cardiovascular patients. These professionals offer counseling, guidance, and support to individuals with N-O CAD, helping them navigate the emotional challenges associated with their condition.
In addition to professional support, Acibadem Healthcare Group encourages an open and supportive environment where patients can connect with others going through a similar experience. Support groups and educational resources are available to individuals with N-O CAD, providing a sense of community and shared knowledge.
By addressing both the physical and mental aspects of non obstructive coronary artery disease, Acibadem Healthcare Group helps patients achieve better overall well-being and improved quality of life.
Research and Advancements in Non Obstructive Coronary Artery Disease
As medical science continues to evolve, researchers and healthcare professionals are making significant strides in understanding and treating non obstructive coronary artery disease (N-O CAD). Ongoing studies and innovative advancements are shedding new light on this complex condition, offering hope to individuals living with N-O CAD.
One area of focus in current research is the development of new diagnostic methods for N-O CAD. Traditional tests may not always detect the presence of non obstructive coronary artery disease, leading to underdiagnosis and delayed treatment. Researchers are exploring advanced imaging techniques, such as intravascular ultrasound and optical coherence tomography, to provide more accurate and detailed assessments of coronary artery health.
Emerging treatment options are also being investigated to improve outcomes for individuals with N-O CAD. In addition to lifestyle modifications and medication management, innovative therapies, like enhanced external counterpulsation and transcutaneous electrical nerve stimulation, are showing promise in relieving symptoms and enhancing overall cardiovascular health.
Current Research Highlights:
- Studies on the link between N-O CAD and inflammatory markers in the blood
- Investigations into the role of endothelial dysfunction in the progression of N-O CAD
- Ongoing clinical trials evaluating the effectiveness of novel medications for N-O CAD management
- Research on the impact of gender and hormonal factors on the development and progression of N-O CAD
These research efforts are vital in advancing knowledge and improving patient outcomes in the realm of non obstructive coronary artery disease. By expanding our understanding of the underlying mechanisms and exploring innovative treatment approaches, healthcare professionals are striving to provide optimal care and support to individuals with N-O CAD.
Key Research Findings | Implications |
---|---|
Inflammatory markers play a significant role in N-O CAD | Potential for targeted anti-inflammatory therapies for improved disease management |
Endothelial dysfunction contributes to the progression of N-O CAD | Focus on interventions that improve endothelial function to prevent disease advancement |
Gender and hormonal factors influence N-O CAD development and outcomes | Personalized treatment approaches considering hormonal differences between male and female patients |
These research findings and ongoing studies underscore the importance of a comprehensive approach to non obstructive coronary artery disease. By staying at the forefront of scientific advancements, healthcare providers can offer the most up-to-date and effective strategies for managing N-O CAD and promoting heart health.
Partnering with Acibadem Healthcare Group for N-O CAD Care
When it comes to non obstructive coronary artery disease (N-O CAD) care, partnering with a reputable healthcare organization is crucial. Acibadem Healthcare Group stands out as a leading provider of cardiac health services, offering a range of specialized care options for individuals with N-O CAD.
One of the key advantages of choosing Acibadem Healthcare Group is their expertise in N-O CAD management. Their team of highly skilled physicians and specialists are well-versed in the intricacies of this condition, ensuring that patients receive the most accurate diagnosis and tailored treatment plans.
Acibadem Healthcare Group also adopts a multidisciplinary approach to N-O CAD care, collaborating closely with various healthcare professionals to provide comprehensive and holistic treatment. This integrated approach combines the expertise of cardiologists, cardiology surgeons, physiotherapists, and nutritionists, among others, to address the unique needs of each patient.
In addition to their medical expertise, Acibadem Healthcare Group boasts state-of-the-art facilities and cutting-edge technology, enabling them to deliver advanced and personalized care for individuals with N-O CAD. From diagnostic procedures to minimally invasive interventions, their facilities are equipped to support all stages of the treatment journey.
For those seeking comprehensive cardiac healthcare services for non obstructive coronary artery disease, partnering with Acibadem Healthcare Group offers extensive benefits. Their commitment to excellence, expertise, and patient-centered care sets them apart as a trusted partner in managing N-O CAD and promoting long-term cardiac health.
FAQ
What is non obstructive coronary artery disease (N-O CAD)?
Non obstructive coronary artery disease (N-O CAD) is a type of coronary artery disease where there is a lack of significant blockages in the arteries supplying blood to the heart. It is characterized by abnormalities in the smaller blood vessels of the heart, known as coronary microvascular dysfunction (CMD). N-O CAD can still cause symptoms and complications similar to obstructive CAD, despite the absence of major blockages.
How does non obstructive coronary artery disease (N-O CAD) impact heart health?
Non obstructive coronary artery disease (N-O CAD) can have a significant impact on heart health. Although there may not be blockages in the major coronary arteries, the abnormalities in the coronary microvasculature can lead to reduced blood flow and oxygen supply to the heart. This can result in symptoms such as chest pain, shortness of breath, and fatigue. N-O CAD is also associated with an increased risk of heart attacks and other cardiovascular events.
What is Acibadem Healthcare Group?
Acibadem Healthcare Group is a renowned healthcare organization specializing in cardiac health. With a network of hospitals and medical centers, Acibadem provides comprehensive cardiovascular care, including the diagnosis and treatment of non obstructive coronary artery disease. Their team of experienced cardiologists and state-of-the-art facilities ensure high-quality services and patient-centered care.
