Coronary Artery Disease (CAD) is a common heart condition that occurs when the major blood vessels that supply the heart with blood, oxygen, and nutrients (the coronary arteries) become damaged and narrowed. This damage is usually due to the buildup of fatty deposits, called plaque, inside the arteries (atherosclerosis). Atherosclerosis can reduce blood flow to the heart muscle, leading to serious complications like angina (chest pain), heart attack, and heart failure.
Causes:
CAD develops primarily due to atherosclerosis, a process that begins when damage occurs to the inner layers of the coronary arteries. Several risk factors contribute to this damage and plaque buildup:
- High Blood Pressure (Hypertension): Uncontrolled high blood pressure can harden and thicken your arteries, narrowing the channel through which blood can flow.
- High Cholesterol: High levels of low-density lipoprotein (LDL) cholesterol (“bad” cholesterol) contribute to plaque formation.
- Diabetes: High blood sugar levels from diabetes can damage blood vessels, including the coronary arteries.
- Smoking: Nicotine and other chemicals in tobacco smoke damage the artery walls, accelerate atherosclerosis, and increase blood clot formation.
- Obesity: Excess weight often contributes to other risk factors like high blood pressure, high cholesterol, and diabetes.
- Physical Inactivity: Lack of exercise is linked to higher blood pressure, cholesterol levels, and obesity.
- Unhealthy Diet: A diet high in saturated and trans fats, cholesterol, sodium, and sugar can contribute to atherosclerosis.
- Age: The risk of damaged and narrowed arteries increases with age.
- Sex: Men are generally at greater risk, but the risk for women increases after menopause.
- Family History: A strong family history of heart disease, especially at an early age, increases your risk.
- Stress: Chronic stress may contribute to CAD risk factors.
Symptoms:
Symptoms of CAD can vary. Some people may have no symptoms until they experience a significant event like a heart attack. When symptoms do occur, they often include:
- Angina (Chest Pain): This is the most common symptom. It’s often described as a pressure, tightness, heaviness, or squeezing in the chest. It may spread to the arms (especially the left), neck, jaw, back, or stomach. Angina is typically triggered by physical activity or emotional stress and relieved by rest or nitroglycerin.
- Shortness of Breath (Dyspnea): Feeling breathless, especially during exertion. This can occur if the heart isn’t pumping enough blood to meet the body’s needs or if fluid builds up in the lungs due to heart failure.
- Fatigue: Unusual tiredness, especially during activity.
- Nausea.
- Sweating.
- Dizziness or Lightheadedness.
- Pain in other parts of the body: Such as the arms, neck, jaw, or back.
Diagnosis:
Diagnosing CAD involves assessing risk factors, symptoms, and various diagnostic tests:
- Medical History and Physical Exam: The doctor will ask about your symptoms, risk factors, family history, and conduct a physical examination, including checking blood pressure and listening to your heart.
- Blood Tests:
- Cholesterol levels: To check for high LDL cholesterol and triglycerides.
- Blood sugar (glucose) and A1C: To check for diabetes or prediabetes.
- High-sensitivity C-reactive protein (hs-CRP): A marker of inflammation that can indicate heart disease risk.
- Electrocardiogram (ECG/EKG): Records the electrical signals of your heart to detect heart attacks or signs of reduced blood flow.
- Stress Test: Involves exercising on a treadmill or stationary bike while your heart activity is monitored. If you can’t exercise, medication may be used to simulate the effects of exercise on your heart. This helps evaluate blood flow to the heart during stress.
- Echocardiogram: An ultrasound of the heart that shows how well your heart chambers and valves are pumping blood.
- Coronary Angiography (Cardiac Catheterization): A thin, flexible tube (catheter) is inserted into an artery (usually in the groin or wrist) and guided to the heart. Dye is injected into the coronary arteries, and X-ray images are taken to show blockages or narrowing. This is considered the gold standard for diagnosing CAD.
- Cardiac CT Angiography (CCTA): A non-invasive CT scan that uses dye to visualize the coronary arteries and detect plaque buildup.
Treatment:
Treatment for CAD aims to reduce symptoms, slow the progression of atherosclerosis, prevent complications like heart attack, and improve quality of life. Treatment plans are individualized.
- Lifestyle Changes (Cornerstone of Treatment):
- Healthy Diet: Emphasize fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit saturated and trans fats, cholesterol, sodium, and added sugars.
- Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity per week.
- Quit Smoking: This is the most important step to prevent further damage.
- Weight Management: Lose excess weight and maintain a healthy weight.
- Stress Management: Practice relaxation techniques like meditation, yoga, or deep breathing.
- Medications:
- Cholesterol-lowering medications (Statins): Reduce LDL cholesterol and stabilize plaque (e.g., atorvastatin, simvastatin).
- Aspirin: Low-dose aspirin may be prescribed to reduce the risk of blood clots.
- Beta-blockers: Slow the heart rate and lower blood pressure, reducing the heart’s oxygen demand (e.g., metoprolol, carvedilol).
- Nitroglycerin: Relieves angina by dilating blood vessels.
- ACE inhibitors or ARBs: Lower blood pressure and can protect the heart (e.g., lisinopril, valsartan).
- Calcium channel blockers: Relax blood vessels and can help with angina.
- Procedures:
- Angioplasty and Stent Placement (Percutaneous Coronary Intervention – PCI): A catheter with a balloon is used to open narrowed arteries, and a stent (a small mesh tube) is often placed to keep the artery open.
- Coronary Artery Bypass Grafting (CABG) Surgery: A healthy blood vessel from another part of the body is used to bypass (go around) a blocked or narrowed coronary artery, restoring blood flow to the heart.
Managing CAD is a lifelong process that requires close collaboration with your healthcare team. Regular follow-up, adherence to medications, and commitment to lifestyle changes are crucial for preventing complications and living a healthier life.
