Coronary Artery Disease
Many people have no idea about myocardial ischemia, how is it diagnosed, as well as about CAD symptoms. However, coronary artery disease is widespread. Coronary artery disease treatment includes lifestyle changes, medications. Sometimes, depending on the stage of arteries blockages, a patient may need an angioplasty and stenting or coronary artery bypass surgery to be done. Let’s below review all the aspects of development, treatment and diagnosis of CAD together.
When the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased, coronary artery disease develops.
What is Coronary Artery Disease?
When plague builds up in your coronary arteries, a condition called Atherosclerosis may develop and may lead to blockages. When this occurs, your arteries may become narrow and stiff.
In the first stage of plague development, blood flow is restricted due to rigid arteries. The heart may potentially become starved of oxygen. The most concerning part of the disease is that it could lead to a rupture and result in a heart attack and potentially sudden cardiac death.
What causes Coronary Artery Disease?
Cholesterol-containing deposits (plaque) in your arteries and inflammation are normally the cause of this disease.
Your coronary arteries become narrow when plaque builds up. This decreases blood flow to your heart. The decreased blood flow will eventually cause chest pain (angina), shortness of breath, or other signs and symptoms of the coronary artery disease. A complete blockage may lead to a heart attack.
You might not notice a problem until you have a significant blockage or a heart attack as coronary artery disease often develops over decades. However, there’s plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact.
Your arteries can’t supply enough oxygen-rich blood to your heart when they become narrow especially when it’s beating hard, such as during exercise. In the initial stages, the decreased blood flow may not cause any symptoms. However, as the plaque continues to build up in your coronary arteries, you may develop signs and symptoms including:
- Chest pain (angina): The feeling of pressure or tightness in your chest (as if someone were standing on your chest). This pain is referred to as angina and is normally experienced on the middle or left side of the chest. Generally, physical or emotional stress is the triggers of angina. Angina normally goes away within minutes after stopping the stressful activity. This pain may be fleeting or sharp and experience in the neck, arm or back in certain people, especially women.
- Shortness of breath (angina): You may develop shortness of breath or extreme fatigue with exertion if your heart can’t pump enough blood to meet your body’s needs.
- Heart attack (angina): The common signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm (sometimes with shortness of breath and sweating). A completely blocked coronary artery may lead to a heart attack. Men are more likely to experience typical signs and symptoms of a heart attack. Women are more likely to experience less typical signs and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart attack may occur without any apparent signs or symptoms.
TREATMENT OF CORONARY ARTERY DISEASE
Lifestyle changes, drugs or certain medical procedures are normally the treatment for coronary heart disease.
Committing to the following healthy lifestyle changes can promote healthier arteries:
- Quit smoking
- Eat healthy foods
- Exercise regularly
- Lose excess weight
- Reduce stress
Various types of drugs can be used to treat the disease such as:
- Cholesterol-modifying medications: Decreases the amount of cholesterol in the blood, especially low-density lipoprotein cholesterol (LDL, or the “bad”). They decrease the primary material that deposits on the coronary arteries. A range of medications such as statins, niacin, fibrates and bile acid sequestrants may be chosen by your doctor.
- Aspirin: You may be recommended to take a daily aspirin or other blood thinner. They reduce the tendency of blood clots (to help prevent obstruction of your coronary arteries). Aspirin can help prevent future attacks if you’ve had a heart attack. If you have a bleeding disorder or you’re already taking another blood thinner, aspirin may not be appropriate so it is important to let your doctor know before starting the medication.
- Beta Blockers: They slow down your heart rate and decrease your blood pressure which will decrease your heart’s demand for oxygen. Beta blockers reduce the risk of future attacks if you’ve had a heart attack.
- Nitroglycerin: The come in tablets, sprays and patches and can control chest pain by temporarily dilating your coronary arteries as well as reducing your heart’s demand for blood.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): They help to decrease blood pressure and may help prevent progression of coronary artery disease.
Procedures to restore and improve blood flow
Sometimes, more aggressive treatment is needed. Here are some options:
- Angioplasty and stent placement (percutaneous coronary revascularization): A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a deflated balloon makes its way through the catheter to the narrowed area. The balloon will then be inflated. This compresses the deposits against your artery walls. A stent is normally left in the artery to help keep the artery open. Some stents also slowly release medication to keep the artery open.
- Coronary artery bypass surgery: A graft to bypass blocked coronary arteries is created using a vessel from another part of your body. This lets blood flow around the blocked or narrowed coronary artery. As this requires open-heart surgery, it is often reserved for cases of multiple narrowed coronary arteries.
DIAGNOSING CORONARY ARTERY DISEASE
- History taking and physical exam: Your doctor will ask you questions about your usual life style, symptoms you are having and family history of heart diseases. Then he will perform a physical examination, which includes checking you pulse, blood pressure, auscultation and percussion of your heart.
- Blood tests: Your doctor may order a general blood test to see your overall condition and also, which is very important, to see the level of cholesterol in your blood.
- Electrocardiogram (ECG): This device records electrical signals as they travel through your heart. It can often reveal evidence of a previous heart attack or one that’s in progress.
- Holter monitoring: This is a type of ECG where you wear a portable monitor for 24 hours (as you go about normal activities). Certain abnormalities may reveal inadequate blood flow to your heart. Sometimes, this technique may be recommended.
- Echocardiogram: Sound waves are used to produce images of your heart. Your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity in the echocardiogram. The areas that move weakly may mean it has been damaged during a heart attack or it may mean it’s receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
- Stress test: Your doctor may perform an exercise stress test on you. During this test, you will be asked to walk on a treadmill or ride a stationary bike during an ECG if your signs and symptoms occur most often during exercise. In certain cases, medication may be used to stimulate your heart instead of exercise. Some stress tests may be done using an echocardiogram. For instance, your doctor may perform an ultrasound before and after you exercise on a treadmill or bike.Likewise, your doctor may use medication to stimulate your heart during an echocardiogram. A nuclear stress test is another test that can help measure blood flow to your heart muscle (at rest and during stress). It is a routine exercise stress test but with images. A tracer is injected into your bloodstream and special cameras can identify areas in your heart that receive less blood flow.
- Cardiac catheterization (angiogram): Your doctor may inject a special dye into your coronary arteries that is threaded through an artery, usually in the leg, to the arteries in the heart to view blood flow through your heart. The dye outlines narrow spots and blockages in the coronary arteries on the X-ray images. If a blockage is detected and it requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in the affected coronary arteries. A stent may then be used to keep the dilated artery open.
- Heart scan: Your doctor may use computerized tomography (CT) technologies to see calcium deposits in your arteries. If there is a substantial amount of calcium detected, coronary artery disease may be likely.