Coronary Artery Disease

Coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease (CAD) occurs when these arteries become damaged or diseased. The cause mainly is cholesterol-containing deposits (plaque) in your arteries. Narrowing of the arteries occurs when plaques build up, causing your heart to receive less blood. The decreased blood flow, eventually, may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. Heart attack occurs when there is a complete blockage.
CAD can go virtually unnoticed until you have a heart attack because coronary artery disease often develops over decades. It can lead to angina or acute myocardial infarction if left untreated. However, one can actually do a lot to prevent and treat coronary artery disease, starting from committing to a healthy lifestyle. Treatment for coronary artery disease can include medications or surgical and minimally invasive procedures.

There are many risk factors for CAD which includes:

  • Increasing age: Increasing age and getting older increases your risk of damaged and narrowed arteries.
  • Male Sex: As compared to women, men are generally at greater risk of coronary artery disease. For women, however, the risk increases after menopause.
  • Family history: Higher risk of coronary artery disease is there if a family history of heart disease is present, especially if a close relative developed heart disease at an early age. You have the highest risk if your father or a brother was diagnosed with heart disease before age 55, or your mother or a sister developed it before age 65.
  • Cigarette smoking: Smoking causes a constriction in your blood vessels, and can damage their inner lining, making them more susceptible to atherosclerosis. Heart attack incidence in persons who smoke at least 20 cigarettes a day is six times that of persons who’ve never smoked.
  • High blood pressure: High blood pressure which is untreated can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.
  • High blood cholesterol levels: The risk of formation of plaques and atherosclerosis increases with high levels of cholesterol in your blood. High cholesterol can be caused by a high level of low-density lipoprotein (LDL), known as the “bad” cholesterol. Atherosclerosis is also promoted by a low level of high-density lipoprotein (HDL), known as the “good” cholesterol.
  • Diabetes: An increased risk of CAD is seen in patients with diabetes. Both conditions share similar risk factors, such as obesity and high blood pressure.
  • Obesity: Being overweight typically worsens other risk factors.
  • Physical inactivity: Low level of exercise or it’s complete absence is associated with coronary artery disease and some of its risk factors, as well.
  • High stress: Unmanaged mental stress in your life can damage your arteries as well as worsen other risk factors for coronary artery disease.

  • In some cases, CAD develops without any classic risk factors. Researchers are studying other possible factors, including:

  • Sleep apnea: A condition in which you repeatedly stop and start breathing while you’re sleeping.
  • C-reactive protein: Increased amount of this normal blood protein is seen whenever there is swelling in the body.
  • Homocysteine: High levels of homocysteine, an amino acid your body uses to make protein and to build and maintain tissue, may increase your risk of coronary artery disease.
  • Fibrinogen: It is a blood clotting protein. Increased level of this protein causes increased clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke.
  • Lipoprotein (a): Lipoprotein (a) is formed when a low-density lipoprotein (LDL) particle attaches to a specific protein. High level of this may disrupt your body’s ability to dissolve blood clots and increases risk of cardiovascular disease, including coronary artery disease and heart attack.
  • Damage or injury to the inner layer of a coronary artery initiates CAD, sometimes as early as childhood. The damage may be caused by various factors, including:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Radiation therapy to the chest, as used for certain types of cancer

  • Damage to the inner wall of an artery leads to fatty deposits (plaques) made of cholesterol and other cellular waste products to accumulate at the site of injury in a process called atherosclerosis. Rupture of the surface of these plaques causes blood cells called platelets to clump at the site to try to repair the artery. Heart attack can occur due to this dumping.

    Narrowed coronary arteries are unable to supply enough oxygen-rich blood to your heart — especially when it’s beating hard, such as during exercise. Initially, the decreased blood flow may not cause any coronary artery disease symptoms. But, you may develop coronary artery disease symptoms as the plaques continue to build up in your coronary arteries. The symptoms are:

  • Chest pain (angina): It is typically a feeling of pressure or tightness in your chest as if someone were standing on your chest. This symptom, called as angina, is usually triggered by physical or emotional stress. It abolishes within minutes after stopping the stressful activity. This pain may be fleeting or sharp and noticed in the abdomen, back or arm in some people, especially women.
  • Shortness of breath: You may develop shortness of breath or extreme fatigue with exertion if your heart can’t pump enough blood to meet your body’s needs.
  • Heart attack: Heart attack ensues if a coronary artery becomes completely blocked. Heart attack classically presents with crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Less typical signs and symptoms are present in women. Sometimes a heart attack occurs without any apparent signs or symptoms.
  • Upon presentation to doctor, a medical history will be taken, a physical exam will be conducted routine blood tests will be ordered. Doctor may suggest one or more diagnostic tests as well, including:

