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Coronary Artery Disease

The Heart

Coronary Artery Disease

Coronary Artery Disease (CAD) is the term commonly used to describe the build-up of fatty deposits and fibrous tissue (plaques) inside the coronary arteries. This build-up is called atherosclerosis. Coronary atherosclerosis eventually can cause the coronary arteries to become significantly narrower, i.e. stenosis, which, in turn, reduces the flow of blood and oxygen to the heart which results in chest pain called angina.

Atherosclerosis also can cause a blood clot to form inside a narrowed coronary artery. When this happens, the result is a heart attack, which can cause significant damage to the heart muscle.

The factors that increase the risk of developing coronary artery disease are basically the same as those for atherosclerosis:   

A high blood cholesterol level

A high level of LDL cholesterol, commonly called “bad cholesterol”

A low level of HDL cholesterol, commonly called “good cholesterol”

High blood pressure (hypertension)


Family history of coronary artery disease at a younger age

Cigarette smoking


Physical inactivity (too little regular exercise)

In most patients, the most common symptom of coronary artery disease is the type of chest pain called angina, or angina pectoris. Angina usually is described as a squeezing, pressing or burning chest pain that tends to be focused either in the center of the chest or just below the center of the rib cage. It also can spread to the arms (especially the left arm), abdomen, neck, lower jaw or neck. Other symptoms can include sweating, nausea, dizziness or light-headedness, breathlessness or palpitations (often associated with the symptoms of a heart attack). Sometimes, when coronary artery disease produces burning chest pain and nausea, a patient may mistake heart symptoms for indigestion.

There are two types of chest pain related to coronary artery disease — stable angina and Acute Coronary Syndrome (ACS).

In stable angina, chest pain follows a predictable pattern, usually occurring after extreme emotion, overexertion, a large meal, cigarette smoking or exposure to extreme hot or cold temperatures. Symptoms usually last one to five minutes, and they disappear after a few minutes of rest. Stable angina is caused by a smooth plaque that partially obstructs blood flow in one or more coronary arteries.  

• Demonstrating an artery narrowed by Atherosclerosis

Acute coronary syndrome (ACS) is much more dangerous. In most cases of ACS, fatty plaque inside an artery has developed a tear or break. The uneven surface can cause blood to clot on top of the disrupted plaque. This sudden blockage of blood flow results in unstable angina or a heart attack (myocardial infarction). In unstable angina, chest pain symptoms are more pronounced and less predictable compared to stable angina. Chest pains occur more frequently, often at rest, and last several minutes to hours. In addition, people with unstable angina frequently develop profuse sweating with aching in the jaw, shoulders and arms.   

• Showing how a Blood Clot can cause a Heart Attack

Many people with coronary artery disease, especially women, do not have any symptoms or have unusual symptoms. In these people, the only sign of CAD may be a suspicious change in the pattern of a test called an ECG, which records the heart's electrical activity. The test can be done at rest or during exercise stress test.

The stress test is able to detect the problem in the coronary artery because exercise increases the heart muscle's demand for blood, a demand that can't be met when the coronary arteries are significantly narrowed. In areas of the heart affected by narrowed coronary arteries, the heart muscle starves for blood and oxygen, and its electrical activity changes. This altered electrical activity is reflected in the patient's ECG results.  

• Demonstrating Plaque in the coronary artery

Coronary artery disease usually is diagnosed after a person has chest pain or other symptoms such as shortness of breath with physical activity.

Your doctor may suspect that you have coronary artery disease based on your medical history and the pattern of your symptoms. To confirm the diagnosis, he or she first will examine you, paying special attention to your chest and heart. During the physical examination, your doctor will press on your chest to see if it is tender. Tenderness in the area where you have chest pain could be a sign of a non-cardiac problem involving chest muscles, ribs or rib joints. Your doctor also will use a stethoscope to listen for any abnormal heart sounds. The physical examination will be followed by one or more diagnostic tests to look for coronary artery disease. Possible tests include.  

  • An ECG — An ECG is a record of the heart's electrical impulses. It can identify abnormalities in heart rate and rhythm, and it can provide clues that part of your heart muscle isn't getting enough blood.

  • Blood test for heart enzymes — When heart muscle is damaged, even a little, enzymes leak out of the damaged muscle cells into the bloodstream. Elevated heart enzymes suggest a heart problem.

  • An exercise stress test on a treadmill — An exercise stress test monitors the effects of treadmill exercise on blood pressure and ECG and can identify heart problems.

  • An echocardiogram — This test uses ultrasound to produce images of the heart's movement with each beat. It also gives us an indication of how strongly or weakly the heart muscle is contracting and of all the different pathologies of the diseased hearts.

  • Imaging test with radioactive tracers — In this test, a radioactive material is injected and is taken up by the heart muscle, which helps certain features show up on images taken with special cameras.

  • A coronary angiogram (a series of X-rays of the coronary arteries) — The coronary angiogram is considered the most accurate way to measure the severity of coronary disease. During an angiogram, a thin, long, flexible tube called a catheter is inserted into an artery in the forearm or groin, and then threaded through the circulatory system into the coronary arteries. Dye is injected to show the blood flow within the coronary arteries and to identify any areas of narrowing or blockage.

