Coronary Artery disease

What is coronary artery disease?

The heart serves as a powerful muscular pump that tirelessly maintains the circulation of blood throughout your body. It relies on its own dedicated blood supply, known as coronary arteries, to deliver oxygen-rich blood to its muscles, which is essential for its proper functioning.

In certain individuals, these arteries can gradually narrow due to the build-up of cholesterol and calcium deposits, known as plaques. This narrowing process is referred to as atherosclerosis. When this occurs in the coronary arteries, it leads to a condition called coronary artery disease. If left untreated and becomes severe, it can eventually restrict the blood flow to the heart muscle, resulting in symptoms like chest pain and shortness of breath. In critical cases where there is a complete blockage, it can lead to a heart attack, also known as myocardial infarction (MI) or acute coronary syndrome (ACS).

Coronary artery disease is a prevalent condition that can develop over many decades, often remaining silent until the narrowing reaches a point where symptoms arise. However, adopting a healthy lifestyle can significantly reduce the likelihood of developing or worsening coronary artery disease. By engaging in regular physical activity, maintaining a balanced diet, refraining from tobacco use, managing stress, and effectively controlling conditions like high blood pressure and diabetes, the chances of coronary disease can be decreased. It is also important to undergo regular check-ups with a healthcare professional to detect and manage risk factors associated with coronary artery disease in its early stages.

How many coronary arteries are there?

The coronary artery system consists of three primary arteries and their branches: the left anterior descending (LAD), the circumflex (LCx), and the right coronary artery (RCA). Initially, the LAD and LCx originate from the left main (LM) coronary artery before dividing into two separate branches. It’s important to note that variations in this arrangement can occur, and some individuals may have more than three main coronary arteries. Typically, these coronary arteries emerge from the aortic root, ensuring a vital blood supply to the heart muscle.

What are the symptoms of coronary artery disease?

Coronary artery disease commonly goes unnoticed until it reaches an advanced stage, causing a reduction in blood flow to the heart muscle. Typically, symptoms arise when the heart is subjected to heightened stress or increased workload, like during exercise or physical exertion. As coronary artery disease advances, these symptoms may become more frequent and intense. It’s important to note that in certain cases, a heart attack or myocardial infarction can occur as the initial presentation of the disease.

Some of the common signs and symptoms of coronary artery disease includes:

Chest pain (also called angina):Typically, individuals experiencing symptoms of coronary artery disease describe a sensation of pressure or tightness in the centre of the chest. This discomfort can be accompanied by jaw pain and discomfort in the left shoulder or arm. Generally, these symptoms subside when physical activity is stopped. It’s important to note that not everyone experiences angina in the same manner. Diabetic patients and women, in particular, may exhibit different symptoms when presenting with coronary artery disease.

Shortness of breath and fatigue:Engaging in physical activity can cause a feeling of breathlessness, and understanding its cause can be perplexing. Shortness of breath can be associated with a range of conditions, but it is crucial to also take into consideration the potential presence of coronary artery disease.

Heart attack:When the coronary arteries are completely or severely blocked, it can cause damage to the heart muscle, leading to a heart attack. A heart attack is commonly marked by a pronounced, crushing pressure in the centre of the chest. This discomfort may radiate to the lower jaw, left shoulder, and upper arm. Along with these symptoms, individuals may also experience shortness of breath and sweating. It is noteworthy that women and individuals with diabetes might have distinct or milder symptoms. Furthermore, it is possible for some individuals to have a heart attack without experiencing any noticeable symptoms.

What are the risk factors for coronary artery disease?

The likelihood of developing coronary artery disease tends to rise with age. Apart from genetic factors, various environmental and behavioural risk factors contribute to the development of coronary artery disease. These risk factors can be classified as either fixed or modifiable:

Fixed risk factors

Age:Getting older increases risk of coronary artery disease.

Genetics:Coronary artery disease in first degree relatives at a relatively young age (<55y.o) increases your risk of coronary artery disease.

Gender:Men are more at risk of coronary artery disease. However, the risk in women increases after menopause.

Modifiable risk factors

Smoking:Smoking is terrible. If you smoke, quit immediately. Smoking increases risk of atherosclerosis and coronary disease.

High cholesterol:Cholesterol exists in both good and bad forms, and maintaining a balance between the two is crucial. Having excessive levels of bad cholesterol and insufficient levels of good cholesterol can lead to the progression of atherosclerosis and coronary artery disease.

High blood pressure / Hypertension: Poorly controlled blood pressure can result in damage to your arteries that can promote and worsen coronary artery disease.

