What is Coronary Artery Disease?
Coronary artery disease (CAD), also known as Ischaemic heart disease, is a common type of heart disease. Coronary arteries supply blood to the heart muscle. CAD is characterised by reduced blood flow to the heart muscle due to blockage in the artery. Sudden occlusion of the artery causes acute coronary syndrome, where the patient presents with sudden-onset angina, and gradual occlusion causes symptoms over a period of time.
Coronary Artery Disease Symptoms
An individual may experience symptoms of coronary artery disease when the heart does not get sufficient oxygen-rich blood. Coronary artery disease symptoms may include:
1. Angina or chest pain
The most typical symptom of coronary artery disease is chest pain. The patient typically describes the pain as central squeezing, as if he/ she has been stabbed. Occasionally, it can radiate to the neck, back, and left arm. Some patient can also present as indigestion or heart burn.
Stable angina is temporary chest discomfort or pain that may come and go in predictable patterns. In women, the chest pain can be brief or sharp and felt in the back, arm, or neck.
2. Fatigue
When the heart cannot pump enough oxygen-rich blood to fulfil the body’s needs and requirements, an individual may experience unusual tiredness.
3. Shortness of breath
Some people may experience dyspnoea or shortness of breath during light physical activity.
4. Palpitation
Some patients experience sudden rises in heartbeat; occasionally, the heartbeat may become so low that the patient may collapse.
Note: Coronary artery disease symptoms may not be noticeable at first. In some individuals, symptoms may occur when the heart is beating at a faster pace such as during exercise. As the coronary arteries narrow, these symptoms can get more frequent or severe.
Coronary Artery Disease Causes:
Coronary artery disease is caused by a buildup of cholesterol, fats and other substances (plaque) in and on the heart's arteries. This condition is referred to as atherosclerosis. This plaque build-up can burst, causing a blood clot.
Some of the leading causes of coronary artery disease are:
Modifiable causes:
Non-modifiable causes:
Age: The risk of narrowed and damaged arteries increases with age
Gender: Men are at a greater risk of developing coronary artery disease
Genetics: A family history of heart disease increases the risk of coronary artery disease. The risk of CAD is also higher if a person’s father or brother was diagnosed with heart disease before 55 or if your mother or sister developed CAD before 65.
Modifiable causes of coronary artery disease :
1. Smoking and tobacco use :
Smoking (including passive smoking) is harmful to heart health, and smokers are at a much greater risk of developing CAD as compared to non-smokers.
2. Hypertension
High blood pressure can cause stiffness in the arteries of the heart. This can lead to plaque buildup, which can ultimately cause coronary artery disease.
3. Cholesterol
High levels of bad cholesterol or low-density lipoprotein (LDL) in the blood or not enough high-density lipoprotein (HDL) cholesterol are major risk factors for CAD.
4. Diabetes
Diabetes patients are at very high risk for coronary artery disease.
5. Obesity
Being overweight or obese deteriorates overall health and well-being. It can lead to high blood pressure and type 2 diabetes. It is one of the most common causes of coronary artery disease.
6. Lack of physical activity
Not getting enough exercise is linked to coronary artery disease and some of its risk factors.
7. Prolonged stress and an unhealthy diet
High-stress levels can damage the arteries and lead to coronary artery disease. Also, eating foods high in sugar, salt, trans fat, and saturated fat can increase the risk of CAD.
8. Alcohol consumption
Excessive consumption of alcohol can damage the heart muscle. It can worsen other risk factors of coronary artery disease.
Note: When grouped together, some of these risk factors can increase the risk of developing coronary artery disease (CAD). For example, a group of conditions, including high blood pressure, high body fat content, high blood sugar, and high triglycerides levels (metabolic syndrome), makes an individual more susceptible to CAD.
Coronary Artery Disease Diagnosis
A doctor may diagnose coronary artery disease through a physical examination and tests that may include:
Measuring the blood pressure
Ask in detail about the symptoms, medical history and family history
This information will help determine the risk for coronary heart disease
Tests to Diagnose CAD and Assess Heart Function
1. Blood tests
Check blood sugar levels, triglycerides and cholesterol in the blood.
