Coronary Heart Disease

What is coronary artery disease?

Coronary heart disease (CAD) refers to the blockage or narrowing of the coronary arteries that supply the heart with oxygen-rich blood. This occurs with time as the plaque, which includes cholesterol, accumulates in these arteries, hence limiting the amount of blood reaching the heart muscle.

Imagine two lanes of traffic merging into one because of construction. Although traffic continues to flow, it moves much more slowly. Likewise, with coronary artery disease, you may not realize any problem till the plaque causes a blood clot. This clot acts like a concrete barrier in the centre of the road, stopping traffic. When blood can no longer reach the heart, it results in a heart attack.

Coronary artery disease types

The two primary types of coronary artery disease are:

• Stable ischemic heart disease: This is a chronic CAD in which the coronary arteries slowly narrow down through decades. With time the heart begins to get insufficient oxygen-rich blood. Although symptoms may be experienced, one can still live a normal life with the condition.
• Acute coronary syndrome: This type is a medical emergency. The cholesterol deposits in the coronary artery rupture suddenly, forming a clot that obstructs blood supply to the heart. Such sudden blockage leads to a heart attack.

Understanding the Symptoms of Coronary Artery Disease

At first, the symptoms of CAD may go unnoticed or might only arise during physical exercises when the heart is working harder. But as coronary arteries keep narrowing down, blood flow to the heart is reduced, causing more frequent or severesymptoms.

The signs and symptoms of coronary artery disease are:

• Angina or chest pain: This may feel like tightness or pressure in the chest. Other people describe it as a feeling of someone standing on your chest. Angina often occurs on the left side or middle of the chest and can be triggered by certain activities or strong emotions. Usually, the pain resolves in minutes once the provoking events stop. For some individuals, particularly women, the discomfort may be sharp or brief and can be felt in the back, neck, or arm.
• Shortness of breath: This is a feeling described as though you cannot catch your breath.
• Fatigue: You might feel oddly exhausted if the heart does not pump sufficient blood meeting the requirements of the body.
• Heart attack: A total coronary artery blockage causes a heart attack. The heart attack typical symptoms are severe pain or pressure in the chest, breathlessness, sweating, and arm or shoulder pain. Women might experience less common symptoms like nausea, fatigue, and jaw or neck pain. However, some cases of heart attacks may not cause any evident signs.

Causes

CAD begins when cholesterols, fats, and other components build up on the heart arteries' inner walls, a condition known as atherosclerosis. The accumulation is referred to as plaque and can cause narrowing of the arteries, which blocks blood circulation. This plaque might also burst sometimes, resulting in a blood clot formation.

In addition to high levels of cholesterol, coronary artery damage can as well occur due to:

• High blood pressure
• Diabetes or insulin resistance
• Lack of enough exercise (sedentary lifestyle)
• Smoking or use of tobacco

Risk factors

Coronary artery disease is prevalent and influenced by factors such as age, genes, lifestyle choices, or other medical problems, which can impact overall heart arteries health.

The CAD risk factors are:

• Age: The risk of narrowed and damaged arteries tends to increase with age.
• Gender: Men are usually at a higher risk of developing coronary artery disease. The risk among women however increases postmenopause.
• Family history: Having a family history of CAD especially if a close family member developed the disease earlier, increases your possibility of the condition.
• High blood pressure: High blood pressure that is uncontrolled cause the arteries to harden, and stiffen (arterial stiffness). This makes the coronary arteries narrow and slows down blood circulation.
• Smoking: You should consider quitting if you smoke since it'sunfavourable for heart health and significantly raises the risks of CAD. Also, second-hand smoke can contribute to the disease.
• High cholesterol: Excessive bad cholesterol, known as low-density lipoprotein (LDL) cholesterol, in the bloodstream can raise atherosclerosis risks. Likewise, insufficient good cholesterol, referred to as high-density lipoprotein (HDL), also causes atherosclerosis.
• Diabetes: This condition increases the possibility of developing coronary artery disease. Both CAD and type 2 diabetes have some similar risk factors including high blood pressure and obesity.
• Obesity or overweight: Generally, being overweight is unfavourable for your health and is also linked to high blood pressure and type 2 diabetes. Talk to your doctor to determine the weight that is healthy for you.
• Chronic kidney disease: People with chronic kidney disease have increased risks of developing CAD.
• Lack of enough exercise: Getting sufficient physical activities is essential for good heart health. However, not exercising enough (a sedentary lifestyle) is connected with CAD and its risk factors.
• Too much stress: High levels of emotional stress can damage arteries and aggravate coronary artery disease risk factors.
• Unhealthy diet: Consuming foods rich in trans-fat, saturated fat, sugar, and salt is likely to contribute to CAD.
• Alcohol consumption: Too much alcohol intake can cause damage to the heart muscle, and could also aggravate other CAD risk factors.
• Sleep amount: Having too much or little sleep can increase the possibility of getting coronary heart disease.

