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CORONARY ARTERY DISEASE

ManipalHospitals • July 9, 20180 Comment

Coronary Artery Disease is the most common type of heart disease. It develops when the blood vessels that supply our heart with blood, oxygen and vital nutrients are damaged or diseased. The arteries which supply blood to the heart become hardened and narrowed due to a buildup of cholesterol and other substances known as plaque on their inner walls. This results in reduced blood flow to the arteries. Therefore, the heart doesn’t receive enough blood or oxygen needed to function properly, leading to a heart attack. If CAD is allowed to progress, over time, it adversely affects the blood supply to the body and can lead to changes in the normal beating rhythm of the heart, called arrhythmia.

Symptoms of Coronary Artery Disease
As the plaque builds up inside the arteries and the blood vessels, the person may develop the following symptoms:
1. Chest Pain (Angina): A crushing pain or tightness in the chest, usually in the middle or the left side of the chest. This is usually triggered by physical and/or emotional stress and is characterized by nausea and shortness of breath.
2. Pain in the arms and shoulders
3. Sweating
4. Dizziness
5. Heart Attack: A blocked artery commonly results in a heart attack, which can be identified by the same symptoms as mentioned above.
6. Indigestion
7. Upper abdominal or back pain
8. Vomiting
9. Jaw pain

Causes and Risk Factors of CAD
The various factors which cause CAD are:
Smoking: Smokers have a significantly increased risk of heart disease. Even second-hand smoking is equally harmful, if not more.
High blood pressure: This results in the hardening and thickening of the arteries which in turn constricts the channel through which blood flows.
Diabetes
Sedentary lifestyle: An inactive lifestyle leads to obesity and excess weight and typically aggravate other risk factors and conditions.
Hypertension
History of Preeclampsia during pregnancy: This causes high blood pressure and higher levels of protein in the urine. This can result in an increased risk of heart attack later in life.
Family History: If a close family member developed heart disease, a person is at a greater risk of actually getting affected by this condition. The risk is even greater if either of the parents were diagnosed with heart disease before the age of 60.
Excessive alcohol consumption: Drinking too much alcohol can damage the heart muscles.
Obstructive sleep apnea: The breathing intermittently starts and stops in this condition, which leads to sudden decrease in blood oxygen levels. This puts pressure on the cardiovascular system, leading to coronary artery disease.
Emotional stress: High stress levels add strain our heart muscles, thus increasing the risk of coronary artery disease.
Abnormal blood cholesterol levels: Both low levels of high-density lipoprotein (HDL) cholesterol and high levels of low-density lipoprotein (LDL) can increase the risk of plaque formation, which results in atherosclerosis.

How is Coronary Artery Disease diagnosed?
The doctor will first get an accurate family history and then perform some routine blood tests and diagnostic tests in order to diagnose for CAD. These tests include:


  • Echocardiogram: This test involves using sound waves to produce images of the heart in order to assess if the heart is pumping properly.

  • Electrocardiogram: This records the electrical signals that travel through the heart and is can give evidence of previous heart attacks or one in progress.

  • Cardiac Catheterization: In this test, the doctor injects a special dye into the coronary arteries through a catheter inserted into the forearm or groin.

  • Heart CT Scan: CT Scans can help detect calcium deposits which clog up the arteries. High amounts of calcium deposition can be a strong indicator or coronary artery disease.

  • Stress Test: This test measures the stress on the heart by monitoring the electrical activity of the heart during physical activity and during rest. This is carried out if a person experiences the signs and symptoms of CAD usually while exercising. A person may be asked to ride a stationary bike or walk on a treadmill and an electrocardiogram is performed at the same time. Medications like adenosine, dobutamine may be used to stimulate the heart if a person is unable to perform physical exercise.

  • Nuclear Imaging: This is another type of stress test which measures the blood flow to the heart muscle. In this test, a radioactive tracer is injected into the bloodstream and special cameras are used to detect the parts of the heart that receive less blood flow.


Treatment
There is no permanent cure for CAD, but it can be managed effectively. The purpose of treatment is to reduce or control the risk factors. The treatment depends on the current health condition as well as the overall well-being of the individual. It usually involves lifestyle changes, but also includes drugs and certain medical procedures, if necessary. The common treatment measures for CAD are as follows:

  • Lifestyle Changes:

    • Quit smoking

    • Reduce alcohol consumption

    • Regular exercise

    • Healthy diet which is low in fat and sodium

    • Maintaining healthy weight



  • Medications:

    • Depending on whether other risk factors are present, aspirin may be prescribed in order to reduce the platelet count. This decreases the tendency of blood to clot and hence diminishes the risk of heart attack.

    • Beta-blocker drugs slow down the heart and decrease the blood pressure, which reduces the heart’s demand for oxygen. They help in reducing the risk of future attacks.

    • Calcium channel blockers help the heart muscle contract and pump more efficiently.

    • Cholesterol-modifying medications decrease the level of LDL cholesterol in the body, which forms the bulk of the deposits in the arteries.

    • Angiostenin-Converting Enzyme (ACE) Inhibitors are drugs that help decrease the blood pressure and prevent further progression of CAD.

    • Nitroglycerin tablets, sprays or patches temporarily widen the coronary arteries, reduce the heart’s demand for blood and help relieve chest pain.



  • Surgery

    • Coronary Artery Bypass Surgery: The surgeon creates a graft using a blood vessel from any other part of the body in order to bypass the blocked artery. This allows blood to flow around the blocked artery.

    • Balloon Angioplasty: A stent is inserted in order to keep the lumen open in order to widen the blocked arteries and eliminate the plaque build-up.

    • Angioplasty and stent placement: A catheter is inserted into the clogged artery and a deflated balloon is passed through the catheter to the affected area. When it is inflated, it compresses the fatty deposits against the artery walls. A stent is then left in the artery to keep it open.

    •  Laser Surgery: This involves making numerous tiny holes in the heart muscle, which promotes the formation of new blood vessels.




Although CAD is a major disease, the measures or steps to be taken to prevent it are quite simple. A healthy lifestyle with nutritious diet, regular exercise, limited or no alcohol consumption and no tobacco goes a long way in preventing the onset of this disease.

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