What is coronary artery disease?

 

What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease. Over time, a fatty material called atheroma can build up inside your coronary arteries. This process is called atherosclerosis .  Eventually, your arteries may become so narrow that they can't get enough oxygen rich blood to your heart. 

Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis.

 

Coronary heart disease

Coronary heart disease (CHD) is when your coronary arteries become narrowed by a build-up of fatty material within their walls. These arteries supply your heart muscle with oxygen-rich blood. CHD is sometimes called ischaemic heart disease.

Coronary artery disease (CAD) is a condition that affects your coronary arteries, which supply blood to your heart. With CAD, plaque buildup narrows or blocks one or more of your coronary arteries. Chest discomfort (angina) is the most common symptom. CAD can lead to a heart attack or other complications like arrhythmia or heart failure.

What are the symptoms of coronary heart disease?

Coronary heart disease (CHD) develops slowly over time and the symptoms can be different for everyone. Some people don't know they have CHD before they have a heart attack. 

Angina is the term used to describe the most common symptoms of CHD. These include: 

• chest pain
• shortness of breath
• pain travelling through the body
• feeling faint
• nausea.

What increases my risk of coronary heart disease?

There are several risk factors that can increase the risk of developing CHD. These include:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Being overweight
• not doing enough physical activities. 

Risk factors you can't control include:

• Family history
• age
• Ethnic background.

 

 

 

Who does coronary artery disease affect?

Coronary artery disease is the leading cause of death in the U.S. and around the world. This is true for men and people assigned male at birth (AMAB), as well as women and people assigned female at birth (AFAB).

In the U.S., coronary artery disease affects nearly 1 in 10 people aged 40 to 80. About 1 in 5 deaths from CAD occur in people under age 65.

What are the symptoms of coronary artery disease?

You may have no symptoms of coronary artery disease for a long time. CAD is a chronic condition. Plaque buildup takes many years, even decades. But as your arteries narrow, you may notice mild symptoms. These symptoms indicate your heart is pumping harder to deliver oxygen-rich blood to your body.

Symptoms of chronic CAD include:

• Stable angina: This is the most common symptom. Stable angina is temporary chest pain or discomfort that comes and goes in a predictable pattern. You’ll usually notice it during physical activity or emotional distress. It goes away when you rest or take nitroglycerin (medicine that treats angina).
• Shortness of breath (dyspnea): Some people feel short of breath during light physical activity.

Sometimes, the first symptom of CAD is a heart attack. Symptoms of a heart attack include:

• Chest pain or discomfort (Angina). Angina can range from mild discomfort to severe pain. It may feel like heaviness, tightness, pressure, aching, burning, numbness, fullness, squeezing or a dull ache. The discomfort may spread to your shoulder, arm, neck, back or jaw.
• Shortness of breath or trouble breathing.
• Feeling dizzy or lightheaded.
• Heart palpitations.
• Feeling tired.
• Nausea, stomach discomfort or vomiting. This may feel like    Indigestion.
• Weakness.

Women and people AFAB are more likely to have additional, atypical symptoms   that include:

• Shortness of breath, fatigue  and insomnia that began before the heart attack.
• Pain in their back, shoulders, neck, arms or belly.
• Hart racing.
• Feeling hot or flushed.

 

What causes coronary artery disease?

 Atherosclerosis causes coronary artery disease. Atherosclerosis is the gradual buildup of plaque in arteries throughout your body. When the plaque affects blood flow in your coronary arteries, you have coronary artery disease.

Plaque consists of  Cholesterol, waste products, calcium and fibrin (a substance that helps your blood clot). As plaque continues to collect along your artery walls, your arteries become narrow and stiff.

Plaque can clog or damage your arteries, which limits or stops blood flow to a certain part of your body. When plaque builds up in your coronary arteries, your heart muscle can’t receive enough blood. So, your heart can’t get the oxygen and nutrients it needs to work properly. This condition is called myocardial ischemia. It leads to chest discomfort (angina) and puts you at risk for a heart attack.

People who have plaque buildup in their coronary arteries often have buildup elsewhere in their body, too. This can lead to conditions like carotid artery disease and peripheral artery disease:

CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body.

 

How is coronary artery disease diagnosed?

Healthcare providers diagnose coronary artery disease through a physical exam and testing.

During your physical exam, your provider will:

• Measure your blood pressure. 
• Listen to your heart with a stethoscope.
• Ask what symptoms you’re experiencing and how long you’ve had them.
• Ask you about your medical history.
• Ask you about your lifestyle.
• Ask you about your family history. They’ll want to know about heart disease among your biological parents and siblings.

All of this information will help your provider determine your risk for heart disease.

Tests that help diagnose coronary artery disease

Your provider may also recommend one or more tests to assess your heart function and diagnose CAD. These include:

• Blood tests: Check for substances that harm your arteries or increase your risk of CAD.
• Cardiac catheterization: Inserts tubes into your coronary arteries to evaluate or confirm CAD. This test is the gold standard for diagnosing CAD.
• Computed tomography (CT) coronary angiogram: Uses CT and contrast dye to view 3D pictures of your heart as it moves. Detects blockages in your coronary arteries.
• Coronary calcium scan: Measures the amount of calcium in the walls of your coronary arteries (a sign of atherosclerosis). This doesn’t determine if you have significant blockages, but it does help determine your risk for CAD.
• Echocardiogram (echo): Uses sound waves to evaluate your heart’s structure and function.
• Electrocardiogram (EKG/ECG): Records your heart’s electrical activity. Can detect old or current heart attacks, ischemia and heart rhythm issues.
• Exercise stress test: Checks how your heart responds when it’s working very hard. Can detect angina and blockages in your coronary arteries.

