Coronary artery disease is the name that is frequently used to describe the buildup of fatty deposits and fibrous tissue (plaques) inside the arteries that are responsible for supplying blood to the heart (the coronary arteries). This buildup is known as atherosclerosis. Coronary atherosclerosis can finally cause the coronary arteries to become considerably narrower. This reduces the blood supply to parts of the heart muscle and activates a type of chest pain known as angina. Atherosclerosis may also lead to a blood clot to mold inside a narrowed coronary artery. This results in a heart attack, which can bring about considerable damage to the heart muscle.
The factors increasing the risk of developing coronary artery disease are mostly the same as those for atherosclerosis:
* A high level of blood cholesterol
* A high level of LDL cholesterol, widely known as "bad cholesterol"
* A low level of HDL cholesterol, widely know as "good cholesterol"
* High blood pressure (hypertension)
* Diabetes
* A family history of coronary artery disease at a very young age
* Smoking cigarettes
* Obesity
* Lack of physical activity (too little regular exercise)
Coronary artery disease is the most frequent chronic, life-threatening disease in the United States. It strikes eleven million American citizens. Earlier in life, men have are at higher risk of coronary artery disease than women. Nevertheless, after menopause, a woman’s risk finally equals that of a man.
Symptoms of Coronary Artery Disease
In the majority of people, the most widespread symptom of coronary artery disease is the kind of chest pain known as angina, or angina pectoris. Normally, angina is described as a squeezing, pressing or burning chest pain that is usually felt mainly in the center of the chest or just below the center of the rib cage. It may also spread to the arms (particularly the left arm), abdomen, neck, lower jaw or neck. Other symptoms of coronary artery disease include: sweating, nausea, dizziness or lightheadedness, breathlessness, or palpitations. In some cases, when coronary artery disease leads to burning chest pain and nausea, heart symptoms may be mistaken with indigestion.
There occur two types of chest pain related to coronary artery disease — stable angina and acute coronary syndrome.
In terms of stable angina, chest pain follows a predictable pattern. Normally, it takes place after extreme emotion, overexertion, a large meal, smoking a cigarette, or exposure to extreme hot or cold temperatures. Symptoms normally persist one to five minutes, and they fade away after several minutes of rest. Stable angina is caused by a smooth plaque that partly obstructs blood flow in at least one coronary arteries.
Acute coronary syndrome (ACS) is much more hazardous. In the majority of cases of ACS, fatty plaque inside an artery has developed a tear or break. The uneven surface can make blood clot on top of the disrupted plaque. This unexpected blockage of blood flow leads to unstable angina or a heart attack (myocardial infarction). In terms of unstable angina, symptoms of chest pain are more pronounced and less predictable in comparison to stable angina. Chest pains appears more often, frequently at rest, and persists a few minutes to hours. Additionally, people suffering from unstable angina often sweat profusely at times and experience aches in the jaw, shoulders and arms.
A lot of people suffering from coronary artery disease, particularly women, do not experience any symptoms or have untypical symptoms. In these people, the only sign of coronary artery disease may be a suspicious change in the pattern of a test known as an electrocardiogram (EKG), which records the heart’s electrical activity. The test may be performed at rest or in the course of physical activity (exercise stress test). The stress test can easily detect the trouble in the coronary artery due to the fact that physical activity increases the heart muscle’s demand for blood. The body is not able to meet this demand when the coronary arteries are considerably narrowed. In areas of the heart affected by narrowed coronary arteries, the heart muscle starves for blood and oxygen, and its electrical activity alters. This changed electrical activity is reflected in the patient’s EKG results.
If it happens that the problem is not recognized, the initial symptom of coronary artery narrowing may be a heart attack. A patient who experiences a heart attack has a 15 per cent chance of dying before receiving medical help.
Diagnosis
Coronary artery disease is normally diagnosed after a patient has chest pain or other symptoms including: shortness of breath whileexercising.
Your healthcare provider will examine you, paying particular attention to your chest and heart. In the course of the physical examination, your healthcare professional will press on your chest to check if it is tender. Tenderness in the area where you experience chest pain could be a symptom of a non-cardiac problem involving chest muscles, ribs or rib joints. Your healthcare provider will use a stethoscope in order to listen for any anomalous heart sounds. The physical exam will be followed by one or more diagnostic tests to search for coronary artery disease. The possible tests are:
* An EKG — An EKG is a record of the heart’s electrical impulses. It is performed to identify problems in heart rate and rhythm, and it can give clues that part of your heart muscle isn’t getting enough blood.
* Blood test for heart enzymes — When heart muscle is damaged, enzymes leak out of the damaged muscle cells into the bloodstream. Increased heart enzymes indicate that there is a heart problem.
* An exercise stress test on a treadmill — An exercise stress test controls the effects of treadmill exercise on blood pressure and EKG and can recognize heart problems.
* An echocardiogram — This test makes use of ultrasound to create images of the heart’s movement with each beat.
* Imaging test with radioactive tracers — In this test, a radioactive material is injected and is taken up by the heart muscle, which helps particular features show up on images taken with special cameras.
* A coronary angiogram (a series of X-rays of the coronary arteries) — The coronary angiogram is regarded as the most precise way of measuring the severity of coronary disease. During an angiogram, a thin, long, flexible tube known as a catheter is inserted into an artery in the forearm or groin and after that it is threaded through the circulatory system into the coronary arteries. Dye is injected to show the blood flow within the coronary arteries and to recognize any areas of narrowing or blockage.