Risk factors of CAD usually happen together and one can trigger the other.

Some risk factors, when they occur together, can increase the likelihood of developing coronary heart disease. For instance, metabolic syndrome, which is a group of conditions like high blood sugar, high blood pressure, excessive waist fat, and high levels of triglyceride, raises the risk of CAD.

In some cases, CAD occurs with no typical risk factors. Additional factors that may contribute to the condition are:

• Obstructive sleep apnoea: This disorder, which is characterized by breathing pauses while sleeping, can lead to an abrupt drop in levels of blood oxygen. Since the heart has to work much harder, the blood pressure tends to increase.
• High-sensitivity C-reactive protein (hs-CRP): Higher amounts of this protein, which appears following inflammation in a section of the body, may be a contributing risk factor for CAD. Narrowing of the coronary arteries is thought to increase hs-CRP levels.
• High triglycerides: Having high levels of this type of lipid (fat) increases the possibility of developing CAD, particularly in women.
• Homocysteine: This is an amino acid used to produce protein and is necessary for building and maintaining tissue. However, having increased homocysteine levels can raise the risk of CAD.
• Preeclampsia: This is a pregnancy complication causing high blood pressure and excess protein in the urine. Preeclampsia may result in increased heart disease risks later in life.
• Additional pregnancy complications: High blood pressure or diabetes in pregnancy are likely to contribute to coronary heart disease.
• Certain autoimmune conditions: Individuals with lupus, rheumatoid arthritis, or other inflammatory diseases are at a high risk of getting atherosclerosis.

Complications

Some of the complications associated with coronary artery disease are:

• Angina or chest pain: Narrowing of the coronary artery limits the heart from receiving sufficient blood, especially during exercise when needed the most. This could lead to chest pain or breathlessness.
• Heart attack: A rupture of cholesterol plaque can form a blood clot, which could cause a heart attack. The clot can obstruct the flow of blood and this can lead to heart muscle damage. The extent of the damage is determined by how fast treatment is given.
• Heart failure: High blood pressure or narrowed heart arteries can slowly weaken or stiffen the heart, making it difficult to supply blood. When the heart fails to pump blood as usual, heart failure occurs.
• Arrhythmias: Insufficient blood flow to the heart can impact normal signalling, resulting in irregular heart rhythms.

The role of genetics in coronary artery disease

Genetics significantly influence a person's vulnerability to coronary heart disease. Some gene variations are likely to elevate the risk of the condition. Therefore, genetic examination is essential in identifying such variations and providing insightful information to help with treatment and prevention.

CAD gene risk factors involve variations in genetics linked to lipid metabolism, blood clotting, inflammation, and regulation of blood pressure. Identifying these gene variations enables medical providers to create a tailored treatment plan addressing particular risks and recommend personalized lifestyle changes.

In addition, gene testing can help identify people who are likely to benefit from prompt intervention as well as preventive strategies. Usually, those with a high CAD genetic risk factor require frequent screenings, lead a heart-healthy lifestyle while at an early age, and opt for medications or interventions for risk management.

Diagnosis of Coronary Artery Disease: Tests and Procedures

Your medical provider will start by examining you during coronary artery disease diagnosis. They will also ask questions regarding your symptoms and medical history and order blood tests to assess your overall health.

Tests

To diagnose or monitor CAD, these diagnostic tests can be done:

• Electrocardiogram (ECG/EKG): This is a fast, painless procedure that measures the heart's electrical activity, revealing how quick or slow it is beating. The signal patterns can help determine if a person has had or is having a heart attack.
• Echocardiogram: Using sound waves to produce images of the heartbeats, this test shows blood circulationthrough the heart and its valves. Areas of the heart moving weakly may indicate a heart attack or insufficient oxygen, which could be a sign of CAD or other related problems.
• Exercise stress test: During the echocardiogram, the doctor can recommend walking on a treadmill or riding a stationary bike for cases where symptoms arise mostly while exercising. An ECG performed while doing these exercises is known as a stress echo. For people who cannot exercise, drugs that provoke the heart may be administered.
• Nuclear stress test: This diagnostic procedure is similar to stress echo but includes pictures of the ECG records. It shows blood movement to the heart muscle during stress and while resting. A radioactive tracer is administered through an IV to make heart arteries appear clearer in the images.
• Cardiac or heart CT scan: This displays calcium deposits, which can constrict the arteries and obstructions within the heart arteries. During this test, dye may sometimes be administered to help produce detailed images, a procedure known as CT coronary angiogram.
• Cardiac catheterization and angiogram: A cardiologist (heart specialist) performs this test by gently inserting a flexible tube called a catheter inside the blood vessel in the groin or wrist. The tube is then guided into the heart with the help of an X-ray. Dye is injected through the catheter to help show the blood vessels more clearly in the images and highlight any obstructions.

