Heart Health: Understanding and Managing Coronary Artery Disease

What is coronary artery disease (CAD)?

Coronary Artery Disease (CAD) is a prevalent and potentially life-threatening cardiovascular condition affecting millions worldwide. It is the leading cause of heart-related morbidity and mortality in the US, imposing a significant burden on public health systems and individuals alike. CAD develops when the coronary arteries, the blood vessels responsible for supplying oxygen and nutrients to the heart muscle, become narrowed or blocked due to atherosclerosis, characterized by the accumulation of fatty deposits and plaque on the arterial walls.

As the disease progresses, it hinders blood flow to the heart, depriving the cardiac muscle of the necessary oxygen and nutrients required for proper functioning. This can lead to various symptoms, such as chest pain (angina), shortness of breath, and fatigue. In severe cases, CAD can result in a heart attack, where a sudden and complete coronary artery blockage leads to the death of a portion of the heart muscle.

Forms of coronary artery disease

Coronary artery disease can present in various forms, each with its distinct characteristics and implications for heart health. It is essential to recognize and diagnose the specific form of CAD in each individual, as treatment strategies and management approaches may vary.

The different forms of coronary artery disease include:

Chronic Artery Disease Forms

Stable Angina: Stable angina is the most common form of CAD. It occurs when there is a partial blockage or narrowing of the coronary arteries, leading to chest pain or discomfort during physical exertion or emotional stress. The pain is predictable and tends to subside with rest or medication.
Unstable Angina: Unstable angina is a more severe and unpredictable form of CAD. It happens when a plaque in the coronary artery ruptures, causing a sudden and severe reduction in blood flow. Unstable angina can occur at rest or with minimal exertion and requires immediate medical attention, as it may lead to a heart attack.
Acute Myocardial Infarction (Heart Attack): A heart attack occurs when a coronary artery becomes completely blocked by a blood clot, cutting off blood flow to a portion of the heart muscle. This leads to the death of heart tissue. Heart attacks are medical emergencies that require urgent treatment to restore blood flow and prevent further damage.
Chronic Total Occlusion (CTO): CTO refers to a complete blockage of a coronary artery that persists for an extended period, often over three months. People with CTO may experience chronic chest pain, reduced exercise tolerance, and, in severe cases, heart failure.
Silent Ischemia: Some individuals with coronary artery disease may not experience typical symptoms like chest pain or discomfort. Instead, they may have “silent ischemia,” where the heart muscle does not receive enough blood and oxygen without noticeable symptoms. This type of CAD is concerning as it can lead to heart damage without the person knowing it.

Risk factors of coronary artery disease

Coronary artery disease are often associated with modifiable risk factors, such as an unhealthy diet, sedentary lifestyle, smoking, high blood pressure, high cholesterol levels, and diabetes. However, genetic predisposition and older age are the 2 major non-modifiable risk factors that significantly affect the development of coronary artery disease.

Coronary Artery Disease Risk Factors

Symptoms of coronary artery disease

The symptoms of CAD may not be immediately apparent, as it is a chronic condition that progresses slowly over many years, possibly even decades. However, as the arteries narrow due to plaque accumulation, mild symptoms may emerge, indicating that the heart is working harder to supply oxygen-rich blood to the body.

Common symptoms of chronic CAD include:

Coronary Artery Disease Symptoms

Chest Discomfort: One of the most common and characteristic symptoms of coronary artery disease is chest discomfort, often described as a feeling of pressure, tightness, squeezing, or heaviness in the chest. This discomfort may be mistaken for indigestion or heartburn, but it typically occurs during physical exertion or emotional stress and eases with rest. Such kind of pain is seen with stable angina. It is essential not to ignore persistent or recurrent chest discomfort that does not go away with rest or nitroglycerine then, it might be more severe conditions like unstable angina or myocardial infarction.
Shortness of Breath: People with CAD may experience shortness of breath, especially during activities that once seemed effortless. As the coronary arteries become narrowed, the heart may struggle to pump blood efficiently, leading to reduced oxygen supply to the body. Shortness of breath can occur even during mild physical exertion or at rest in more advanced stages of the disease.
Fatigue: Persistent fatigue is another common symptom of CAD. As the heart’s blood supply diminishes, the heart muscle may not receive enough oxygen, leading to a feeling of constant tiredness and reduced stamina. Fatigue may be particularly pronounced after physical activity or during stressful situations.
Unexplained Pain in Other Areas: In some cases, the pain or discomfort associated with coronary artery disease may radiate to other body parts. Pain may be felt in the arms (usually the left arm), shoulders, neck, jaw, or back. This referred pain can vary in intensity and may come and go, making it important to recognize these unusual symptoms.
Dizziness and Lightheadedness: Insufficient blood flow to the brain due to narrowed coronary arteries can cause dizziness or lightheadedness. People with CAD may experience fainting spells or suddenly feel dizzy when standing up.
Palpitations: CAD can disrupt the heart’s rhythm, leading to palpitations or a sensation of irregular heartbeats.

