Coronary Artery Disease

Coronary artery disease is characterized by narrowed coronary arteries, the major blood vessels supplying oxygenated blood to your heart. Fatty deposits, called plaques, can reduce blood flow to your heart.

You may experience severe chest pain (angina), breathlessness or other symptoms as your heart receives significantly low amount of blood. Heart attack can result if the arteries are completely blocked. Coronary heart disease progresses over time and in most cases, the condition becomes evident only when you have a significant blockage or a heart attack.

Treatments include a combination of healthy lifestyle, medications and other medical procedures.

Normally you may not experience any symptoms of coronary artery disease. But during increased physical activities, blood supply to your heart is severely reduced and some symptoms become apparent.

Signs and symptoms of coronary artery disease include: 

• Chest pain (angina): Physical activities or emotional stress can elicit an excruciating pain in the middle or left side of your chest, which often radiates to your neck, arm or back. The pain fades away once you discontinue the triggering factor. 
• Shortness of breath: Breathing difficulties occur when your heart can't pump enough blood to meet the demand of your body, especially during physical activities. 
• Heart attack: When your coronary arteries are completely blocked, it can lead to a heart attack, which is signaled by severe chest pain, pain in your shoulder or arms, breathlessness and sweating. Women may also experience some unusual symptoms such as neck or jaw pain. 

When to see a doctor?

Having a heart attack? Immediately call 911 or your local emergency number. If you can't contact emergency medical services, ask someone to take you to the nearest hospital. Drive yourself if it’s the only option. Discuss with your doctor about the risk factors such as high blood pressure, high cholesterol, tobacco use, diabetes, and family history of heart disease or obesity. If your signs and symptoms indicate a Coronary artery disease, you may need further tests to confirm the diagnosis.

An injury to interior of a coronary artery is the main cause of Coronary artery disease. Following factors are likely to cause injury:

• Smoking
• Elevated blood pressure
• High cholesterol
• Diabetes or insulin resistance
• Inactive lifestyle

Atherosclerosis is an accumulation of fatty deposits or plaque, principally composed of cholesterol and other cellular waste products at the injury sites. Any further injury at the site can prompt platelets, a type of blood cells, to collect at the site causing arterial blockage that may lead to a heart attack. 

Making a diagnosis of coronary artery disease is done by performing several tests.

After a thorough medical history review, a physical exam and other blood tests, your doctor may order one or more of the following tests:

• Electrocardiogram (ECG): An ECG measures electrical impulses from your heart which make specific pattern under normal conditions. Abnormal ECG patterns may indicate an ongoing heart attack. In a special type of ECG called Holter monitoring, the electric impulses are measured while you are continuing your daily activities, usually for 24 hours. Any abnormal electrical signals may indicate impaired blood flow to your heart. 
• Echocardiogram: Echocardiogram: An echocardiogram creates images of your heart by picking sound waves that are bounced off when they hit your heart. Using an echocardiogram, your doctor gathers information about your heart's pumping activity. Any abnormal movement of heart muscles can signal coronary artery disease or other conditions.
• Stress test: Stress test measures your heart’s activities while you are walking on a treadmill or riding a stationary bike. Sometimes, medications may be given instead of asking you to exercise. A special stress test called a nuclear stress test creates radio images of your heart along with an ECG.
• Cardiac catheterization or angiogram: A thin tube called catheter is inserted through your blood vessels, generally in the groin area, that leads to your heart. The process is carried out by using X-rays as a guide. Coronary angiogram can also be done during cardiac catheterization. In coronary angiogram, a dye visible in X-rays is injected into your blood vessels so that your blood vessels show up on X-rays. This test may be used to rule out any blockages in your blood vessels.  
• Computerized tomography (CT) scans show areas of narrowed blood supply, especially due to calcium deposits. Increased calcium deposits indicate likelihood of coronary artery disease. You may receive injection of a special dye while undergoing CT scan. This is called a CT coronary angiogram which can produce detailed images of your heart arteries.

Lifestyle modifications and drugs or medical procedures may be suggested for coronary artery disease treatment.

Medications

• Cholesterol-lowering medications such as statins, niacin, fibrates and bile acid sequestrants may be prescribed to reduce cholesterol levels, especially low-density lipoprotein (LDL) or the "bad" cholesterol.

• Aspirin: Aspirin or other blood thinner prevents the formation of blood clot and hence facilitates blood flow through coronary arteries. Your doctor may prescribe aspirin after heart attack to avoid the likelihood of another attack. DO NOT take aspirin if you have bleeding disorders or you are taking another blood thinner. 

• Beta blockers: Beta blockers reduce the amount of blood required for heart by decreasing heart rate and lowering blood pressure. Beta blockers also reduce the chances of another heart attack if you already had one. 

