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| Photo from thekeyholeheartclinic.com |
Coronary artery disease occurs when the major blood vessels supplying your heart become damaged or diseased. Coronary artery disease is typically caused by cholesterol-containing deposits (plaques) in your coronary arteries as well as inflammation.
The coronary arteries supply your heart with blood, oxygen, and nutrients. Plaque buildup can narrow these arteries, reducing blood flow to your heart. Eventually, the reduced blood flow may cause chest pain (angina), shortness of breath, or other signs and symptoms of coronary artery disease. A total blockage can result in a heart attack.
Because coronary artery disease often develops over a long period of time, you may not notice a problem until you have a significant blockage or a heart attack. However, there are steps you can take to prevent and treat coronary artery disease. A healthy lifestyle can have a significant impact.
WHAT ARE THE SYMPTOMS OF CORONARY ARTERY DISEASE?
When your coronary arteries narrow, they can't deliver enough oxygen-rich blood to your heart, especially when it's working hard, as it does during exercise. Initially, the reduced blood flow may not cause any symptoms. However, as plaque accumulates in your coronary arteries, you may experience the following coronary artery disease signs and symptoms:
- Angina (chest pain): You may experience pressure or tightness in your chest, as if someone were standing on it. Angina is a type of chest pain that usually occurs on the middle or left side of the chest. Angina is usually brought on by physical or emotional stress. The pain usually subsides within minutes of ceasing the stressful activity. Some people, particularly women, may experience brief or sharp pain in the neck, arm, or back.
- Shortness of breath: If your heart is unable to pump enough blood to meet your body's demands, you may experience shortness of breath or extreme fatigue during physical activity.
- Heart attack: A heart attack is caused by a completely blocked coronary artery. A heart attack's classic signs and symptoms include crushing pressure in your chest and pain in your shoulder or arm, sometimes accompanied by shortness of breath and sweating.
Women are slightly more likely than men to experience less common symptoms of a heart attack, such as neck or jaw pain. They may also experience other symptoms such as shortness of breath, fatigue, and nausea.
A heart attack can occur without any obvious signs or symptoms.
WHAT ARE THE CAUSES OF CORONARY ARTERY DISEASE?
Coronary artery disease is thought to start when the inner layer of a coronary artery is damaged or injured, which can happen as early as childhood. The damage could be caused by a variety of factors, including:
- Smoking
- Hypertension
- High levels of cholesterol
- Diabetes, also known as insulin resistance
- Being inactive (sedentary lifestyle)
When the inner wall of an artery is damaged, fatty deposits (plaque) consisting of cholesterol and other cellular waste products tend to accumulate at the site of injury. This is known as atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets clump together to try to repair the artery. This clump can block the artery, leading to a heart attack.
WHAT ARE THE RISK FACTORS FOR CORONARY ARTERY DISEASE?
The following are risk factors for coronary artery disease:
- Age: As you get older, your chances of having damaged and narrowed arteries increase.
- Sex: Men are more likely than women to develop coronary artery disease. Women's risk, on the other hand, rises after menopause.
- Family history: A family history of heart disease is linked to an increased risk of coronary artery disease, especially if a close relative developed heart disease at a young age. Your risk is increased if your father or brother were diagnosed with heart disease before the age of 55, or if your mother or sister were diagnosed before the age of 65.
- Physical inactivity: Lack of exercise is also linked to coronary artery disease and some of its risk factors.
- High levels of stress: Unrelieved stress in your life may cause artery damage as well as exacerbate other risk factors for coronary artery disease.
- Unhealthy eating habits: Eating foods high in saturated fat, trans fat, salt, and sugar can raise your risk of coronary artery disease.
- Smoking: People who smoke are at a significantly higher risk of developing heart disease. Secondhand smoke also raises a person's risk of coronary artery disease.
- Hypertension (high blood pressure): Uncontrolled high blood pressure can cause your arteries to harden and thicken, narrowing the channel through which blood can flow.
- High cholesterol levels in the blood: High cholesterol levels in the blood can increase the risk of plaque formation and atherosclerosis. A high level of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol, can cause high cholesterol. A low level of high-density lipoprotein (HDL), or "good" cholesterol, can also contribute to the development of atherosclerosis.
