Coronary artery disease (CAD), also known as ischemic heart disease, is the most common form of heart disease and occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrowed or blocked due to the buildup of fatty deposits called plaque. This process, known as atherosclerosis, restricts blood flow to the heart, which can lead to chest pain (angina), shortness of breath, heart attacks, and, in severe cases, heart failure. CAD develops gradually over time and is a leading cause of death worldwide.
Symptoms and Causes
Symptoms: The symptoms of CAD can vary depending on the severity of the blockage and whether it has caused complications, such as a heart attack. Common symptoms include:
- Chest Pain or Discomfort (Angina): A common symptom of CAD, angina is often described as pressure, tightness, or squeezing in the chest, which may radiate to the shoulders, arms, neck, jaw, or back. Angina is typically triggered by physical activity or stress and may go away with rest.
- Shortness of Breath: As the heart struggles to pump blood due to narrowed arteries, patients may experience difficulty breathing, especially during exertion.
- Fatigue: Feeling unusually tired or weak during physical activity or daily tasks can be a sign that the heart isn’t receiving enough oxygen.
- Heart Attack (Myocardial Infarction): If a coronary artery becomes completely blocked, it can cause a heart attack. Symptoms of a heart attack may include intense chest pain, sweating, nausea, dizziness, and shortness of breath. Immediate medical attention is required.
In some cases, CAD may not cause noticeable symptoms (a condition known as silent ischemia) until a heart attack occurs, making early detection and management critical.
Causes: The primary cause of CAD is atherosclerosis, a process in which fatty deposits (plaque) build up in the walls of the coronary arteries, reducing blood flow to the heart muscle. Several risk factors can accelerate the development of atherosclerosis, including:
- High Blood Pressure: Increased pressure on the artery walls damages the arteries, making it easier for plaque to form.
- High Cholesterol: Elevated levels of LDL (“bad”) cholesterol contribute to plaque buildup in the arteries.
- Smoking: Smoking damages the arteries and accelerates atherosclerosis.
- Diabetes: High blood sugar levels increase the risk of developing CAD.
- Obesity: Excess body weight is linked to other risk factors, such as high blood pressure and diabetes.
- Sedentary Lifestyle: Lack of physical activity increases the risk of CAD.
- Family History: A family history of heart disease can increase the likelihood of developing CAD.
- Age: The risk of CAD increases with age, particularly after age 45 in men and 55 in women.
Diagnosis and Treatment
Diagnosis: If CAD is suspected, a physician will conduct a physical exam, review your medical history, and perform diagnostic tests to assess heart function and detect blockages in the coronary arteries. Common diagnostic tests include:
- Electrocardiogram (ECG/EKG): This test records the heart’s electrical activity to detect abnormal heart rhythms or signs of a previous heart attack.
- Stress Test: A stress test monitors how the heart functions during physical exertion, which can reveal reduced blood flow to the heart.
- Echocardiogram: This ultrasound test provides images of the heart’s structure and function, helping to assess how well the heart is pumping blood.
- Coronary Angiography: A specialized imaging test where a dye is injected into the coronary arteries, followed by X-rays to identify blockages or narrowing.
- CT Coronary Angiogram: A non-invasive test that uses CT imaging to visualize the coronary arteries and detect plaque buildup.
- Blood Tests: Blood tests may be done to check for elevated levels of cholesterol, triglycerides, and other markers that indicate heart disease.
Treatment: The treatment for CAD focuses on relieving symptoms, improving blood flow, and preventing further complications like heart attacks. Treatment plans often include lifestyle changes, medications, and, in some cases, medical procedures.
Lifestyle Changes:
- Heart-Healthy Diet: A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help reduce cholesterol levels and improve heart health. Limiting saturated fats, trans fats, and sodium is also important.
- Exercise: Regular physical activity, such as walking, swimming, or cycling, can improve heart function and help manage risk factors like high blood pressure, cholesterol, and weight.
- Quit Smoking: Smoking cessation is critical to preventing further damage to the arteries and reducing the risk of heart attack.
- Weight Management: Maintaining a healthy weight helps reduce strain on the heart and lowers the risk of developing other cardiovascular risk factors.
Medications:
- Cholesterol-Lowering Medications (Statins): These drugs help reduce LDL cholesterol levels and slow the progression of atherosclerosis.
- Antiplatelet Medications: Aspirin and other blood thinners can help prevent blood clots from forming in narrowed arteries.
- Beta-Blockers: Lower heart rate and blood pressure, reducing the heart’s workload.
- ACE Inhibitors or ARBs: Help relax blood vessels and lower blood pressure, improving blood flow.
- Nitrates: These medications help widen blood vessels to relieve chest pain (angina).
Medical Procedures:
- Angioplasty and Stenting: In this minimally invasive procedure, a balloon is used to widen a narrowed coronary artery, and a stent (a small wire mesh tube) is placed to keep the artery open.
- Coronary Artery Bypass Grafting (CABG): In more severe cases, a surgeon may perform bypass surgery to create a new path for blood to flow around blocked arteries using a blood vessel from another part of the body.
When to See a Physician
It is essential to see a physician if you experience any of the following symptoms:
- Persistent or recurring chest pain (angina) during physical activity or stress
- Shortness of breath, especially during exertion
- Unexplained fatigue or weakness
- Signs of a heart attack, such as intense chest pain, discomfort radiating to the arms or jaw, shortness of breath, or sweating
Additionally, if you have risk factors for CAD—such as high blood pressure, high cholesterol, diabetes, obesity, or a family history of heart disease—it’s important to schedule regular check-ups to monitor your heart health and manage risk factors.
Benefits of Early Diagnosis and Treatment
- Reduced Risk of Heart Attack: Early detection and treatment of CAD can significantly reduce the risk of heart attacks by improving blood flow and preventing blockages.
- Improved Quality of Life: Managing symptoms like chest pain and shortness of breath allows patients to remain active and maintain a better quality of life.
- Prevention of Complications: Treating CAD can prevent serious complications such as heart failure, arrhythmias, and strokes.
- Long-Term Heart Health: Implementing lifestyle changes and adhering to treatment plans can slow the progression of atherosclerosis and improve heart health over time.