• Showing blood flow through a normal coronary artery and one that has been blocked by plaque

• Risk Factors for Coronary Artery Disease (CAD)

Several factors place you at added risk of coronary artery disease. Some of these you can control, and some you cannot.  

A. Uncontrollable risk factors for coronary artery disease include:

  • Sex. Men are generally at greater risk than are women for heart disease. However, the risk for women increases after menopause. In fact, coronary artery disease is the leading cause of death for both men and women in the United States.

  • Heredity and race. If your siblings, parents or grandparents have heart disease, you may be at risk, too. Your family may have a genetic condition that contributes to higher blood cholesterol levels or high blood pressure. In addition, families may contribute to coronary artery disease by practicing or promoting poor health habits, such as eating unhealthy diets and smoking. Race can also be a factor. Blacks have a higher risk of heart disease and high blood pressure than do whites. Mexican-Americans, American Indians and native Hawaiians also have an increased risk of heart disease.

  • Age. Most people who die of coronary artery disease are older than 65. However, with the rising rates of obesity in America, more younger people may start developing coronary artery disease.

B. The major controllable risk factors for coronary artery disease include:

  • Smoking. Exposure to cigarette smoke acts with other factors to greatly increase your risk of coronary artery disease by damaging blood vessels.

  • High blood pressure. Over time, high blood pressure greater than 115/75 millimeters of mercury (mm Hg) can damage your coronary arteries by accelerating atherosclerosis.

  • High blood cholesterol. The risk of coronary artery disease increases as your blood cholesterol level rises.

  • Diabetes. People with diabetes have an increased risk of coronary artery disease. That risk is even higher if your blood sugar (glucose) level isn't well controlled.

  • Obesity. Excess weight increases the strain on your heart, raises your blood pressure, increases your blood cholesterol levels and increases your risk of diabetes.

  • Physical inactivity. Regular exercise is important in preventing heart disease.

  • Stress and anger. Stress and anger may increase your risk of coronary artery disease, especially if they cause you to engage in other risk factors, such as overeating or smoking.

  • Excessive alcohol consumption. While moderate amounts of alcohol — no more than one drink a day for women or two drinks for men — may lower your risk of coronary artery disease, excessive amounts of alcohol can raise your blood pressure and triglyceride level, which raises your risk.

Prevention of CAD

  • How you live your life can greatly affect the health of your heart and your coronary arteries. Taking the following steps can help you prevent coronary artery disease, as well as a heart attack and congestive heart failure:

  • Don't smoke. Smoking and secondhand smoke are major risk factors for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder. Carbon monoxide reduces oxygen in blood and damages the lining of blood vessels.

  • Control your blood pressure. Have your blood pressure checked every two years. Your doctor may recommend more frequent measurement if you have blood pressure higher than 115/75 mm Hg or a history of heart disease. Your risk of coronary heart disease doubles with every 20/10 mm Hg increase over 115/75 mm Hg.

  • Check your cholesterol. Have your blood cholesterol levels checked regularly. If your blood cholesterol level is undesirably high, your doctor can prescribe changes in your diet and medications to help lower your cholesterol and protect your cardiovascular health. Having an LDL level above 160 or HDL below 40 places you at a higher risk of heart disease.

  • Exercise regularly. Exercise helps prevent coronary artery disease by helping you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. Try to exercise at least 30 minutes on most days. If it's been a while since you exercised, check with your doctor before starting any exercise program and start exercising in 10-minute intervals, and then gradually increase the amount of time you spend exercising.

  • Maintain a healthy weight. Being overweight increases your risk of coronary artery disease, but by losing weight, you can reduce that risk.

  • Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow the arteries leading to your heart. A diet high in salt can raise your blood pressure. Follow your doctor and dietitian's advice on eating a heart-healthy diet. Fish is part of a heart-healthy diet because it contains omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. Eating plenty of fruits and vegetables also is encouraged. Fruits and vegetables contain antioxidants — vitamins and minerals that help prevent everyday wear and tear on your coronary arteries.

  • Get regular medical checkups. Some of the main risk factors for coronary artery disease — high blood cholesterol, high blood pressure and diabetes — have no symptoms in their early stages. Coronary artery disease itself may produce no symptoms. But your doctor can perform tests to check that you're free of these conditions. If a problem is found, you and your doctor can manage it early to prevent complications.

  • Manage stress. To reduce your risk of cardiovascular disease, reduce stress in your daily activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events as well as anger in your life.

• A Simple Word Of Advice

Seek emergency help immediately if you have chest pain, even if you think that you are too young to be having heart problems. In patients whose chest pain signals heart attack, prompt treatment can limit damage to the heart muscle.

Because the extent of coronary artery disease does not always match the severity and length of chest pain, it is important for patients with chest pain to have their symptoms evaluated promptly by a doctor. You should not waste precious time by just watching the clock and hoping that your chest pain disappears. Remember, in about 15 percent of patients having a heart attack, death occurs soon after chest symptoms begin, and the patients never reach the hospital alive.

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