- Diabetes: Diabetes is linked to a higher risk of coronary artery disease. Obesity and high blood pressure are both risk factors for type 2 diabetes and coronary artery disease.
- Obesity or being overweight: Excess weight usually exacerbates other risk factors.
Risk factors frequently coexist, and one may set off another. Obesity, for example, can lead to type 2 diabetes and high blood pressure. Certain risk factors, when combined, make you more likely to develop coronary artery disease. Metabolic syndrome, for example, raises the risk of coronary artery disease by combining high blood pressure, high triglycerides, low HDL, or "good," cholesterol, high insulin levels, and excess body fat around the waist.
Coronary artery disease can develop without any of the traditional risk factors. Other potential risk factors being investigated by researchers include:
- Sleep apnea: This disorder causes you to stop and start breathing repeatedly while sleeping. Sudden drops in blood oxygen levels caused by sleep apnea raise blood pressure and put strain on the cardiovascular system, potentially leading to coronary artery disease.
- C-reactive protein with high sensitivity (hs-CRP): When there is inflammation in your body, this protein appears in higher-than-normal amounts. High hs-CRP levels may be associated with an increased risk of heart disease. It is thought that as your coronary arteries narrow, you will have higher levels of hs-CRP in your blood.
- Preeclampsia: This condition, which can develop in pregnant women, causes high blood pressure and a higher level of protein in the urine. It can increase the risk of developing heart disease later in life.
- Using alcohol: Heavy alcohol consumption can cause heart muscle damage. It can also exacerbate other coronary artery disease risk factors.
- Autoimmune diseases: People with rheumatoid arthritis and lupus (as well as other inflammatory conditions) are more likely to develop atherosclerosis.
- High triglyceride: This is a type of fat (lipid) found in your bloodstream. High levels have been linked to an increased risk of coronary artery disease, particularly in women.
- Homocysteine: Homocysteine is an amino acid that your body uses to build and maintain tissue as well as to make protein. High levels of homocysteine, on the other hand, may increase your risk of coronary artery disease.
WHAT ARE THE COMPLICATIONS OF CORONARY ARTERY DISEASE?
Coronary artery disease can result in the following:
- Angina (chest pain): When your coronary arteries constrict, your heart may not receive enough blood when it is most needed, such as during physical activity. This can result in angina (chest pain) or shortness of breath.
- Heart attack: If a cholesterol plaque ruptures and a blood clot forms, your heart artery may become completely blocked, resulting in a heart attack. A lack of blood flow to your heart may cause heart muscle damage. The extent of the damage is determined in part by how quickly you receive treatment.
- Heart failure: If certain areas of your heart are chronically deprived of oxygen and nutrients due to decreased blood flow, or if your heart has been damaged by a heart attack, your heart may become too weak to pump enough blood to meet your body's needs. This is referred to as heart failure.
- Arrhythmia (abnormal heart rhythm): Inadequate blood supply to the heart or damage to heart tissue can interfere with electrical impulses in the heart, resulting in abnormal heart rhythms.
HOW IS CORONARY ARTERY DISEASE DIAGNOSED?
The doctor will inquire about your medical history, perform a physical examination, and order routine blood tests. He or she may also recommend one or more diagnostic tests, such as:
- Electrocardiogram (ECG): An electrocardiogram is a recording of electrical signals as they pass through your heart. An ECG can frequently reveal evidence of a previous or ongoing heart attack.
- Echocardiogram: An echocardiogram creates images of your heart using sound waves. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to the pumping activity of your heart.
Parts that move slowly may have been damaged during a heart attack or are getting insufficient oxygen. This could be an indication of coronary artery disease or another condition.
- Cardiac catheterization and angiogram: A doctor gently inserts a catheter into an artery or vein in your groin, neck, or arm and up to your heart during cardiac catheterization. X-rays are used to direct the catheter into the proper position. Dye is sometimes injected through the catheter. The dye enhances the visibility of blood vessels on the images and highlights any blockages.
If you have a blockage that needs to be treated, a balloon can be inserted and inflated through the catheter to improve blood flow in your coronary arteries. To keep the dilated artery open, a mesh tube (stent) is typically used.
