CONDITIONS
Coronary Artery Disease
Coronary Artery Disease
The most common type of heart disease, coronary artery disease (CAD) is a condition in which the major blood vessels (coronary arteries) supplying blood, oxygen and nutrients to the heart muscle are unable to do it due to the buildup of plaque in it.
Asian Indians have the highest CAD rates, with the percentage as high as 11% for non-diabetic patients and 21.4% for diabetics.
What are the different forms of Coronary Artery Disease?
Stable ischemic heart disease: Is a type of CAD which increases the load of heart and it is harder than normal for the blood and oxygen work flow to your heart.
Acute coronary syndrome (ACS): Sudden reduction of blood flow to the heart that may lead to a heart attack. Hence, ACS is treated like an emergency, and in case of severe chest pain, call the ambulance or rush to the doctor right away.
Atherosclerotic coronary artery disease: Over time, plaque (a sticky, fatty substance) deposits in the arteries which makes it blood flow harder and raises the risk for a heart attack or stroke.
What are the symptoms of Coronary Artery Disease?
Early stages may not show symptoms but shortness of breath or fatigue may be noticed as the plaque builds up, coronary arteries narrow, and blood flow to the heart is reduced.
The signs and symptoms include:
Chest pain (angina): Most common symptom of CAD is angina or chest pain. Points to keep in mind with angina:
- Angina is often mistaken for heartburn or indigestion.
- Feeling of pressure or tightness in the chest.
- For some, it feels like someone is standing on their chest.
- Chest pain may occur on the middle or left side of the chest.
- Excessive activity or strong emotions may trigger angina.
- The pain usually goes away within minutes after the triggering event ends.
- In women, the pain may be brief or sharp and felt in the neck, arm or back.
Symptoms of CAD in women:
Women may have different heart attack symptoms than men. While most common symptom is still chest pain, women may also feel shortness of breath, extreme fatigue, nausea, vomiting, and back or jaw pain.
When should a person call an ambulance?
- Chest pain – lasting for a few minutes or is going and coming back.
- It can feel like pressure, squeezing, fullness, or pain.
- Sometimes it might be mistaken for indigestion or heartburn.
- Discomfort in any upper body, including one or both arms, the shoulders, neck, jaw, or upper part of the stomach.
- Shortness of breath with or without chest discomfort
- Nausea or vomiting with lightheadedness, dizziness, or
- Cold sweat
What are the causes and risk factors of Coronary Artery Disease?
The start of CAD is when fats, cholesterol and other substances (plaque) collect on inner walls of the heart arteries. This condition is called atherosclerosis.
Plaque may cause narrowing of the arteries reducing or even blocking blood flow. In some cases, the plaque may burst leading to a clot, which may result in a heart attack or stroke.
Besides high cholesterol, there are many risk factors that may lead to CAD, such as:
- High Cholesterol
- Diabetes or insulin resistance
- High blood pressure
- Atherosclerosis (hardening or thickening of the arteries)
- Smoking or vaping
- Autoimmune diseases like rheumatoid arthritis or inflammatory bowel disease
- Kidney disease
- HIV or AIDS
- Obesity and being overweight
- Lack of exercise
- High Stress, depression, and anger
- Unhealthy diet that includes high sugar, fried foods, packaged food, etc.
- Excessive alcohol consumption
- Sleep disorders, including sleep apnea (sleep-related breathing disorder, causes repetitive pauses in breathing)
Anemia - Not getting enough exercise (sedentary lifestyle)
- Smoking or tobacco use
How is Coronary Artery Disease diagnosed?
- Blood tests: To assess the levels of blood sugar, cholesterol, and triglycerides (a type of fat in the blood)
- Electrocardiogram (ECG or EKG):
- Quick and painless test procedure to measure the electrical activity of the heart.
- Sensors (electrodes) are attached to the chest, wires connect the sensors to a machine, displaying or printing the results.
- ECG helps to determine if blood flow to the heart has been reduced.
- Exercise stress test:
- The heart rate while walking on a treadmill or riding a stationary bike is monitored. Because exercise makes the heart pump harder and faster than it does during most daily activities, an exercise stress test may show heart problems that are otherwise missed. If exercising is not possible, then medication mimicking the effect of exercise on heart is given.
- Nuclear stress test: Similar to exercise test but with images obtained with the help of a radioactive tracer is given by IV.
