Coronary artery disease causes blockage in the coronary artery block blood flow to the heart. Coronary artery circulation restriction may lead to heart attack.

Coronary Artery Disease

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Coronary artery disease (CAD) develops when cholesterol blockages develop in the walls of blood vessels, or the coronary arteries become too narrow. The function of the coronary arteries is to supply oxygen and blood to the heart. The cholesterol builds up in the walls of the arteries and creates plaques causing the arteries to narrow and reduce the blood flow to the heart. This can further cause inflammation and hardening of the walls of the blood vessels. In addition, the clot may also obstruct blood flow and cause serious health problems. The coronary arteries are a network of blood vessels that supply oxygen to the heart, and if the arteries are narrow, the heart may not receive enough oxygen.&nbsp;

 
Even though cardiovascular diseases are a major cause of fatality all around the world, there is minimal attention given to the prevention of cardiovascular diseases in South Asia, especially in Pakistan. While the number of cardiovascular disease-related deaths has decreased in high-income countries, they have increased in low- and middle-income countries. Unhealthy eating habits and a sedentary lifestyle among Pakistanis have triggered an increase in cardiovascular diseases in the country. However, the population data for heart disease is limited in Pakistan<a href="https://#accordion">[1]</a>. Two studies conducted in 1965 and 1973 concluded that the prevalence of heart disease in Pakistan is between 0% and 3.7% in rural and urban populations<a href="#accordion">[2]</a>.

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Signs And Symptoms

The buildup of plaque in the arteries may take years or even decades. As the arteries narrow, the heart pumps harder to deliver oxygen-rich blood which causes chest pain and shortness of breath, especially after light physical activity, for example, walking up the stairs and sometimes even at rest. Angina (chest pain) and discomfort are the two most common symptoms of CAD. However, many people won&rsquo;t know they have CAD till they have a heart attack. Symptoms of a heart attack include:&nbsp;

<ul>
	<li>Chest pain or discomfort&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Weakness&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Nausea&nbsp;</li>
	<li>Cold sweat&nbsp;</li>
	<li>Pain or discomfort in the arms or shoulders&nbsp;</li>
</ul>

The symptoms of a heart attack may be slightly different in women:&nbsp;

<ul>
	<li>Discomfort in the neck, abdomen, or back&nbsp;</li>
	<li>Indigestion or heartburn&nbsp;</li>
	<li><a href="https://merisehat.pk/page/sehat-a-z/">Unexplained anxiety</a>&nbsp;</li>
	<li>Cold sweat</li>
</ul>

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Causes

Coronary artery disease is caused by a buildup of plaque inside the arteries. Plaque consists of calcium, fatty substances, cholesterol, and clot-making fibrin. As the plaque continues to collect in the arterial walls, they narrow and stiffen. The plaque can clog your arteries and limit the flow of blood to the heart muscles. The heart muscles do not get an adequate blood supply and oxygen, which leads to chest discomfort or chest pain. This puts you at risk of a heart attack. Coronary artery disease can happen to anyone. However, the speed at which the disease develops varies from person to person. You are at an increased risk of coronary artery disease if you have:&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/cholesterol">High cholesterol</a> levels, especially bad cholesterol (LDL, VLDL)&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/hypertension-57">High blood pressure</a>&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a>&nbsp;</li>
	<li>Family history of heart disease&nbsp;</li>
	<li>History of smoking&nbsp;</li>
</ul>

&nbsp;

Coronary artery disease can exist with minimal or no symptoms. The disease often progresses suddenly or rapidly and may cause sudden cardiac death. The US Preventive Service Task Force (USPSTF) recommends routine screening with electrocardiogram and exercise tolerance testing, where the activity of the heart is measured while exercising. In&nbsp;adults at a high risk of coronary artery disease, electron beam tomography, and coronary calcium scanning are recommended to help detect the presence of severe narrowing of the coronary artery.

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Diagnosis

Your doctor will perform a thorough physical examination and talk about your symptoms, risks, and family history. The doctor may advise tests such as:&nbsp;

<ul>
	<li>Electrocardiogram to measure the heart&rsquo;s electrical activity and assess the extent of heart damage</li>
	<li>Chest X-ray&nbsp;</li>
	<li>Blood tests to check your levels of blood sugar, triglycerides (a type of fat in your blood), and cholesterol</li>
	<li>Coronary angiogram is in which the doctor will put a long, narrow tube called a catheter into a blood vessel in your arm or leg, and see how well your blood vessels supply blood to your heart</li>
	<li>Computed tomography angiogram uses a contrast dye to view 3D pictures of the heart and detect blockages</li>
</ul>

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<h4>"Heart problems? You’re in luck cause the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> can help you monitor your vitals!" </h4>

Treatment

While there are several drugs available for the treatment of coronary artery disease, treatment generally involves lifestyle changes such as eating healthy, exercising, and quitting smoking. However, in some cases, medications and procedures are essential.&nbsp;

&nbsp;

<h5>1. Medications&nbsp;</h5>

There are several drugs available for the treatment of coronary artery disease such as:&nbsp;