Diabetes:Diabetes increases risk of atherosclerosis and coronary artery disease due to changes at cellular level.

Unhealthy diet:Foods high in saturated fat, trans fat, salt and sugar increases risk of atherosclerosis and coronary artery disease.

Kidney disease, Excessive emotional stress, Sedentary lifestyle / lack of exercise and obesity contribute to coronary artery disease.

How does coronary artery disease start?

Coronary artery disease typically begins with the accumulation of cholesterol particles on the inner lining of the arteries. Over time, these deposits progressively increase and can eventually restrict the blood flow to the affected area of the muscle. These plaques can vary in composition, being either soft with cholesterol or containing calcium deposits that cause them to become calcified and hardened. Importantly, it is possible for individuals to have coronary artery disease even if they do not exhibit any calcium deposits on scans. It is crucial to understand that this process is not confined solely to the coronary arteries but can affect any artery in the body, indicating the potential for widespread involvement.

What can I do about coronary artery disease?

By adopting a healthy lifestyle, maintaining a normal weight, engaging in regular exercise, following a nutritious diet, and avoiding smoking or excessive alcohol consumption, you are taking proactive measures to care for your well-being. In many instances, these steps alone are sufficient to promote good health.

Additionally, it is important to regularly monitor your cholesterol and blood pressure levels to ensure they remain within a healthy range. Depending on individual circumstances, further investigations may be necessary to assess the presence of coronary artery disease. In certain cases, medications such as aspirin, blood pressure-lowering drugs, and cholesterol-lowering medications may be prescribed to manage the condition effectively.

How do I find out if I have coronary artery disease?

Multiple tests are available to diagnose coronary artery disease, each serving a distinct purpose. It is important to note that no single test is universally applicable, as the choice of test depends on individual circumstances and specific diagnostic needs.

Common tests include:

An echocardiogram: This is a simple non-invasive test using ultrasound to look for the heart’s structure and function as an indirect assessment.

A Stress echocardiogram: This is a straightforward and non-invasive functional assessment test used to evaluate the presence of significant narrowing that restricts blood flow to the heart muscle during exercise. The test involves utilizing ultrasound technology to examine the heart. However, it’s important to note that this test does not definitively rule out coronary artery disease. During the test, individuals are required to comfortably use a treadmill that gradually increases in speed and incline until a specific target heart rate is achieved. The entire procedure typically takes approximately 30 minutes to complete.

Nuclear medicine stress test:Similar to the treadmill stress echocardiogram, the nuclear medicine stress test is another non-invasive diagnostic tool. In this test, nuclear markers are injected into a vein, which can be visualized in the heart using a specialized scanner. Unlike the treadmill stress test, the nuclear medicine stress test requires a longer duration to complete. In cases where individuals are unable to exercise, a specific medication is administered to mimic the effects of physical stress and assess blood flow.

A Computed Tomography coronary angiogram (CTCA):A computed tomography (CT) scan of the heart arteries is a diagnostic procedure commonly employed in individuals with a lower risk of coronary artery disease to rule out the condition. This test is typically conducted in the radiology department. A specific contrast dye is injected into a vein, enabling visualization of the heart and blood vessels on the CT scanner. It is important to note that in certain cases, the scan may not provide a clear distinction between moderate and severe disease, necessitating further evaluation.

Coronary angiogram: This method is considered the definitive standard for diagnosing coronary artery disease. It is typically conducted in a catheter laboratory using an X-ray machine, where a tube is inserted directly into the artery and advanced to the heart. The tube can be placed in either the wrist or the upper thigh. A specialized contrast dye is then injected through the tube into the heart arteries. This dye appears dark on X-ray images. As the dye fills the coronary artery, any blockages can be observed. To ensure accuracy, the dye injection is often repeated multiple times from different angles to confirm the anatomy of the arteries.

What treatments are available to treat coronary artery disease?

The appropriate course of action will depend on factors such as the severity, location, condition of your heart, and the presence of symptoms. It is essential to have a detailed discussion with your specialist for further guidance.

For mild disease, lifestyle modifications and medications are usually recommended, along with regular monitoring of blood pressure and cholesterol levels.

In specific cases where there are areas of severe narrowing, a metal scaffold called a stent may be placed to open the artery and restore normal blood flow. This procedure is known as percutaneous coronary intervention (PCI).

However, if there are multiple blockages or challenging locations, surgical intervention may be necessary. This procedure is referred to as coronary artery bypass surgery (CABG).

Engaging in discussions about this condition with your immediate family members is crucial to raise awareness and promote a healthy lifestyle to prevent heart-related issues.