What are the causes and risk factors of non obstructive coronary artery disease (N-O CAD)?
The exact causes of non obstructive coronary artery disease (N-O CAD) are not fully understood. However, certain risk factors can contribute to its development. These include hypertension (high blood pressure), diabetes, high cholesterol levels, smoking, obesity, and a family history of cardiovascular disease. Hormonal factors, such as menopause in women, may also play a role in the development of N-O CAD.
How do the symptoms of non obstructive coronary artery disease (N-O CAD) differ from obstructive CAD?
The symptoms of non obstructive coronary artery disease (N-O CAD) may be similar to those of obstructive CAD, but the underlying causes differ. Common symptoms of N-O CAD include chest pain or discomfort (angina), shortness of breath, fatigue, palpitations, and dizziness. Unlike obstructive CAD, where blockages in the major coronary arteries are evident, N-O CAD is characterized by abnormalities in the smaller coronary blood vessels.
When should I seek medical attention for potential symptoms of non obstructive coronary artery disease (N-O CAD)?
If you experience symptoms such as chest pain or discomfort, shortness of breath, or unusual fatigue, it is important to seek medical attention. While these symptoms can have various causes, they could be indicative of non obstructive coronary artery disease (N-O CAD). A healthcare professional can evaluate your symptoms, perform appropriate diagnostic tests, and provide guidance on further management if N-O CAD is suspected.
How is non obstructive coronary artery disease (N-O CAD) diagnosed?
Diagnosing non obstructive coronary artery disease (N-O CAD) involves a comprehensive evaluation of symptoms, medical history, and diagnostic tests. Tests used to diagnose N-O CAD may include coronary angiogram, cardiac MRI, stress testing, coronary CT angiography, and assessments of endothelial function. These tests help identify any abnormalities in the coronary microvasculature and determine the presence and extent of N-O CAD.
What are the treatment options for non obstructive coronary artery disease (N-O CAD)?
Treatment for non obstructive coronary artery disease (N-O CAD) aims to manage symptoms, prevent complications, and improve overall heart health. Lifestyle modifications, such as adopting a heart-healthy diet, engaging in regular physical activity, managing stress, and quitting smoking, are important components of N-O CAD management. In some cases, medications may be prescribed to control symptoms or address underlying risk factors. Consultation with a healthcare professional is crucial for personalized treatment planning.
How is Acibadem Healthcare Group involved in the treatment of non obstructive coronary artery disease (N-O CAD)?
Acibadem Healthcare Group specializes in cardiac health and offers a comprehensive range of services for individuals with non obstructive coronary artery disease (N-O CAD). Their team of cardiologists and other healthcare professionals are experienced in diagnosing and managing N-O CAD. With state-of-the-art facilities and advanced diagnostic capabilities, Acibadem Healthcare Group provides high-quality care for N-O CAD patients.
What is the connection between non obstructive coronary artery disease (N-O CAD) and coronary microvascular dysfunction (CMD)?
Non obstructive coronary artery disease (N-O CAD) is often associated with coronary microvascular dysfunction (CMD). CMD refers to abnormalities in the smaller blood vessels of the heart, which can impair blood flow and cause symptoms similar to obstructive CAD. CMD can contribute to the development and progression of N-O CAD, and managing CMD is an important aspect of N-O CAD treatment and care.
What are some practical tips for managing non obstructive coronary artery disease (N-O CAD) in the long term?
Managing non obstructive coronary artery disease (N-O CAD) requires a long-term approach to cardiovascular health. Some practical tips include adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins, engaging in regular physical activity, managing stress through relaxation techniques or counseling, quitting smoking, and attending regular check-ups with a healthcare professional. These measures can help improve symptoms, reduce the risk of complications, and maintain optimal heart health.
How does non obstructive coronary artery disease (N-O CAD) impact mental health?
Living with non obstructive coronary artery disease (N-O CAD) can have emotional and mental health effects. Managing a chronic cardiovascular condition can lead to psychological challenges, such as anxiety and depression. It is important to address these mental health concerns alongside the medical management of N-O CAD. Acibadem Healthcare Group takes a comprehensive approach to cardiac care and provides support for mental health needs.
What are the latest research and advancements in non obstructive coronary artery disease (N-O CAD)?
Ongoing research and advancements in the field of non obstructive coronary artery disease (N-O CAD) aim to improve understanding, diagnostics, and treatment options. Studies are exploring the roles of inflammation, genetics, and microvascular dysfunction in N-O CAD. New diagnostic methods, such as advanced imaging techniques and blood biomarkers, are being investigated. Emerging treatment options, such as personalized therapies and targeted medications, show promise for individuals with N-O CAD.
Why should I consider partnering with Acibadem Healthcare Group for non obstructive coronary artery disease (N-O CAD) care?
Acibadem Healthcare Group offers specialized care for non obstructive coronary artery disease (N-O CAD) patients. With their expertise, multidisciplinary approach, and state-of-the-art facilities, Acibadem is well-equipped to provide comprehensive cardiovascular care. Their commitment to advancing knowledge through research and their focus on patient-centered care make them an ideal partner for individuals seeking optimal management and treatment for N-O CAD.