Tests to detect coronary artery disease

Tests play a crucial role in diagnosing CAD and evaluating heart function. Besides a thorough medical assessment, your healthcare provider may recommend the following tests to aid the diagnosis:

Blood Tests: These tests analyze specific substances in your blood that may indicate artery damage or an increased risk of developing CAD. Elevated levels of certain biomarkers like Troponin, CK-MB, and BNP can provide valuable insights into your heart health.
Electrocardiogram (EKG/ECG): By recording your heart’s electrical activity, an EKG/ECG can detect previous or current heart attacks, ischemia (reduced blood flow to the heart), and irregular heart rhythms that might be associated with CAD.
Echocardiogram: Utilizing sound waves, an echocardiogram evaluates the structure and function of your heart. It provides valuable information about heart chamber sizes, pumping capacity, and any abnormalities in heart valves, contributing to diagnosing CAD.
Stress Test: This test assesses how your heart responds to physical exertion. It helps detect angina (chest pain) and can identify potential blockages in the coronary arteries by monitoring the heart’s performance during exercise.
Cardiac Catheterization: Considered the gold standard for diagnosing coronary artery disease, this procedure involves inserting thin tubes (catheters) into the coronary arteries to evaluate their condition. It can confirm the presence and severity of blockages, guiding further treatment decisions.
Computed Tomography Coronary Angiogram: Using advanced imaging technology and contrast dye, a CT coronary angiogram generates detailed 3D images of your heart’s movement. This non-invasive test allows the detection of blockages in the coronary arteries, aiding in CAD diagnosis.
Coronary Calcium Scan: This test measures the amount of calcium in the walls of your coronary arteries, which indicates atherosclerosis. Though it does not directly determine significant blockages, it helps assess your risk for developing coronary artery disease.

What is Cardiac catheterization?

Coronary catheterization, also known as cardiac catheterization or coronary angiography, is a widely used and minimally invasive medical procedure that plays a crucial role in assessing the condition of the coronary arteries—the blood vessels responsible for supplying oxygen-rich blood to the heart muscle.

During this diagnostic test, a skilled medical team performs the procedure in a specialized area called the catheterization laboratory or “cath lab.” The patient is usually awake during the procedure, as it involves only local anesthesia to numb the area where the catheter will be inserted.

To begin the process, a small incision is made in the wrist or groin area, where a thin, flexible tube called a catheter is carefully inserted into the blood vessels. The choice of insertion site depends on various factors, such as the patient’s medical history and the preference of the medical team.

Once the catheter is in place, a special dye known as contrast is injected through the catheter and into the coronary arteries. This dye is visible on X-ray images, creating what is called an “angiogram.” As the contrast moves through the arteries, the medical team can visualize the blood flow and identify any potential blockages, narrowings, or abnormalities in the coronary arteries. The X-ray images obtained during the procedure provide valuable information about the condition of the heart’s blood vessels, helping doctors diagnose conditions such as CAD or other heart-related issues.

What is coronary artery calcium scan?

A coronary artery calcium scan, also known as a coronary calcium scan or cardiac CT for calcium scoring, is a specialized imaging test that helps assess the amount of calcium present in the walls of the coronary arteries. This test estimates a person’s risk of developing CAD.

During the scan, the CT machine takes detailed images of the heart, focusing on the coronary arteries. The presence and quantity of calcium deposits in the arterial walls are measured and scored using a numerical scale called the Agatston score.

A higher Agatston score indicates a greater amount of calcified plaque and suggests an increased risk of CAD. The results of the coronary artery calcium scan can help healthcare professionals identify individuals who may benefit from early intervention or lifestyle changes to reduce their risk of heart-related problems.

What is the treatment of coronary artery disease?

CAD is a chronic condition that requires comprehensive management to prevent progression and reduce the risk of complications. The treatment approach for CAD typically involves a combination of medications and, in some cases, surgical procedures.

Coronary Artery Disease Treatment

Medications:

Antiplatelet Drugs: Medications like aspirin and clopidogrel help prevent blood clots from forming by inhibiting platelet aggregation. They are often prescribed to individuals with CAD or those who have undergone coronary stent placement.
Cholesterol-Lowering Drugs: Statins are the most commonly prescribed medications to lower LDL cholesterol levels, reducing the risk of plaque buildup in the arteries. Other lipid-lowering drugs, such as ezetimibe or PCSK9 inhibitors, may also be used with statins.
Beta-Blockers: These drugs help reduce the heart’s workload by slowing the heart rate and reducing blood pressure. Beta-blockers can alleviate angina symptoms and improve heart function too. These drugs help prevent the changes in the heart muscle called remodeling.
Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs): These medications are used to lower blood pressure and reduce strain on the heart. They are often prescribed to individuals with coronary artery disease and heart failure.
Nitroglycerin: Nitroglycerin is used to relieve angina symptoms by relaxing and dilating the coronary arteries, increasing blood flow to the heart.
Calcium Channel Blockers: These medications help widen blood vessels, improve blood flow, and reduce blood pressure. They are sometimes prescribed as an alternative to beta-blockers for angina management.
Antianginal Medications: Ranolazine is a newer antianginal drug that can manage chronic angina when other medications are insufficient.