If a blockage requiring treatment is detected, the cardiologist can inflate the end of the catheter to open up the artery. A stent or a mesh tube is usually placed to maintain the artery open.

 

CAD treatment often includes lifestyle adjustments, like consuming healthy foods, avoiding smoking, and regular exercise. In some cases, medications and surgical procedures may be necessary.

Medications:

Several medications can help treat CAD. They include:

• Cholesterol drugs: These medications, which include niacin, statins, bile acid sequestrants, and fibrates, can reduce bad cholesterol levels and lower accumulation of plaques in the arteries.
• Aspirin: This helps prevent blood clot formation by thinning the blood. For some individuals, low-dose aspirin treatment on a daily basis may be advised to prevent stroke or heart attack.
• Daily aspirin use can, however, cause adverse side effects such as bleeding in the intestines and stomach. It's thus important to consult your doctor before taking daily aspirin.
• Beta-blockers: These medications help slow heart pulse and reduce blood pressure. Beta-blockers can also lower the risks of attacks in the future for people who have suffered a heart attack.
• Calcium channel blockers: For those who can't use beta blockers or if they aren't effective, the doctor can recommend one of calcium channel blockers. These drugs also improve chest pain symptoms.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): These help reduce blood pressure and can also prevent coronary artery disease from worsening.
• Nitroglycerin: Apart from widening the heart arteries, this drug, which is available in pill, patch, or spray, also helps manage and ease chest pain.
• Ranolazine: This medication may be helpful to those with angina and may be taken with or used instead of a beta-blocker.

Surgeries or other procedures:

Surgery may sometimes be necessary to repair a blocked artery. Some of the options include:

• Coronary angioplasty and stent placement: Also known as percutaneous coronary intervention (PCI), this procedure is conducted to open blocked heart arteries. It involves guiding a catheter into the narrowed area and inflating a balloon to help broaden the blocked artery and enhance blood circulation.

During the procedure, the cardiologist can insert a stent into the artery to help keep it open and reduce the risk of another constriction. Other stents gradually release drugs that maintains the arteries open.

• Coronary artery bypass graft surgery (CABG): This involves taking a healthy blood vessel from a different area of the body to make a new heart passage for blood. As a result, blood flows around the narrowed or blocked coronary artery. Since it is an open-heart procedure, CABG is often recommended only for people with several constricted arteries.

Prevention

Can coronary artery disease be prevented?

Preventing CAD is not always possible due to certain factors that are uncontrollable. However, the risk of the disease can be lowered and prevented from worsening by considering the following measures:

• Consuming heart-healthy foods

• Striving to quit smoking and use of tobacco products

• Getting enough sleep

• Maintaining a healthy weight

• Understanding your risks for CAD

• Limiting alcohol intake

• Increasing physical activities

• Taking your medications

Living With Coronary Artery Disease

How do I take care of myself?

Keeping up with treatment plans, such as taking medications and lifestyle adjustments, is essential to caring for oneself. This may also include surgery or other procedures and afterward recovery.

Apart from the treatment, the doctor can also suggest cardiac rehab, a program that helps with heart attack recovery and assists people living with heart failure. Moreover, cardiac rehab aids dietary adjustments, stress management, and exercise.

Coronary artery disease and mental health

Receiving a coronary artery disease diagnosis can lead to increased thoughts regarding your arteries and heart, which can be exhausting and draining. You may also be more concerned about the symptoms and the potential outcomes. Most individuals with CAD experience anxiety and depression. Typically, it's common to worry, especially when living with such a potentially life-threatening disorder.

However, your everyday life should not be consumed by your worries as you can still lead a full, active life even with the disease. See a counsellor if the diagnosis is negatively impacting your mental health, or join a support group to help you connect with like-minded individuals. Don't keep your feelings inside, and you also don't have to stay strong for other people.

Generally, CAD diagnosis can be life-changing. Therefore, it's okay to take your time to process everything and figure out ways to improve both your physical and emotional well-being.