- Exercise stress test: If your symptoms are worse when you exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during your ECG. While performing these exercises, an echocardiogram may be performed. This is known as a stress echo. Medication to stimulate your heart may be used instead of exercise in some cases.
- Nuclear stress test: This test is similar to an exercise stress test, but it includes images in addition to ECG recordings. It measures blood flow to your heart muscle both at rest and when stressed. A tracer is injected into your bloodstream, and special cameras are used to detect areas of your heart that receive less blood flow.
- Cardiac CT scan: A CT scan of the heart can assist your doctor in detecting calcium deposits in your arteries, which can narrow them. If a significant amount of calcium is discovered, coronary artery disease is possible.
A CT coronary angiogram, in which a contrast dye is administered intravenously during a CT scan, can produce detailed images of your heart arteries.
WHAT ARE THE TREATMENTS FOR CORONARY ARTERY DISEASE?
Treatment for coronary artery disease typically entails lifestyle changes as well as, if necessary, drugs and medical procedures.
Lifestyle changes
Making a commitment to the following healthy lifestyle changes can help promote healthier arteries:
- Stop smoking.
- Consume nutritious foods.
- Exercise on a regular basis.
- Get rid of excess weight.
- Reduce your stress.
Drugs
To treat coronary artery disease, a variety of medications can be used, including:
- Medications that lower cholesterol: These drugs reduce (or modify) the primary material that builds up on the coronary arteries. As a result, cholesterol levels, particularly low-density lipoprotein (LDL, or "bad") cholesterol, fall. Your doctor can prescribe a variety of medications, such as statins, niacin, fibrates, and bile acid sequestrants.
- Aspirin: Your doctor may advise you to take aspirin or another blood thinner on a daily basis. This can reduce the tendency of your blood to clot, which may help prevent coronary artery blockage.
If you've had a heart attack, aspirin can help you avoid another one. However, if you have a bleeding disorder or are already taking another blood thinner, consult your doctor before taking aspirin.
- Ranolazine: People suffering from chest pain may benefit from this medication (angina). If you are unable to take a beta blocker, it may be prescribed in addition to or instead of a beta blocker.
- Nitroglycerin: Nitroglycerin tablets, sprays, and patches can alleviate chest pain by temporarily dilapidating your coronary arteries and decreasing your heart's demand for blood.
- Inhibitors of angiotensin-converting enzyme (ACE) and angiotensin II receptor blockers (ARBs): These similar drugs lower blood pressure and may aid in the prevention of the progression of coronary artery disease.
- Beta blockers: These medications slow your heart rate and lower your blood pressure, lowering your heart's demand for oxygen. If you've had a heart attack, beta blockers can lower your risk of having another one.
- Calcium channel blockers: These medications may be used in conjunction with beta blockers if beta blockers alone are ineffective, or in place of beta blockers if you are unable to take them. These medications can help alleviate the symptoms of chest pain.
Procedures to improve and restore blood flow
Sometimes a more aggressive approach is required. Here are some possibilities:
- Angioplasty and stent placement (percutaneous coronary revascularization): A long, thin tube (catheter) is inserted into the narrowed section of your artery by your doctor. To the narrowed area, a wire with a deflated balloon is passed through the catheter. After that, the balloon is inflated, compressing the deposits against the artery walls.
A stent is frequently left in the artery to help keep it open. Most stents release medication gradually to help keep the arteries open.
- Coronary artery bypass surgery: A graft is created by a surgeon using a vessel from another part of your body to bypass blocked coronary arteries. This allows blood to flow around the narrowed or blocked coronary artery. Because it necessitates open-heart surgery, it is typically reserved for people with multiple narrowed coronary arteries.
HOW CAN CORONARY ARTERY DISEASE BE PREVENTED?
The same lifestyle habits that are used to treat coronary artery disease can also be used to prevent it. A healthy lifestyle can help keep your arteries strong and plaque-free. Follow these guidelines to improve your heart health:
- Stop smoking.
- Conditions such as high blood pressure, high cholesterol, and diabetes must be managed.
- Maintain your physical activity level.
- Consume a low-fat, low-sodium diet high in fruits, vegetables, and whole grains.
- Keep a healthy weight.
- Reduce and manage stress.