Coronary Artery Disease: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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Illustration of healthy heart‬‏, coronary artery disease and Coronary artery bypass graft

1Overview

The coronary arteries are the blood vessels that supply the heart tissues or the myocardium with oxygen-rich blood and other nutrients. Since the heart works continuously, the coronary arteries should deliver a continuous blood supply needed by the heart to function properly. The problem arises like angina (chest pain) when the blood flow going to the coronary arteries are restricted.

The Coronary Artery Disease (CAD) or the Ischemic Heart Disease (IHD), is a common type of heart disease where the blood vessels are blocked by plaques (fatty deposits).
These substances make the walls of the arteries thick and hard (atherosclerosis) thereby causing the walls of the coronary arteries to be narrowed.

If this happens, there will be a limited blood flow to the heart tissues (myocardium) making the heart to become ischemic (lack of oxygen supply), since blood carries oxygen.
A heart attack happens if these plaques rupture because these could cause a blood clot that would restrict blood flow going to the heart muscles.

2Symptoms

The common symptoms identified in clients having coronary artery disease are the following:

  • Angina (chest pain characterized as heavy or painful radiating on the left shoulder, arms, neck, and back)
  • Shortness of breath
  • Fatigue
  • weakness
  • Sweating
  • Irregular heartbeats or palpitations

3Causes

Normally, the walls of the coronary arteries are elastic and smooth hollow tubes that allow the oxygenated blood to flow smoothly going to the heart muscles. In coronary artery disease, these tubes are blocked with cholesterol and fat deposits (plaques). These plaques start to form during childhood and eventually remains there till adulthood if there are no modifications in lifestyles.

The buildup of these plaques will lead to a condition known as atherosclerosis where there are the hardening and thickening of the coronary arteries thus causing a limited supply of oxygenated-rich blood going to the heart.

4Risk Factors

There are several identified factors that increase a person’s risk of contracting coronary artery disease (CAD). These include factors that an individual is born with and cannot be changed (non-modifiable); and factors which can be controlled, managed or can be treated (modifiable).

  • Those having parents with a history of heart disease (heredity).
  • Men over the age of 60 have the greater risk than women.
  • Among the races, African Americans have the highest number of cardio vascular death as reported.
  • Having high blood cholesterol levels and triglycerides in the blood particularly the low-density lipoprotein (LDL) which is considered as “bad cholesterol.”
  • Tobacco use or cigarette smoking, especially those who consumed several packs a day for years, have a greater risk of having CAD.
  • Being overweight or obese (due to increasing fat cells in the body) can cause complications like atherosclerosis, high blood pressure, metabolic syndrome, and diabetes.
  • Diabetes (having high levels of  blood sugar or glucose that can damage the blood vessels)
  • Having sedentary lifestyle or lack of physical activities, like exercise, increases the chance of CAD.
  • Increase blood pressure (hypertension) makes the heart work harder (increase cardiac workload) and can make the heart muscles thick.
  • An unhealthy lifestyle like drinking too much alcohol and eating an unhealthy diet and having too much stress predisposes one to have the disease.

5Complications

Coronary Artery Disease can lead to arrhythmia, chest pain, heart attack heart failure, and sudden cardiac death.

Arrhythmia is an abnormal heartbeat that makes the heart beats faster or slower thus having irregular heart rhythm. One type of arrhythmia is the fibrillation where it pumps blood ineffectively to the heart. If this occurs, there will be the limited supply of oxygen –rich blood going to the heart which might trigger chest pain (angina).

If there is a rupture of the blood clot in the heart vessels, it could block the blood flow thus causing a heart attack. Decreased blood flow causes damage to some part of the heart tissue, and at some point, it will die.

Further damage to the heart may cause the heart muscles to weaken and cannot pump sufficient blood that carries oxygen to the body (heart failure) anymore. With this condition, the heart cannot handle the workload anymore.  If the heart loses its function, it may lead to unexpected death or sudden cardiac death.

6Diagnosis

To diagnose a coronary artery disease, aside from the medical history taking, the doctor may require an individual to undergo a physical examination and some blood tests or some laboratory tests.

