What is Coronary Artery Disease?

Coronary artery disease develops when the major blood vessels that supply the heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in the arteries and inflammation are usually to blame for coronary artery disease.

When plaque builds up, it narrows the coronary arteries, decreasing blood flow to the heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.

What are the Symptoms of Coronary Artery Disease?

If the coronary arteries narrow, they can’t supply enough oxygen-rich blood to the heart — especially when it’s beating hard, such as during exercise. At first, the decreased blood flow may not cause any symptoms but as the plaque continues to build up in the coronary arteries, however, the coronary artery disease signs and symptoms will begin to appear. They include:

  • Chest pain (angina). The feeling pressure or tightness in the chest, as if someone were standing on the chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress.
  •  Shortness of breath. If the heart can’t pump enough blood to meet the body’s needs, it may develop shortness of breath or extreme fatigue with exertion.
  •  Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in the chest and pain in the shoulder or arm, sometimes with shortness of breath and sweating.

Causes

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Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes or insulin resistance
  • Sedentary lifestyle

Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.

Risk factors

  • Age. Simply getting older increases the risk of damaged and narrowed arteries.
  • Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
  • Family history. A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. The risk is highest if the father or a brother was diagnosed with heart disease before age 55 or if the mother or a sister developed it before age 65.
  • Smoking. People who smoke have a significantly increased risk of heart disease. Exposing others to secondhand smoke also increases their risk of coronary artery disease.
  • High blood pressure. Uncontrolled high blood pressure can result in hardening and thickening of the arteries, narrowing the channel through which blood can flow.
  •  High blood cholesterol levels. High levels of cholesterol in the blood can increase the risk of formation of plaque and atherosclerosis. High cholesterol can be caused by a high level of low-density lipoprotein (LDL) cholesterol, known as the “bad” cholesterol. A low level of high-density lipoprotein (HDL) cholesterol, known as the “good” cholesterol, can also contribute to the development of atherosclerosis.
  • Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure.
  • Overweight or obesity. Excess weight typically worsens other risk factors.
  • Physical inactivity. Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.
  • High stress. Unrelieved stress in life may damage the arteries as well as worsen other risk factors for coronary artery disease.
  • Unhealthy diet. Eating too much food that has high amounts of saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.

Treatment

Treatment usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

Various drugs can be used to treat coronary artery disease, including;

  • Cholesterol-modifying medications – By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol, these drugs decrease the primary material that deposits on the coronary arteries.
  • Aspirin – Doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of the blood to clot, which may help prevent obstruction of the coronary arteries. If you’ve had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn’t appropriate, such as if you have a bleeding disorder or you’re already taking another blood thinner, so ask your doctor before starting to take aspirin.
  •  Beta blockers – These drugs slow the heart rate and decrease your blood pressure, which decreases the heart’s demand for oxygen. If you’ve had a heart attack, beta blockers reduce the risk of future attacks.
  •  Calcium channel blockers – These drugs may be used with beta blockers if beta blockers alone aren’t effective or instead of beta blockers if you’re not able to take them. These drugs can help improve symptoms of chest pain.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease.

Lifestyle changes can help you prevent or slow the progression of coronary artery disease.

  • Stop smoking
  • Control your blood pressure.
  • Check your cholesterol.
  • Keep diabetes under control.
  • Get moving.
  • Participate in cardiac rehabilitation.
  • Eat healthy foods.
  • Maintain a healthy weight.
  • Manage stress.

In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.

How to prevent the condition

The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing in the first place. Leading a healthy lifestyle can help keep the arteries strong and clear of plaque. To improve heart health, you can:

  • Quit smoking
  • Control conditions such as high blood pressure, high cholesterol and diabetes
  • Stay physically active
  • Eat a low-fat, low-salt diet that’s rich in fruits, vegetables and whole grains
  • Maintain a healthy weight
  • Reduce and manage stress

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