Expected Duration
Coronary artery disease is a long-lasting disease, and patients can experience various symptoms. Plaque in coronary arteries will never completely disappear. Nevertheless, with diet, physical activity and appropriate medicines, the heart muscle adapts to reduced blood flow, and new, small blood channels can develop to increase the blood flow to the heart muscle.
Means of Prevention
You can help to prevent coronary artery disease by monitoring your risk factors for atherosclerosis. In order to achieve this:
* Give up smoking cigarettes.
* Adopt healthy diet.
* Decrease your high blood LDL cholesterol ("bad cholesterol").
* Decrease high blood pressure.
* Lose weight and have a regular exercise to prevent diabetes.
Treatment
Coronary artery disease that results from atherosclerosis is treated with:
* Changes in lifestyle— These include: weight loss in patients with obesity, giving up smoking, proper diet and medicines to reduce high cholesterol, regular physical activity, and techniques of stress reduction (meditation, biofeedback, etc.).
* Nitrates (including nitroglycerin) — These medicines broaden blood vessels (vasodilators). Nitrates widen the coronary arteries and increase the blood flow to the heart muscle. Moreover, they broaden the body’s veins, which lightens the heart’s workload by momentarily reducing the volume of blood returning to the heart for pumping.
* Beta-blockers, for example, atenolol (Tenormin) and metoprolol (Lopressor) — These medicines lower the heart’s workload by slowing the heart rate and decreasing the force of heart muscle contractions, particularly in the course of physical activity. Patients who have experienced a heart attack should stay on a beta-blocker for life to lower the risk of a second heart attack.
* Aspirin — Aspirin is helpful in preventing blood clots from molding inside narrowed coronary arteries. It can lower the risk of heart attack in patients who already suffer from coronary artery disease. Healthcare professionals frequently advise people over the age of fifty to take a low dose of aspirin every day to help prevent a heart attack.
* Cholesterol-lowering medicines — Statins — for instance, lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol) and atorvastatin (Lipitor) — have had the biggest influence on increasing the risk of heart attack and death in patients with coronary artery disease and those at high risk of coronary artery disease. Statins reduce LDL cholesterol and may increase HDL cholesterol slightly. Taking statins on a regular basis also helps to prevent plaques from tearing or breaking, which reduces the likelihood of a heart attack or worsening of angina. Niacin reduces LDL cholesterol, increases HDL cholesterol, and decreases triglyceride levels as well. Medicines known as fibrates, such as gemfibrozil (Lopid), are used initially in patients with high levels of triglyceride. Ezetimibe (Zetia) works within the intestine to reduce the absorption of cholesterol from food.
* Calcium channel blockers, for example, long-acting nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin), diltiazem (Cardizem), amlodipine (Norvasc) — These medicines may help to reduce the frequency of chest pain in patients suffering from angina.
If your stable angina limits you physically due to chest pain, your healthcare provider will probably advise you to take a coronary artery angiography (cardiac catheterization) to search for considerable blockages. A heart specialist (cardiologist) may also perform this test to diagnose coronary artery disease when other tests are not conclusive, in an emergency when a person is experiencing a heart attack, and in some patients with newly diagnosed congestive heart failure.
When one or more important blockages are discovered, the heart doctor will determine if the blockage(s) can be opened with a procedure known as balloon angioplasty, also known as percutaneous transluminal coronary angioplasty or PTCA. In balloon angioplasty, a catheter is inserted into an artery in the groin or forearm and then is threaded through the circulatory system into the blocked coronary artery. When it’s inside the coronary artery, a small balloon at the catheter tip is inflated briefly to open the narrowed blood vessel. Typically, balloon inflation is followed by the placement of a stent, a wire mesh expanding with the balloon. The wire mesh stays inside the artery in order to keep it open. The balloon is deflated and the catheter is eliminated.
In situation when the blockages can’t be opened with balloon angioplasty, the cardiologist will probably recommend coronary artery bypass surgery (CABG). CABG involves grafting at least one blood vessel onto the coronary arteries to bypass the narrowed or blocked areas. The blood vessels that are to be grafted can be taken from an artery inside the chest, an artery in the arm, and from a long vein in the leg.
The objective of treating heart attacks or unexpected worsening of angina is to restore blood flow rapidly to the section of heart muscle not receiving blood flow. Patients obtain medication promptly in order to alleviate pain. Moreover, they get a beta-blocker to slow the heart rate and reduce the work of the heart and aspirin along with other medicines to dissolve or inhibit blood clotting. If it is possible, patients are transferred to a cardiac catheterization laboratory to undergo immediate angiography and balloon angioplasty of the most important blockage. In some patients suffering from coronary artery disease, other symptoms or complications will require different treatment, with additional therapies. For instance, medicines may be necessary for the treatment of cardiac arrhythmias (abnormal heart rhythms), low blood pressure or heart failure.
When To Contact a Specialist
Ask for immediate medical help urgently if you experience chest pain, even if you believe that you are too young to be experiencing heart problems. In patients whose chest pain signals heart attack, immediate treatment may limit heart muscle damage.
You mustn’t waste time hoping that your chest pain disappears. Nearly 15 per cent of patients experiencing a heart attack die shortly after chest symptoms occur and never reach the hospital alive.
Prognosis
In people suffering from coronary artery disease, the viewpoint depends on various factors. People suffering from stable angina who are taking medicines regularly, eating appropriately and exercising as advised by their physicians generally remain active. The prognosis for heart attacks when people reach the emergency room immediately has improved spectacularly over the past ten years. Nevertheless, a lot of people still die before reaching the emergency room. This is why it is so essential to prevent coronary artery disease.