• Nitroglycerin: Nitroglycerin dilates your coronary arteries and alleviates chest pain caused by reduce blood flow to your heart. It is available as tablets, sprays and patches. 

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): They lower blood pressure and prevent worsening of coronary artery disease.

Procedures 

• Angioplasty and stent placement (percutaneous coronary revascularization): An elongated slender tube (catheter) is inserted into your narrowed artery, and a balloon is moved up to the narrowed artery via catheter. Once balloon reaches the place, the balloon is inflated which presses the plaque against the artery walls. Afterwards, the artery is kept open by using stent. 

• Coronary artery bypass surgery: This process requires open heart surgery. So, it is only opted if you have several multiple narrowed arteries. The blocked artery is skipped by creating a graft, which allows normal blood flow. 

Consult with your physician before starting any alternative and homeopathic remedies for coronary artery disease.

Omega-3 fatty acids found in fish oil, flaxseed oil or soybean oil may reduce chances of coronary artery disease. However, more intensive studies are required to establish its beneficial effects. 

Blood pressure or blood cholesterol level may be lowered by following supplements:

• Alpha-linolenic acid (ALA)
• Artichoke
• Barley
• Beta-sitosterol (found in oral supplements and some margarines)
• Blond psyllium
• Cocoa
• Coenzyme Q10
• Garlic
• Oat bran (found in oatmeal and whole oats)
• Sitostanol 

Lifestyle modifications are necessary in order to cope with coronary artery disease.

Following measures can prevent progress of the disease: 

• Don't smoke
• Maintain a healthy weight 
• Eat a healthy diet. Include a variety of fruits, vegetables and whole grains.
• Manage your stress
• Exercise: Consult your doctor to find out which type fits you

There are several risks and complications associated with coronary artery disease.

Risks

• Age: There is a positive correlation between age and risk of coronary artery disease. 

• Sex: In general, men are more vulnerable to coronary artery disease. But women after menopause also have an increased risk of the disease. 

• Family history: Coronary artery disease has a strong family link. You have the highest risk if your father or brother had heart disease before 55 years, or if your mother or sister had the condition before 65 years.

• Smoking: Smokers or those who are exposed to secondhand smoke are at greater risk of coronary artery disease.

• High blood pressure: Hardened and thickened arteries due to persistent high blood pressure can limit blood flow through them.

• High blood cholesterol levels: Plaques and atherosclerosis form more easily in people who have high blood levels of cholesterol. In such people, the level of low-density lipoprotein (LDL) or "bad" cholesterol is increased whereas that of high-density lipoprotein (HDL) or "good" cholesterol is decreased. 

• Diabetes: Your risk of coronary artery increases if you have diabetes. Risk factors of type II diabetes, obesity and hypertension, are similar to those of coronary artery disease.

• Overweight or obesity: Having that extra pad of fat may worsen other risk factors. 

• Physical inactivity: Sedentary lifestyle increases risk of coronary artery disease and other cardiovascular conditions.

• Increased stress can boost your risk of coronary artery disease as well as other heart conditions which in turn could cause coronary artery disease. 

Two or more risk factors occur together and one risk factor can lead to other risk factors, such as obesity can lead to type II diabetes and high blood pressure. This can further increase your risk of coronary artery disease. For example, Coronary artery disease is common in people who have metabolic syndrome, a group of conditions including hypertension, high triglycerides, higher level of insulin and excess body fat around the waist.

Other probable risk factors are: 

• Sleep apnea: It is characterized by temporary cessation of breathing during sleep. Sudden fluctuation in blood oxygen level can increase blood pressure and put more load on cardiovascular systems, eventually causing Coronary artery disease.

• High sensitivity C-reactive protein: Increased level of high sensitivity C-reactive protein (hs-CRP) during inflammation may increase your risk.  In turn, a high level of hs-CRP is seen when you have narrowed coronary arteries.

• High triglycerides:  Women with high levels of triglycerides, a kind of fat, may develop Coronary artery disease.

• Homocysteine:  High levels of homocysteine, building blocks of protein, are likely to increase your risk of Coronary artery disease.

Complications

• Chest pain (angina): Narrowing of coronary arteries results in insufficient blood supply to your heart which can cause severe chest pain or breathing difficulties. 

• Heart attack: Heart attacks are caused by complete obstruction in the flow of blood to your heart. It results when a clot is formed inside your arteries that supply your heart. 

• Heart failure: Heart failures occur when a portion of your heart receives insufficient oxygen and nutrients for a long time or if your heart has been damaged due to a heart attack. If you have a heart failure, your heart cannot pump sufficient amount of blood as required by your body.

• Irregular heartbeats (arrhythmia): When your heart is damaged or deprived of blood supply, abnormal cardiac electrical impulses may be generated, which can lead to irregular heart rhythms.