2. Electrocardiogram (ECG/EKG)
In an EKG, electrodes are placed to study the heart's function. This helps determine heart health and diagnose CAD.
3. Echocardiogram
An echo test or echocardiogram uses sound waves to determine how well the blood flows to and from the heart.
4. Exercise stress test
At times, CAD symptoms only show when an individual is active. During this type of test, you may be asked to walk or run on a treadmill or a stationary bike during an EKG.
5. Coronary calcium scan
A cardiac calcium scan, also known as a heart calcium scan, detects calcium deposits blocking the arteries and hampering the flow of blood.
6. Cardiac catheterisation
In this test, a cardiologist guides a catheter (thin and flexible tube) through a blood vessel in the arm or leg to reach the heart. A dye is then injected through a catheter, and X-ray videos are used to determine the condition of the heart.
7. CT (computed tomography) coronary angiogram
This type of test allows for a close-up look at the arteries, using a special dye injected into the brain before a CT scan.
Coronary Artery Disease Treatment
Depending on the severity of the condition, the treatment plan for CAD may include one or a combination of the following treatment options:
Medications
Medications for CAD treatment may include anticoagulants (blood thinners), anti-clotting medicines, beta-blockers, ACE inhibitors, calcium channel blockers, nitroglycerin, statins
Interventional procedure
The interventional procedure may include Percutaneous Transluminal Coronary Artery (PTCA) stenting of the coronary artery (also commonly called coronary artery stenting) or Coronary Artery Bypass Grafting (CABG):
Percutaneous Transluminal Coronary Artery (PTCA)/ Coronary artery angioplasty:
Also known as percutaneous coronary intervention (PCI), it is a minimally invasive procedure that aims to reopen blocked arteries and improve blood flow. It is either done through the artery in the leg or the hand. Catheters are placed through which the arteries of the heart are accessed. The blocked segment is then crossed with a wire. First, the blocked segment is ballooned with a balloon, and finally, a stent is placed in that segment so patency is maintained.
Most of the time, the patient does not require ventilatory support and is usually fit to go home the day after the procedure.
CABG (Coronary Artery Bypass Grafting)
CABG is a surgical method of treating coronary artery blockage in which a new passage is created by bypassing the blocked segment by opening the chest. The patient requires ventilatory support and may also require heart-lung support during the procedure. Usually, the patient requires 5-8 days of hospitalisation.
Prevention
It is not possible to completely prevent coronary artery disease because of some risk factors that can’t be controlled. However, it’s possible to lower the risk of coronary artery disease and prevent it from getting worse. The nine golden rules in the prevention of coronary artery disease are:
Quit smoking
Control diabetes
Control BP
Maintain healthy weight
Exercise regularly
Consume more fruits & vegetables
Refrain/reduce alcohol intake
Maintain healthy cholesterol levels
Avoid stress
FAQs
1. How is coronary artery disease caused?
CAD is a common type of heart disease that affects the main blood vessels that supply blood to the heart, called the coronary arteries. It is caused by a buildup of cholesterol, fats, and other substances on the walls of the arteries around the heart, ultimately restricting blood flow to the heart.
2. Can I live a long life with coronary artery disease?
The survival rates of CAD vary depending on several factors, including the severity of the condition and the type of treatment. However, timely diagnosis and treatment can help individuals with CAD live long and productive lives.
3. What foods clear arteries?
Certain foods that can help prevent clogging in the arteries and lower the risk of coronary heart disease include:
Leafy greens
Oats
Berries
Tomatoes
Beans
Fish
4. Which test confirms coronary artery disease?
A coronary angiogram is one of the best methods to diagnose coronary artery disease. It is a type of X-ray that is used to examine the coronary arteries supplying blood to the heart muscle.
Article By Dr. Amit Kumar Chaurasia
Chief Cath Lab & TAVI (Unit I) - Cardiology
Artemis Hospitals