Coronary artery disease (CAD)

2021-07-31 10:47 AM

Chest pain, shortness of breath, heart attack, call emergency immediately. If you have high blood pressure, high cholesterol, diabetes or obesity, there are risk factors

Define

Coronary artery disease develops when coronary arteries - the large blood vessels that supply blood, oxygen, and nutrients to the heart muscle, are damaged or become diseased. Plaque-containing cholesterol that adheres to artery walls is often identified as the cause of coronary artery disease.

As plaque grows, it narrows the coronary arteries, allowing the heart muscle to receive less blood. Finally, decreased blood flow can cause chest pain (angina), shortness of breath, or other symptoms of coronary artery disease. Complete blockage of a coronary artery can cause a heart attack.

Because coronary artery disease often develops over decades, it can go largely unnoticed until it triggers a heart attack. But there is much that can be done to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.

Symptoms

If the coronary artery becomes narrowed, it cannot deliver enough oxygen and blood to the heart - especially during exertion, such as during physical activity. At first, restricted blood flow may not cause any symptoms of coronary artery disease. However, as plaque continues to build up in the coronary arteries, symptoms of coronary artery disease can develop, including:

Chest pain. You may feel pressure or tightness in your chest like someone is standing on your chest. The pain, called angina, is often triggered by physical or emotional stress. It usually goes away within minutes of stopping the stressful activity. In some people, especially women, this pain can be transient or pronounced and is noticed in the abdomen, back, or arms.

Shortness of breath. If the heart cannot pump enough blood to meet the body's needs, shortness of breath may develop or fatigue with exertion.

Heart attack. If a coronary artery becomes completely blocked, a heart attack is possible. Classic signs and symptoms of a heart attack include pressure in the chest and pain radiating to the shoulder or arm, sometimes with shortness of breath and sweating. Women are less likely than men to experience typical signs and symptoms of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any obvious signs or symptoms.

If you suspect a heart attack, call your local emergency department immediately. If not, have someone take you to the nearest hospital. Driving by yourself only as a last resort.

If you have risk factors for coronary artery disease, such as high blood pressure, high cholesterol, diabetes, or obesity, talk to your doctor. Your doctor may order testing for this condition, especially if there are signs or symptoms of narrowed arteries. Even if there is no evidence of coronary artery disease, your doctor may recommend aggressive treatment of risk factors. Diagnosis and treatment can stop the progression of coronary artery disease and help prevent a heart attack.

Causes

Coronary artery disease is thought to begin with damage or damage to the inner layer of the coronary arteries, sometimes as early as childhood. Damage can be caused by many factors, including:

Smoke.

Hypertension.

High blood cholesterol.

Diabetes.

Radiation therapy to the chest area, used for some types of cancer.

When the inner wall of an artery is damaged, cholesterol plaque and other cellular products tend to build up at the point of injury, a process called atherosclerosis. If the plaque ruptures, blood platelets will condense to form a clot there to try to repair the arterial wound. This blood clot can block an artery, leading to a heart attack.

Risk factors

Risk factors for coronary heart disease include:

Age. The older you get, the greater your risk of damage and narrowing of your arteries.

Gender. Men are generally at greater risk for coronary heart disease. However, the risk for women increases after menopause.

Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if close relatives developed heart disease at a young age. The risk is highest if a father or brother was diagnosed with heart disease before age 55, or a mother or sister developed it before age 65.

Smoke. Nicotine constricts blood vessels, and carbon monoxide can damage the inner lining of blood vessels, making them more susceptible to atherosclerosis. The rate of heart disease in women who smoke at least 20 cigarettes a day is six times that of women who never smoke. For men who smoke, this rate is three times higher than for non-smokers.

Hypertension. Uncontrolled high blood pressure can lead to hardening and thickening of the artery walls, narrowing blood vessels.

High cholesterol in the blood. High levels of cholesterol in the blood can increase the risk of plaque formation and atherosclerosis. High cholesterol can be caused by high low-density lipoprotein (LDL) cholesterol, known as "bad" cholesterol. Low levels of high-density lipoprotein (HDL), known as "good" cholesterol, can also promote atherosclerosis.

Diabetes. Diabetes is associated with an increased risk of coronary heart disease. Both conditions share similar risk factors, such as obesity and high blood pressure.

Obesity. Excess weight often aggravates other risk factors.

Inactive. Lack of exercise is also associated with coronary artery disease and a number of risk factors.

Stress. Stress in life can damage arteries as well as worsen other risk factors for coronary heart disease.

Risk factors often occur in combination and can overlap, such as obesity leading to diabetes and hypertension. When grouped together, certain risk factors for coronary artery disease were at greater risk. For example, metabolic syndrome, a group of conditions that includes high blood pressure, high cholesterol, high insulin levels, and excess body fat around the waist increases the risk of coronary heart disease.