Surgical Procedures:

Angioplasty and Stent Placement: Percutaneous Coronary Intervention (PCI) involves inserting a catheter with a balloon at the tip into the narrowed coronary artery. The balloon is inflated to widen the artery, and a stent (a mesh-like tube) is placed to keep the artery open and improve blood flow.
Coronary Artery Bypass Grafting (CABG): In this surgical procedure, a healthy blood vessel from another part of the body is grafted to the blocked coronary artery, bypassing the blocked segment and restoring blood flow to the heart muscle.
Enhanced External Counterpulsation (EECP): EECP is a non-invasive treatment option for individuals with refractory angina. It involves applying external pressure cuffs to the legs to improve blood flow to the heart.
Transmyocardial Laser Revascularization (TMR): This procedure involves using a laser to create tiny channels in the heart muscle to improve blood flow to areas with reduced blood supply.

Importance of blood thinners after angioplasty

The importance of blood thinners after angioplasty cannot be overstated, as these medications play a vital role in preventing complications and ensuring the success of the procedure.

Angioplasty involves the insertion of a stent to open narrowed or blocked coronary arteries, improving blood flow to the heart. However, this procedure can cause the inner layer of the blood vessel to be damaged, leading to the formation of blood clots.

Blood thinners, also known as antiplatelet medications, such as aspirin, Plavix or brilinta, are prescribed after angioplasty to prevent these clots from forming. Your cardiologist will recommend dual antiplatelet therapy like as aspirin and plavix or aspirin or brilinta after angioplasty for at least one year. By inhibiting platelet aggregation and reducing the risk of clot formation, blood thinners help maintain the newly opened artery’s patency and reduce the chance of restenosis (re-narrowing) at the stent site.

Additionally, these medications lower the risk of heart attacks and other cardiovascular events, providing essential protection to individuals who have undergone angioplasty, and contributing to improved heart health and overall well-being. It is crucial for you to adhere to their prescribed blood thinner regimen even while you are on vacation with your friends.

What is cardiac rehabilitation?

Cardiac rehabilitation is a medically supervised program aimed at improving cardiovascular health for individuals who have undergone heart attack, heart failure, angioplasty, or heart surgery.

The program encompasses three essential components: exercise counseling and training to promote heart health through physical activity, education on heart-healthy living to manage risk factors and make nutritious choices, and counseling to address and reduce stress, which impacts heart health. Cardiac rehab involves a collaborative effort, with doctors, nurses, pharmacists, family, and friends working together to manage lifestyle choices and habits affecting the heart.

To get started, individuals need to consult their doctor for eligibility, register for a cardiac rehab program, set heart health goals with the medical team, and actively participate in their care to achieve these objectives. Consistent adherence to medication and promptly seeking medical attention for any new or worsening symptoms are also emphasized for a successful cardiac rehabilitation journey.

What are the ways to prevent coronary artery disease?

Preventing coronary artery disease is not always entirely within our control, as some risk factors are beyond our influence. However, we can take numerous proactive steps to lower our risk and manage the condition effectively if diagnosed. To reduce the risk of CAD and slow its progression, consider the following strategies:

Coronary Artery Disease Prevention

Quit Smoking and Tobacco Use: Connect with resources and support groups to aid in the challenging process of quitting. Seek recommendations from healthcare providers for assistance in your community.
Adopt a Heart-Healthy Diet: Avoid foods high in saturated and trans fats, sodium, and sugar. Opt for whole grains over refined carbohydrates and learn about nutrition’s impact on cholesterol levels.
Prioritize Quality Sleep: Strive for seven to nine hours of restful sleep per night. Discuss strategies with healthcare providers to ensure adequate sleep to support heart health.
Maintain a Healthy Weight: Work with healthcare providers to determine your ideal weight and set achievable goals. Avoid extreme diets and focus on lifestyle changes for long-term success.
Assess Heart Disease Risk: Undergo regular risk screenings with healthcare providers starting around age 20. These screenings include blood pressure and BMI measurements and may use risk calculators to predict future heart disease risk.
Limit Alcohol Consumption: Be mindful of alcohol intake, aiming for no more than two drinks per day for men and people assigned male at birth (AMAB) and one drink per day for women and people assigned female at birth (AFAB).
Engage in Regular Exercise: Aim for 150 minutes of planned and intentional weekly exercise, such as 30-minute walks on five days. Incorporate additional movement throughout the day, like parking farther away or walking around the house during daily activities.
Adhere to Prescribed Medications: Take medications as healthcare providers recommend to reduce CAD risk and prevent heart attacks if diagnosed. Understand their benefits and how they contribute to prolonging life.