 

Treatment

Treatment for coronary artery disease usually involves lifestyle changes such as not smoking, eating healthy and exercising more. Sometimes, medications and procedures are needed.

Medications

There are many drugs available to treat coronary artery disease, including:

·         Cholesterol drugs. Medications can help lower bad cholesterol and reduce plaque buildup in the arteries. Such drugs include statins, niacin, fibrates and bile acid sequestrants.

·         Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in some people.

Daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Don't start taking a daily aspirin without talking to your health care provider.

·         Beta blockers. These drugs slow the heart rate. They also lower blood pressure. If you've had a heart attack, beta blockers may reduce the risk of future attacks.

·         Calcium channel blockers. One of these drugs may be recommended if you can't take beta blockers or beta blockers don't work. Calcium channel blockers can help improve symptoms of chest pain. 

·         Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These medicines lower blood pressure. They may help keep coronary artery disease from getting worse.

·         Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain. Nitroglycerin is available as a pill, spray or patch.

·         Ranolazine. This medication may help people with chest pain (angina). It may be prescribed with or instead of a beta blocker.

 

Sometimes, surgery is needed to fix a blocked artery. Some options are:

·         Coronary angioplasty and stent placement. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). The heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow.

A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents slowly release medication to help keep the arteries open.

·         Coronary artery bypass graft surgery (CABG). A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. CABG is an open-heart surgery. It's usually done only in those with many narrowed heart arteries.

Risk factors

Coronary artery disease is common. Age, genetics, other health conditions and lifestyle choices can affect the health of the heart arteries.

Coronary artery disease risk factors include:

·         Age. Getting older increases the risk of damaged and narrowed arteries.

·         Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.

·         Family history. A family history of heart disease makes you more likely to get coronary artery disease. This is especially true if a close relative (parent, sibling) developed heart disease at an early age. The risk is highest if your father or a brother had heart disease before age 55 or if your mother or a sister developed it before age 65.

·         Smoking. If you smoke, quit. Smoking is bad for heart health. People who smoke have a significantly increased risk of heart disease. Breathing in secondhand smoke also increases the risk.

·         High blood pressure. Uncontrolled high blood pressure can make arteries hard and stiff (arterial stiffness). The coronary arteries may become narrow, slowing blood flow.

·         High cholesterol. Too much bad cholesterol in the blood can increase the risk of atherosclerosis. Bad cholesterol is called low-density lipoprotein (LDL) cholesterol. Not enough good cholesterol — called high-density lipoprotein (HDL) — also leads to atherosclerosis.

·         Diabetes. Diabetes increases the risk of coronary artery disease. Type 2 diabetes and coronary artery disease share some risk factors, such as obesity and high blood pressure.

·         Overweight or obesity. Excess body weight is bad for overall health. Obesity can lead to type 2 diabetes and high blood pressure. Ask your health care provider what a healthy weight is for you.

·         Chronic kidney disease. Having long-term kidney disease increases the risk of coronary artery disease.

·         Not getting enough exercise.Physical activity is important for good health. A lack of exercise (sedentary lifestyle) is linked to coronary artery disease and some of its risk factors.

·         A lot of stress. Emotional stress may damage the arteries and worsen other risk factors for coronary artery disease.

·         Unhealthy diet. Eating foods with a lot of saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.

·         Alcohol use. Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease.

·         Amount of sleep. Too little and too much sleep have both been linked to an increased risk of heart disease.

Risk factors often occur together. One risk factor may trigger another.

When grouped together, certain risk factors make you even more likely to develop coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes high blood pressure, high blood sugar, excess body fat around the waist and high triglyceride levels — increases the risk of coronary artery disease.

Sometimes coronary artery disease develops without any classic risk factors. Other possible risk factors for coronary artery disease may include:

·         Breathing pauses during sleep (obstructive sleep apnea). This condition causes breathing to stop and start during sleep. It can cause sudden drops in blood oxygen levels. The heart must work harder. Blood pressure goes up.

·         High-sensitivity C-reactive protein (hs-CRP). This protein appears in higher-than-usual amounts when there's inflammation somewhere in the body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as coronary arteries narrow, the level of hs-CRPin the blood goes up.

·         High triglycerides. This is a type of fat (lipid) in the blood. High levels may raise the risk of coronary artery disease, especially for women.

·         Homocysteine. Homocysteine is an amino acid the body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase the risk of coronary artery disease.

·         Preeclampsia. This pregnancy complication causes high blood pressure and increased protein in the urine. It can lead to a higher risk of heart disease later in life.

·         Other pregnancy complications.Diabetes or high blood pressure during pregnancy are also known risk factors for coronary artery disease.

·         Certain autoimmune diseases.People who have conditions such as rheumatoid arthritis and lupus (and other inflammatory conditions) have an increased risk of atherosclerosis.

 

Complications

Coronary artery disease can lead to:

·         Chest pain (angina). When the coronary arteries narrow, the heart may not get enough blood when it needs it most — like when exercising. This can cause chest pain (angina) or shortness of breath.

·         Heart attack. A heart attack can happen if a cholesterol plaque breaks open and causes a blood clot to form. A clot can block blood flow. The lack of blood can damage the heart muscle. The amount of damage depends in part on how quickly you are treated.

·         Heart failure. Narrowed arteries in the heart or high blood pressure can slowly make the heart weak or stiff so it's harder to pump blood. Heart failure is when the heart doesn't pump blood as it should.

·         Irregular heart rhythms (arrhythmias). Not enough blood to the heart can alter normal heart signaling, causing irregular heartbeats.

Prevention

The same lifestyle habits used to help treat coronary artery disease can also help prevent it. A healthy lifestyle can help keep the arteries strong and clear of plaque. To improve heart health, follow these tips:

·         Quit smoking.

·         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.