- Echocardiogram (2D echo): Sound waves are used to show blood flow through the heart. This assesses the condition of the heart, if oxygen flow is restricted to heart or any of the heart valves. Chest X-ray
- Coronary calcium scan (heart scan): Using computerized tomography (CT) imaging, detailed pictures of the heart are taken to show calcium deposits in the artery walls. In presence of calcium a higher score is obtained which indicates a higher the risk of heart disease.
- Cardiac catheterization and angiogram: To check if coronary arteries are narrowed or blocked. A dye is inserted in a blood vessel through a long, thin flexible tube (catheter), and guided to the heart and flows through the catheter to arteries in the heart. This dye provides a clearer picture on images taken during the test.
Can we check heart blockage at home and how?
It is impossible to determine CAD at home, but certain tests can assess heart in general as follows:
- Heart rate measurement: Pulse is calculated to check the heart rate by putting two fingers on the inside of your wrist, to feel the pulse. A timer or stopwatch for 10 seconds is put and the person counts the number of pulses felt during that time. This number is multiplied by 6 to calculate the heart rate per one minute.
Normal Heart Rate: Between 60 and 100 beats per minute. - Blood pressure cuff: 120/80 is the normal blood pressure. Repot extreme variations to the doctor. (Check how to measure blood pressure at Blood pressure monitoring)
- The stair test: If a person can’t climb four flights of stairs within 90 seconds, it may be a sign of the heart not as healthy as it should be.
What are the treatment options for Coronary Artery Disease?
Depending on the person’s CAD case, treatment plan varies and includes one or a combination of the following treatments:
- Medications:
Depending on the accompanying conditions such as diabetes, hypertension, treatment options may be suggested by the doctor such as:- Blood thinners such as aspirin and other anti-clotting medicines,
- Blood pressure reducing medications.
- Cholesterol reducing medications.
- Invasive procedures:
Treatment plan may involve surgery. Most performed procedures for coronary artery disease include:
- Angiography, Angioplasty and stenting: To help open a clogged or blocked artery, as thin tube is inserted into an artery in your leg or arm to get to diseased arteries to check for blockages. Angioplasty (using a catheter with a balloon tip) and stenting is used to open a blocked artery.
- Coronary artery bypass grafting: Blood vessels from other parts of the body is used to make a detour around blockages in your coronary arteries. Considered as a major operation, the patient of this procedure probably needs hospitalization for at least 5 days.
What is the care and how is the road to recovery post cardiac surgery?
Cardiac rehabilitation and recovery
In case of a heart attack or cardiac surgery, the doctor advises a complete cardiac rehab program to aid in proper recovery. Cardiac rehab starts while in the hospital and continues as outpatient appointments post discharge. Typically, these programs include the following:
- Exercise training.
- Cardiac risk factors are addressed.
- Heart health education
- Nutritional guidance
- Emotional support
Cardiac rehab may help lower the future risk of stroke, heart attack, depression, and cardiac-related death.
Lifestyle changes
Normal day-to-day habits that we all may know but do not follow stringently are a must post cardiac surgery.
- Healthy eating and favouring foods low in trans fats, saturated fats, simple sugars, and sodium.
- Quit smoking.
- Being active, ideally for 30 minutes or more a day. (Consult the doctor first)
- Following everything to stick to a healthy weight.
- In highly stressful conditions, learning effective ways to manage stress.
Can Coronary Artery Disease be prevented?
The same lifestyle habits used to help treat coronary artery disease can also help prevent it.
The goal to prevent CAD is to help keep plaque clear of the arteries, to make them strong for a stronger function.
To improve heart health, follow these tips:
- Quit smoking (if a person does).
- Control high blood pressure, high cholesterol and diabetes.
- Exercise often.
- Maintain a healthy weight.
- Eat a low-fat, low-salt diet that’s rich in fruits, vegetables and whole grains.
- Reduce and manage stress.
References
- Ardeshna DR, Bob-Manuel T, Nanda A, Sharma A, Skelton WP 4th, Skelton M, Khouzam RN. Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States. Ann Transl Med. 2018 Jan;6(1):12.
- Coronary artery disease. Mayo Clinic. March 2024. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-treatment/drc-20350619
- What Is Coronary Artery Disease? WebMD. March 2024. https://www.webmd.com/heart-disease/coronary-artery-disease