<ul>
	<li>Cholesterol Drugs &ndash; The drugs include statins, fibrates, niacin, and bile acid sequestrants to help lower bad cholesterol and reduce the buildup of plaque in the arteries.&nbsp;</li>
	<li>Aspirin &ndash; Aspirin thins the blood and prevents blood clots. A low dose of aspirin therapy is the primary prevention of heart attack and stroke in some people. However, the daily use of aspirin can have serious side effects, for example, bleeding in the stomach and intestines. Therefore, don&rsquo;t take any medications before speaking to your doctor.&nbsp;</li>
	<li>Beta-Blockers &ndash; These drugs slow the heart rate and lower blood pressure. If you have a history of heart attacks, then beta-blockers will reduce the risk of future attacks.&nbsp;</li>
	<li>Calcium Channel Blockers &ndash; The drug is recommended if the beta-blockers don&rsquo;t work, or if you are intolerant to the drug.&nbsp;</li>
	<li>Angiotensin-Converting Enzyme (ACE) Inhibitors And Angiotensin II Receptor Blockers (ARBs)&nbsp;- The medications prevent CAD from getting worse by lowering blood pressure.&nbsp;</li>
	<li>Nitroglycerin &ndash; The medicines widen the arteries and help relieve chest pain. It is also used to control heart failure in case of myocardial infarction.&nbsp;</li>
	<li>Ranolazine &ndash; The medication helps with chest pain and is generally prescribed with or in place of a beta-blocker.&nbsp;</li>
</ul>

In some cases, surgery may be required to fix a blocked artery:

<ul>
	<li>Coronary Angioplasty And Stent Placement &ndash; The procedure includes placing a small wire mesh tube or stent in the clogged artery during angioplasty. In addition, it prevents the artery from narrowing again.</li>
	<li>Coronary Artery Bypass Graft Surgery (CABG) &ndash; The procedure is an open-heart surgery in which the surgeon will take a healthy blood vessel from another part of the body for creating a new path for blood in the heart. The blood will then go around the blocked or narrowed artery.</li>
</ul>

&nbsp;

Coronary artery disease causes impairment and reduction in the blood flow through the coronary arteries. The arteries supply blood to the heart muscles and when blood flow to the heart is reduced, it can lead to several complications, including:&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/congenital-heart-diseases">Heart failure</a>&nbsp;</li>
	<li>Bradycardia (slow heart rate)</li>
	<li>Tachycardia (fast heart rate</li>
	<li>Atrial fibrillation (irregular and chaotic rhythm in the upper chambers of the heart)</li>
	<li>Chest pain&nbsp;</li>
	<li>Heart attack&nbsp;</li>
	<li>Sudden death</li>
</ul>

&nbsp;

<ul>
	<li>Family history of heart disease&nbsp;</li>
	<li>Diabetes&nbsp;</li>
	<li>Overweight&nbsp;</li>
	<li>Physical inactivity&nbsp;</li>
	<li>Unhealthy eating&nbsp;</li>
	<li>Smoking tobacco&nbsp;</li>
</ul>

If you have any of the above-mentioned symptoms or risk factors, speak to your doctor. Your doctor may want to test you for coronary artery disease.

&nbsp;

Preventing coronary artery disease is ideally about preventing the risk factors. Steps to prevent coronary artery disease include:&nbsp; 
&nbsp;

<ul>
	<li>Quit Smoking: Active smoking and exposure to second-hand smoke are both key risk factors in the development of coronary artery disease.&nbsp;</li>
	<li>Eat Healthily: Eat less of the foods that cause heart problems and more of foods that help with heart health. A diet low in saturated and trans fats and high in mono- and poly-saturated fats, for example, fish and olive oil will protect the heart. A healthy diet is also high in fiber (found in plant foods), and low in sugar and salt.&nbsp;&nbsp;</li>
	<li>Stay Active: 150 minutes of moderate exercise and 75 minutes of vigorous exercise every week will help keep the heart healthy.&nbsp;</li>
	<li>Keep A&nbsp;Check On Your Weight:&nbsp;If you are overweight, then losing a few kilos will lower the risk of developing coronary artery disease.&nbsp;</li>
	<li>Manage <a href="https://merisehat.pk/disease/depression">Stress</a>: While some stresses are unavoidable in life, they can push us towards unhealthy habits such as sedentary behavior and overeating. Your heart will be healthier if you manage stress in ways you enjoy, such as exercise and meditation.</li>
</ul>

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Key Points

<ul>
	<li>Coronary artery disease is a leading cause of fatality in Pakistan because of unhealthy eating habits and a sedentary lifestyle.&nbsp;</li>
	<li>Coronary artery disease develops when cholesterol blockages develop in the walls of blood vessels, or the coronary arteries become too narrow.</li>
	<li>While there are several drugs available for the treatment of coronary artery disease, treatment generally involves lifestyle changes such as eating healthy, exercising more, and quitting smoking.</li>
</ul>

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[1] Barolia, R. and Sayani, A.H., 2017. Risk factors of cardiovascular disease and its recommendations in Pakistani context. JPMA. The Journal of the Pakistan Medical Association, 67(11), p.1723.