Sometimes coronary heart disease develops without any of the classic risk factors. Researchers are studying other possible factors, including:

Sleep apnea. This disorder causes breathing to stop and start many times during sleep. The sudden drop in blood oxygen levels that occurs during sleep apnea increases blood pressure and puts stress on the cardiovascular system, which can lead to coronary heart disease.

C - reactive protein. C - reactive protein (CRP) is a protein that is higher when there is inflammation somewhere in the body. High CRP can be a risk factor for heart disease, as can narrow coronary arteries.

Homocysteine. Homocysteine ​​is an amino acid the body uses to make proteins and to build and maintain tissue. But excessive homocysteine ​​can increase the risk of coronary and cardiovascular disease, CRP, and other conditions.

Fibrinogen. Is a blood protein that plays a central role in blood clotting. But too much can increase adhesion to platelets, the types of blood cells primarily responsible for blood clotting. That can cause a blood clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis.

Lipoproteins (a). This substance forms when low-density lipoprotein (LDL) attaches to a specific protein. Lipoprotein (a) may disrupt the body's ability to dissolve blood clots. High lipoprotein(a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.

Complications

Coronary artery disease can lead to:

Chest pain. When the coronary arteries narrow, the heart may not receive enough blood when the need is greater, especially during physical activity. This can cause chest pain (angina) or difficulty breathing.

Heart attack. If the cholesterol plaque ruptures and the clot completely block the heart artery, a heart attack can be triggered. The lack of blood flow to the heart can damage the heart muscle. The amount of damage depends in part on the duration of treatment.

Heart failure. If certain areas of the heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if the heart has been damaged by a heart attack, the heart may become too weak to pump enough blood to meet the body's needs. body. This condition is called heart failure.

Abnormal heart rhythm (arrhythmia). Lack of blood supply to the heart or damage to heart tissue can affect the heart's electrical impulses, causing an irregular heartbeat.

Tests and diagnostics

Your doctor will ask questions about your medical history, do a physical exam, and do routine blood tests. One or more diagnostic tests may be suggested, including:

Electrocardiogram (ECG). Electrocardiogram records - electrical signals as they travel through the heart. An ECG can often reveal evidence of a previous heart attack or ischemic progression. In other cases, Holter monitoring may be recommended.

Echocardiography. An echocardiogram uses sound waves to create images of the heart. During an echocardiogram, your doctor can determine how well your heart's walls are pumping. Weak moving parts may have been damaged during a heart attack or received too little oxygen. This could indicate coronary artery disease or other problems.

Stress test. If signs and symptoms occur most often during exercise, your doctor may recommend walking on a treadmill or cycling with an ECG attached. This is known as a stress test. In some cases, heart stimulants may be used instead of exercise.

Some stress tests are done using echocardiography. For example, your doctor may do an ultrasound before and after exercise. Or your doctor may use medication to stimulate your heart during an echocardiogram.

The stress test is known as the radionuclide test. It is similar to a stress test, but with images that further contribute to the diagnosis of the electrocardiogram. A radioactive substance, such as thallium or the compound sestamibi, is injected into a blood vessel. Special cameras can detect areas in the heart that receive less blood flow.

Insert coronary catheter. To see blood flow through the heart, the doctor may inject a special dye into the blood vessels. The dye is injected into the arteries of the heart through a catheter, usually a vessel in the leg, to the arteries in the heart. This procedure is called a cardiac catheterization. The dye outlines narrowing and blockages on the X-ray images. If there is an obstruction that requires treatment, the balloon can be pushed through the catheter and inflated to improve blood flow in the coronary arteries. A mesh tube (stent) may then be used to keep the arteries open.

CT scan. A computed tomography (CT) scan, such as an electron beam computed tomography (EBCT) scan or a coronary CT angiogram can help your doctor visualize the arteries. EBCT, also called a rapid CT scan, can detect calcium in plaque that narrows the coronary arteries. If significant amounts of calcium are detected, coronary artery disease is likely. A coronary CT angiogram, which uses contrast dye intravenously during a CT scan, can also produce images of the heart arteries.

Magnetic Resonance Angiogram (MRA). This procedure uses MRI technology, often combined with an injectable contrast dye to check for narrowed or blocked areas, although the details may not be as obvious as coronary catheterization.

Treatments and drugs

Treatment for coronary artery disease usually involves lifestyle changes and if necessary medications and certain medical procedures are used.

Lifestyle change.

Make a commitment to the following healthy lifestyle changes that can work towards promoting healthy arteries

Quit smoking.

Eat healthy foods.

Exercise regularly.

Excessive weight loss.

Reduce stress.

Quit drugs.

Different drugs may be used to treat coronary artery disease, including

Cholesterol-lowering drugs. By reducing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL), these drugs reduce the main material that forms plaque in the coronary arteries. Promotes high-density lipoprotein (HDL), which may help. Your doctor may choose from a range of medications including statins, niacin, fibrates, and acid sequestrants.