  • Electrocardiogram (ECG): It is an electrical recording of the signals as they travel through your heart. Evidence of a previous heart attack can be revealed by an ECG. If the signs and symptoms of your atherosclerosis are more evident during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
  • Blood tests: Blood is tested for elevation of certain heart enzymes that slowly leak out into your blood if your heart has been damaged by a heart attack.
  • Abnormal heart rhythms (arrhythmias): Electrical “short circuits” can develop if your heart muscle is damaged by a heart attack. These can cause abnormal heart rhythms, some of which can be serious, even fatal.
  • Stress test: Stress test is also an exercise stress test. It is used to gather information about how well your heart works during physical activity. By doing exercise on bike or treadmill your heart pumps harder and faster than it does during most daily activities. Testing of the heart during and after exercise can reveal problems within your heart that might not be noticeable otherwise. The procedure usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. In patients who are unable to exercise due to some or other reason, a medication that mimics the effect of exercise on the heart is used to make it pump harder.
  • Chest X-ray: Images of your heart and lungs are displayed by this test. Also, other conditions can be looked into that might explain your symptoms and to see if you have an enlarged heart.
  • Echocardiogram: It is a type of ultrasound examination of your heart to produce images of the heart. These images are seen by the doctor to identify heart attack-related problems, including whether there are areas of your heart not getting enough blood or heart muscle that’s been damaged by poor blood flow. Sometimes, an echocardiogram is performed during a stress test.
  • Nuclear stress test: This test is performed to assess blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test but uses a radioactive substance.
  • Coronary angiography: Narrowing or blockade in coronary arteries can be revealed by this test. The test involves injecting a liquid dye into the arteries of your heart through a long, thin tube (catheter) that’s fed through an artery, usually in your leg, to the arteries in your heart. The arteries become visible on X-ray, as the dye fills your arteries. Any area of blockage can then be revealed.
  • Cardiac computerized tomography (CT) scan: During performance of this test, you lie on a table inside a doughnut-shaped machine. Inside the machine, there is an X-ray tube which rotates around your body and collects images of your heart and chest. These images can show if any of your heart’s arteries are narrowed or if your heart is enlarged.
  • Cardiac MRI: In this test, the patient is made to lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. Signals are produced when radio waves are broadcast toward these aligned particles. These signals vary according to the type of tissue they are. The signals create images of your heart.
  • Complications of coronary artery disease are:

  • Chest pain (angina): Your heart may not receive enough blood when your coronary arteries are narrow and demand is greatest — particularly during physical activity. This can cause chest pain (angina) or shortness of breath.
  • Heart attack: Complete blockage of your heart artery may trigger a heart attack if a cholesterol plaque ruptures and a blood clot forms. The lack of blood flow to your heart may damage your heart muscle. The pace of getting treatment decides amount of damage.
  • Abnormal heart rhythms (arrhythmias): Electrical “short circuits” can develop if your heart muscle is damaged by a heart attack. These can cause abnormal heart rhythms, some of which can be serious, even fatal.
  • Heart failure: It is a condition where the damaged tissue in your heart can’t do an adequate job of pumping blood out of your heart. Reduced pumping activity reduces blood flow to tissues and organs and may produce shortness of breath, fatigue, and swelling in your ankles and feet.

  • Some of the complications of hypertensive retinopathy include:

  • Loss of vision
  • Central and branch, retinal vein and/or artery occlusion (CRVO or CRAO)
  • Ischemic optic neuropathy or damage to the optic nerve
  • Vitreous hemorrhage or bleeding in the vitreous humor
  • Treatment of coronary artery disease varies depending on the situation. The patient might be treated with medications, undergo an invasive procedure or both — depending on the severity of the condition and the amount of damage to heart.


    Prevention

    Effects of PCOS can be offset by paying attention to the foods you eat and your activity levels:

  • Aspirin: It reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
  • Thrombolytics: Also called clot busters, these drugs help dissolve a blood clot that’s blocking blood flow to your heart.
  • Superaspirins: These are aspirin-like drugs with improved ability to prevent clot forming and include clopidogrel.
  • Blood-thinning medications: Medications like heparin might be given to make your blood less “sticky” and less likely to form more dangerous clots.
  • Pain relievers: Heart attack is associated with intense chest pain and you may receive a pain reliever, such as morphine, to reduce your discomfort.
  • Nitroglycerin: This medication temporarily opens arterial blood vessels, improving blood flow.
  • Beta blockers: These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure making your heart’s job easier.
  • Cholesterol-lowering medications: Unwanted blood cholesterol levels are lowered by these medications.

  • Surgical and other procedures

    Additionally, to medications, one of the following procedures might be done to treat your heart attack:

  • Angioplasty and stenting: These are used when unstable angina or lifestyle changes and medications don’t effectively treat your chronic, stable angina.
  • Coronary artery bypass surgery: This is done when stenting doesn’t help. It is a major surgery on heart arteries and involves creating a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. With this procedure, blood flow is maintained around the blocked or narrowed artery.
  • After these medications/procedure, the blood flow to your heart is restored and your condition is stable.


    Lifestyle Measures for Prevention

    Lifestyle changes can help you prevent or delay the occurrence of heart attack due to coronary artery disease:

  • Stop smoking.
  • Exercise most days of the week.
  • Eat healthy foods.
  • Lose extra pounds and maintain a healthy weight.
  • Manage stress.
  • If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.
  • If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.
  • Medications are required if lifestyle changes alone don’t help your angina. Medications may include:


  • Aspirin :It reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries.
  • Nitrates :This class of drugs relaxes and widens your blood vessels, which allows more blood to flow to your heart muscle. Angina related chest discomfort gets relieved with taking a nitrate tablet under the tongue.
  • Beta blockers: These drugs block the effects of the hormone epinephrine, and slow down the heart beats, thereby reducing blood pressure.
  • Statins: These drugs are used to lower cholesterol.
  • Calcium channel blockers: These drugs relax and widen blood vessels by affecting the muscle cells in the arterial walls.
  • Angiotensin-converting enzyme (ACE) inhibitors: These drugs are also used to relax blood vessels.
  • Ranolazine: This drug used alone or with other angina medications, works specifically to treat angina.

  • Medical procedures and surgery


  • Angioplasty and stenting :These are used when unstable angina or lifestyle changes and medications don’t effectively treat your chronic, stable angina.
  • Coronary artery bypass surgery This is recommended in patients with several blockades or in instances where the blockade is in a position that cannot be treated by stenting. It is a major surgery on heart arteries and involves creating a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. With this procedure, blood flow is maintained around the blocked or narrowed artery.