Physical examination

The doctor will let you characterize the pain you are experiencing: its location, onset, the characteristic of the pain, where the pain progresses or radiates, what triggers the pain and the management you have done for the pain

Echocardiography

Or heart ultrasound is a noninvasive (painless) procedure where the heart’s structure is being viewed and checked if it’s functioning well. This may be needed in cases of unexplained chest pains or if you have had a heart attack.

This also checks the pumping function of the heart and the direction of blood flow.

This is done by a trained sonographer where you will be asked to lie-down on your left side or back, and a special probe will be used to move it over to the chest, thus creating the high-frequency sound waves to get a picture of the heart and its valves.

Electrocardiogram (EKG/ECG)

Records the electrical activity of the heart and can tell signs of previous heart attack or an attack that is happening now.

Stress Test

or exercise test is ordered to see the electrical activity of the heart while the client is on the treadmill. This shows if the heart beats fast or whether there is an irregular heart rhythm. You will also be observed for signs of shortness of breath and chest pain or any abnormal changes while undergoing the test.

Coronary Angiography and Cardiac catheterization

The doctor views the coronary artery with a small catheter being inserted through the skin into blood vessels of the arm, neck or upper thigh then threaded to the heart. An x-ray image of the heart is taken, and a radioactive dye will flow through the bloodstream to the heart’s chambers and valves making the coronary arteries visible for any plaque deposits (coronary angiogram).

Complete blood count (CBC)

to check for signs of anemia and lipid profile test or lipid panel to check for high-density lipoprotein cholesterol (HDL) and low-density lipo protein cholesterol (LDL).

 

7Treatment

Medications may be prescribed by doctors to reduce high blood pressure like:

  • Diuretics to remove excess sodium and water in the body
  • Beta-blockers to reduce heart rate and heart’s workload
  • Angiotensin Converting Enzyme (ACE) helps the blood vessels to relax
  • Angiotensin II receptor blockers help the blood vessels to remain open
  • Calcium channel blockers prevent calcium (makes the heart to contract stronger and harder) from entering the arteries like nifedipine and amlodipine.

Balloon Angioplasty is a procedure where a balloon-tipped catheter is inserted into a small hole in the groin while the client is mildly sedated. These catheters open the clogged artery, and a stent is placed to improve the blood flow through the artery.

Coronary Artery Bypass Graft (CABG) is a procedure done in the operating room. This is invasive because the doctors will get a vein or vessel graft from the arteritis and veins in the patient’s arms, chest or legs. The doctors will create a new passage of blood to the heart muscles. That’s why it’s called bypass because you will go over the blocked vessel.

8Prevention

In the prevention of coronary artery disease, having a healthy lifestyle is very vital.
These provide lifetime benefits and would delay the progression of CAD thereby not causing any further problems like coronary heart diseases.

  • Quit or avoid smoking. Nicotine, a substance found in cigarettes or tobacco, causes the blood vessels to constrict. As a result, there is a higher demand for the heart to work harder to supply oxygen to the body. Over time, the continuous use of these products depletes oxygen to the heart and destroys the lining of the heart muscle and potentially causing tissue damage.
  • Control and monitor blood pressure and check your cholesterol level always.
    Normal blood pressure is less than 120/80 mm Hg or within this range and the normal cholesterol level is 130 mg/dl or less.
  • Exercise daily. This helps you to maintain a healthy weight and control diabetes. Walking and jogging are excellent forms of exercises. Devote at least 30 minutes to 60 minutes of your time doing moderate physical activity. You can engage yourself in sports or participate in dance classes.
  • Monitor your blood sugar if you have diabetes. Strict compliance to blood sugar management helps decrease the risk of heart disease.
  • Have a healthy diet. It should be low in sodium, saturated fats, and cholesterol. If you are watching your cholesterol, choose vegetables, nuts, and high fiber –rich foods like whole grain, beans, and fish rich in omega 3. Limit foods like whole milk, fatty meat, carbonated drinks and other foods rich in saturated fats.
  • Maintain an ideal weight to decrease the risk of coronary artery disease. It also helps lower blood pressure.
  • Learn how to manage stress like deep breathing and muscle relaxation.
  • Have a regular check-up. Early diagnoses and treatment have a higher chance of improving prognosis.