Aspirin. Your doctor may recommend taking a daily aspirin. This can reduce your tendency to form blood clots, which can help prevent blockages in your coronary arteries. If you've had a heart attack, aspirin can help prevent future heart attacks. There are some cases where aspirin is not appropriate, such as having a bleeding disorder, so check with your doctor before starting aspirin.

Beta-blockers. These drugs slow the heart rate and lower blood pressure, reducing the heart's need for oxygen. If you've had a heart attack, beta-blockers reduce your risk of future heart attacks.

Nitroglycerin. Nitroglycerin tablets, sprays, and patches can control chest pain by dilating the coronary arteries.

ACE inhibitors and angiotensin receptor blockers (ARBS). These drugs are similar to other blood pressure medications and may help stop the progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce your risk of future heart attacks.

Calcium channel blockers. The drug relaxes the muscles surrounding the coronary arteries and causes vasodilation, increasing blood flow to the heart. It also controls high blood pressure.

Procedures to restore and improve blood flow

Sometimes more aggressive treatment is needed. Here are a few options:

Angioplasty and stenting (percutaneous coronary revascularization). In this procedure, the catheter is inserted into a narrowed part of the artery. A wire with a deflated balloon is passed through the catheter into the narrowed area, and the balloon is then inflated, compressing the plaque against the artery wall. Stents are usually left in the artery to help keep the artery open. Some stents give slow medication to help keep the artery open.

Coronary artery surgery. The surgeon creates a graft to bypass the blocked coronary artery using a piece of blood vessel from another part of the body. Because this requires open-heart surgery, which is usually reserved for multiple narrowed coronary arteries.

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Alternative medicine

Omega-3 fatty acids are a type of unsaturated fatty acid that reduces inflammation. Omega-3 fatty acids may help lower blood pressure and may reduce the risk of heart attack.

Fish and fish oils are the most effective sources of omega-3 fatty acids. Fatty fish like salmon, herring and tuna contain the most omega-3 fatty acids and are therefore the most beneficial. Fish oil supplements may provide benefits, but the strongest evidence is from food sources.

Flax and flaxseed oil, although studies have not found these sources as effective as fish. Whole flaxseed skins also contain soluble fiber, which can help lower blood cholesterol.

Diets rich in omega-3 fatty acids include walnuts, canola oil, soybeans, and soybean oils. These foods contain smaller amounts of omega-3 fatty acids than fish and fish oils, and the evidence for benefits for heart health is not as strong.

Lifestyle and remedies

Lifestyle changes can help prevent or slow the progression of coronary artery disease.

Stop smoking. Smoking is a major risk factor for coronary heart disease. Nicotine reduces blood flow and makes the heart work harder, and carbon monoxide reduces oxygen in the blood and damages the lining of blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.

Control blood pressure. Take your blood pressure at least every two years. More frequent measurements may be advised if blood pressure is higher than normal or if there is a history of heart disease. Ideal blood pressure is below 120 systolic and diastolic is less than 80, when measured in millimeters of mercury (mm Hg).

Check cholesterol. Get your cholesterol checked in your 20s and then at least every five years. If test results are not in the desired range, your doctor may recommend more frequent measurements. Most should aim for an LDL level below 130 mg/dL (mg/dL), or 3.4 millimoles/liter (mmol/L). If there are other risk factors for heart disease, a possible goal of LDL is less than 100 mg/dL (2.6 mmol/L).

Keep diabetes under control. If you have diabetes, tight control of your blood sugar can help reduce your risk of heart disease.

Exercise helps achieve and maintain a healthy weight and control diabetes, high cholesterol, and high blood pressure - all risk factors for coronary heart disease. With your doctor's goal, 30 - 60 minutes of physical activity every day, five days, or all days of the week.

Eat healthy foods. A heart-healthy diet that's based on fruits, vegetables, and whole grains - and low in saturated fat, cholesterol, and sodium can help control weight, blood pressure, and cholesterol. Eating one or two servings of fish a week is also beneficial.

Maintain a healthy weight. When you gain weight, your risk of coronary heart disease increases. Weight loss is especially important for people with a large waist circumference - more than 102 cm for men and more than 89 cm for women - because people with this body shape are more likely to develop diabetes. sugar and heart disease.

Stress management. Reduce stress as much as possible. Practice healthy techniques for stress management, such as muscle relaxation and deep breathing.

In addition to making healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease - high cholesterol, high blood pressure, and diabetes - have no symptoms in the early stages. Early detection and treatment can establish a life with better heart health.

Ask your doctor about the annual flu shot. Coronary artery disease and other cardiovascular disorders increase the risk of complications from the flu.

Prevention

The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing. Leading a healthy lifestyle can help keep arteries healthy, elastic and smooth, and allow for maximum blood flow. Heart-healthy habits include:

No smoking.

Control problems like high blood pressure, high cholesterol, and diabetes.

Maintain physical activity.

Eat healthy foods.

Maintain a healthy weight.

Reduce and manage stress.