The truth about coronary artery disease: What you need to know

Coronary artery disease (CAD) is a common heart condition which is a result of buildup of cholesterol and plaque in the inner wall of arteries that supply oxygen-rich blood to your heart. Plaque causes a narrowing or blockage that could result in a heart attack.

Every year, more than 400,000 Americans die from coronary artery disease, making it the leading cause of death. Despite its prevalence, there is still a great deal of misinformation about the disease. In this blog post, we’ll debunk some of the myths about coronary artery disease and discuss what you can do to prevent it.

Causes of Coronary artery disease

Normally, coronary artery disease may be caused by one of the following:

• Coronary artery atherosclerosis: atherosclerosis is the most common form of arteriosclerosis, which is a general term for several disorders that cause thickening and loss of elasticity in the arterial wall.
• Coronary artery spasm
• Aneurysm
• Coronary artery embolism
• Vasculitis
• Coronary artery dissection

Symptoms of coronary artery disease

The symptoms of this disease may be hard to tell in early stages, or they may be observed during intense activity like exercise. However, as the arteries continue to get narrow less blood is supplied to the heart leading to severe symptoms.

The symptoms include:

• Chest pain (angina). A person may feel pressure or tightness in his chest. The pain usually occurs on the middle or left side of the chest.
• Shortness of breath.
• Fatigue, feeling unusual tiredness due to inadequate blood circulation.
• Heart attack, this happens only when the coronary arteries are completely blocked.

Risk factors

• Sex: Men are generally at a higher risk. Women are at an increased after menopause.
• Family history: a family history of heart disease makes a person more likely to get CAD. This is especially true if a close relative (parent, sibling) developed heart disease at an early age.
• Age: the older a person is the more risk of damaged and narrowed arteries.
• High blood levels of low-density lipoprotein (LDL) cholesterol: too much cholesterol in the blood can increase the risk of atherosclerosis.
• High blood levels of lipoprotein.
• Too much stress, emotional stress may damage the arteries and worsen risk factor for coronary artery disease.
• Alcohol use, heavy alcohol use can damage heart muscle.
• Disturbed sleep, over sleeping or little sleep have both been linked to an increased risk of heart disease.
• 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.
• Preeclampsia: this pregnancy complication causes high blood pressure and increased protein in the urine.
• Low blood levels of high-density lipoprotein (HDL) cholesterol.
• Diabetes mellitus (particularly type 2)
• Smoking or use of tobacco
• Obesity
• Physical inactivity
• High level of apoprotein B (apo B)
• High blood levels of C-reactive protein (CRP)

Women’s myocardial infarction may be more strongly predicted by smoking than men. Numerous metabolic and systemic conditions, such as hyperhomocysteinemia and hypothyroidism, as well as genetic factors all play a part in risk. When total cholesterol or LDL levels are normal, a high level of apo B may indicate greater risk.

Coronary artery disease risk is increased by the use tobacco, a diet high in fat and calories and low in phytochemicals, fiber, and vitamins C, D, and E, a diet relatively low in omega-3 (n-3) polyunsaturated fatty acids (PUFAs-at least in some people) and by poor stress management.

CAD Complications

Complications of Coronary artery disease(CAD) include:

• Chest pain (angina): When the coronary arteries become thinner, the heart may not get sufficient blood when it needs it most like when exercising.
• Heart attack: this can happen if a cholesterol plaque breaks open and causes a blood clot to form. A clot can block blood flow, hence causing the damage to the heart muscle due to lack of blood.
• Heart failure: Narrowed arteries in the heart or high blood pressure can slowly make the heart weak or stiff so its harder to pump blood.
• Irregular heart rhythms (arrhythmias):, low blood to the heart can lead to normal heart signaling, causing irregular heartbeats.

Treatment of Coronary artery disease

Treatment involves;

• Medical therapy including antiplatelet drugs etc.
• Percutaneous coronary intervention
• For acute thrombosis, sometimes fibrinolytic drugs
• Coronary artery bypass grafting

Treatment often seeks to lessen the oxygen demand on the heart and increase coronary artery blood flow in order to lessen the workload on the heart and, in the long run, to slow down and reverse the atherosclerotic process.

Percutaneous coronary intervention (PCI) or coronary artery bypass grafting can increase the blood flow via the coronary arteries (CABG). Sometimes fibrinolytic medications can dissolve an acute coronary thrombus.

Medical therapy

Medical management of patients with CAD depends on symptoms, heart function, and whether there are disorders present.

The drugs used are;

• Aspirin, clopidogrel, or both
• Beta-blocker
• Glycoprotein IIb/IIIa inhibitor
• A heparin (unfractionated or low molecular weight heparin) or bivalirudin
• IV nitroglycerin
• Fibrinolytics for certain patients
• Angiotensin-converting enzyme (ACE) inhibitor
• Statins
• Calcium channel blockers

Percutaneous Coronary intervention (PCI)

PCI is recommended for some individuals with acute coronary syndrome (ACS) or stable ischemic heart disease who continue to experience angina despite receiving the best available medical care.

Initially, PCI was performed solely using balloon angioplasty. However, after balloon angioplasty, 5 to 8 patients experienced abrupt artery closure, which led to acute myocardial infarction and frequently necessitated emergency bypass surgery.

After angioplasty, the rate of restenosis was lowered by the placement of a bare-metal stent, although many patients still needed further therapy.

The rate of restenosis has been lowered to less than 10% thanks to drug-eluting stents, which release an antiproliferative medication (such as everolimus or zotarolimus) over the course of several weeks. In most centers, the usage of drug-eluting stents has reduced since the debate concerning these devices and abrupt stent thrombosis began in 2006. The risk of acute thrombosis is substantially lower than initially thought, according to later investigations.

In stable patients receiving elective stent implantation (i.e., those without comorbidities or acute coronary syndrome), glycoprotein IIb/IIIa inhibitors are no longer commonly employed. They should not be thought of as routine even if they may be helpful in some patients with an acute coronary syndrome.

Coronary artery bypass grafting (CABG)

Cardiopulmonary bypass, where a machine pumps and oxygenates blood while the heart is halted, is usually used during CABG. The surgery carries risks such as MI and stroke. The risk of developing a MI during surgery is 5%, that of having a stroke is 1% to 2%, and that of dying is less than 1% for patients with a normal-sized heart, no history of MI, good ventricular function, and no other risk factors.

The risk rises with age, poor Left Ventricle function, and the presence of underlying disease. A second bypass has a 3–5 times higher operational mortality rate than a first bypass.

About 25 to 30 percent of individuals who have cardiopulmonary bypass experience cognitive impairment or behavioral problems; these changes may be brought on by microemboli that originate in the bypass machine.

Older patients frequently have cognitive or behavioral problems, which are most likely brought on by a decreased NEURONAL RESERVE, rendering them more vulnerable to minor wounds sustained during cardiac bypass. From mild to severe, dysfunction can last for weeks to years.

In order to reduce this risk, some facilities employ an off-pump CABG procedure (which does not include cardiopulmonary bypass), in which the surgical site is mechanically stabilized by a device.

Prevention of Coronary Artery Disease

• Quit smoking/tobacco use
• Avoid being over weight
• Eat healthy food
• Exercise regularly
• Modify serum lipid levels
• Minimize salt intake
• Control hypertension and diabetes

Conclusion

In conclusion, coronary artery disease is a serious condition that can lead to heart attacks and death. However, there are many things you can do to reduce your risk of developing the disease. These include exercising regularly, eating a healthy diet, quitting smoking, and managing your stress levels. If you are concerned about your risk of coronary artery disease, talk to your doctor. Thank you for reading.

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