Coronary Artery Disease

But there's plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle may have a big impact.

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Symptoms

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If your coronary arteries narrow, they cannot supply enough blood to your heart — especially during exercise. Firstly, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including:

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• Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress.

• The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back.

• Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion.

• Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating.

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Causes

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Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:

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• Smoking

• High blood pressure

• High cholesterol

• Diabetes or insulin resistance

• Sedentary lifestyle

 

Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.

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Risk factors

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Risk factors for coronary artery disease include:

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Age. Simply getting older increases your risk of damaged and narrowed arteries.

Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.

Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65.

Smoking. People who smoke have a significantly increased risk of heart disease. Exposing others to your secondhand smoke also increases their risk of coronary artery disease.

High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.

High blood cholesterol levels. High levels of blood cholesterol can increase the risk atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL) cholesterol, known as the "bad" cholesterol. A low level of high-density lipoprotein (HDL) cholesterol, known as the "good" cholesterol, can also contribute to the development of atherosclerosis.

Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure.

Overweight or obesity. Excess weight typically worsens other risk factors.

Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.

High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease.

Unhealthy diet. Eating too much food that has high amounts of saturated fat, trans fat, salt and sugar can increase your risk of coronary artery disease.

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Risk factors often occur in groups and may create one another, such as obesity leading to type 2 diabetes and hypertension. If grouped together, put the patient at an even greater risk of coronary disease. For example, metabolic syndrome — a group of conditions that includes, hypertension high triglycerides, low HDL, or "good," cholesterol, elevated insulin levels and excess body fat around the waist — increases the risk of coronary artery disease.

 

Sometimes coronary artery disease develops without any known risk factors. Researchers keep studying for other possible factors such as:

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Sleep apnea. This disorder makes the patient stop and start breathing while sleeping and sudden drops in blood oxygen levels lead to hypertension and strain the cardiovascular system, possibly leading to coronary artery disease.

High sensitivity C-reactive protein. High sensitivity C-reactive protein (hs-CRP) is a normal protein that appears in higher amounts when there's inflammation somewhere in your body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, you'll have more hs-CRP in your blood.

High triglycerides. This is a type of fat (lipid) in your blood. High levels may raise the risk of coronary artery disease, especially for women.

Homocysteine. Homocysteine is an amino acid your body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase your risk of coronary artery disease.

Preeclampsia. This condition that can develop in women during pregnancy causes high blood pressure and a higher amount of protein in urine. It can lead to a higher risk of heart disease later in life.

Alcohol use. Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease.

Autoimmune diseases. Conditions such as rheumatoid arthritis and lupus (and other inflammatory rheumatologic conditions) have an increased risk of atherosclerosis.

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Complications

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Coronary artery disease can lead to:

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• Angina. If the coronary arteries narrow, the heart may not receive enough blood when demand is greatest during physical activity. This causes chest angina or shortness of breath.

• Heart attack. If there is a complete blockage of your heart artery, this may trigger a heart attack. The reduced blood flow to the heart will damage the heart muscle. The amount of damage depends vary in how quickly the patient receives treatment.

• Heart failure. If part of the heart is for long time deprived of oxygen and nutrients cause of reduced blood flow, or if the heart has been damaged by a heart attack than it becomes too weak to pump enough blood to the body. This condition is known as heart failure.

• Arrhythmia. Inadequate blood supply to the heart or damage to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms.

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Prevention

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The same lifestyle that can help treat coronary artery disease can also help prevent it from developing in the first place. Leading a healthy lifestyle can help keep arteries free of plaque. To improve your heart health, you can:

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• Stop smoking

• Control high blood pressure, cholesterol and diabetes

• Be physically active

• Eat vegetables and whole grains also low-fat, low-salt diet that's rich in fruits, vegetables and whole grains

• Maintain a healthy weight

• Reduce stress

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Diagnosis

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The doctor will ask questions about your medical history, he will do a physical exam and order routine blood tests and also may suggest one or more diagnostic tests as well, including:

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Electrocardiogram (ECG). An electrocardiogram records the electrical activity of the heart and often reveal evidence of a previous heart attack or one that's in progress.

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In other cases, Holter monitoring may be recommended. Holter is r a portable monitor for 24 hours as the patient goes about a normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.

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Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. During an echocardiogram doctor can determine whether all parts of the heart wall are contributing normally to the heart's pumping activity.

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Areas of the myocardium that move weakly may have been damaged from a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.

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Stress test. If symptoms occur most often during exercise, doctor may need you to walk on a treadmill during an ECG. This is known as exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise. Sometimes stress tests are done using an echocardiogram or MRI or in form of nuclear stress test.

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Cardiac catheterization and angiogram. To view blood flow through artery, the injection of a special dye into your coronary arteries maybe needed. This is known as an angiogram. The dye is injected into the arteries of the heart through catheter that is threaded through an artery.

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This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.

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Heart scan. Computerized tomography (CT) technologies can help doctor see calcium deposits in the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.

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Treatment

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Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

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Lifestyle changes

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Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:

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• Stop smoking.

• Healthy diet.

• Exercise regularly.

• Reduce excess weight.

• Avoid stress.

• Drugs

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Various drugs can be used to treat coronary artery disease, including:

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• Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL) cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.

• Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries.

• If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin.

• Beta blockers. These drugs slow the heart rate and decrease blood pressure, which decreases the heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.

• Calcium channel blockers. These drugs may be used with beta blockers if beta blockers alone aren't effective or instead of beta blockers if you're not able to take them. These drugs can help improve symptoms of chest pain.

• Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating coronary arteries and reducing your heart's demand for blood.

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure.

 

Revascucarization procedures

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Percutaneous coronary revascularization. Doctor inserts a catheter into the narrowed part of the artery. A wire with a balloon is passed through the catheter and then the balloon is inflated, compressing the deposits against the artery walls. A stent is often left in place in order to keep the artery open.

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Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of the body. This allows blood to flow around the stenotic coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple coronary arteries disease.

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Treatment choices

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Treatment options depend on various factors, such as:

 

• Coronary artery disease extent and severity

• Symptoms, like chest pain and shortness of breath

• Grade of heart function

• Medical conditions, such as heart attack, prior stroke, diabetes, peripheral artery disease

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For some people, medications and lifestyle changes may be the treatment of choice.

In other cases, percutaneous coronary intervention may be recommended to open the narrowed arteries. Angioplasty especially is recommended if someone is having angina not responding to medical therapy and lifestyle changes.

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If the arteries are stenotic or blocked in multiple areas, or your left main coronary artery is narrowed, the doctor may bypass. Studies show coronary bypass surgery is also e an appropriate choice for multiple blocked or narrowed arteries associated with diabetes.

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During bypass surgery, surgeons take parts of healthy blood vessel often from the chest wall or the lower leg and attach it below the blocked artery. This allows blood to bypass the blocked area and flow to the heart muscle.