Coronary artery disease

 

Coronary artery disease (CAD) is a disease of the blood vessels that supply blood to the muscles of the heart. Atherosclerosis, i.e., the deposition of plaque on the inner wall of the vessels, is the primary cause of the CAD.

The disability and fatality associated with CAD have a significant impact and is estimated to be more than about 4.5 million in the developing world. In the western world, it is estimated that 11.5%, i.e., 24.7 million are living with CAD. It contributes to about 1/3rd of all deaths in individuals over age 35.

 

 

1. Atherosclerosis initiates as the fatty streak or plaques which appear initially in the aorta and coronary vessels. This appears on the inner vessel wall with deposits of fat. It increases with age. Men are more at risk of developing heart disease than premenopausal women.

2. Menopausal women with a history of oral contraceptives who are over the age of 35 and are smokers

3. People with familial history of premature heart attacks

4. Chronic conditions such as hypertension and Type II diabetes

5. Obesity

6. Smoking

7. Chronic kidney conditions

 

 

1. Narrowing of the blood vessels may lead to angina or chest pain. This occurs when any part of the heart muscle does not get enough blood supply.

2. Sharp neck or back pain or a feeling of pressure which is located in the center of the chest or the breastbone.

3. Nausea, a rapid heartbeat, or abnormal rhythms

4. Fatigue, weakness and shortness of breath, and anxiety

 

 

1. Blood tests for cholesterol, HDL and LDL.

2. Coronary angiography

3. Exercise stress test or treadmill test can help uncover irregular heart rhythms due to exertion.

4. Echocardiogram

5. Electron beam computed tomography [EBCT] helps to detect calcium deposits in the vessel walls

6. Heart CT or MRI confirms findings of narrowing or blocks in the vessels.

 

 

1. General modifications include;

a) Lifestyle changes such as diet and exercise changes

b) Adherence to medical treatment including for chronic underlying diseases such as hypertension, type II diabetes, etc., regular exercise, weight control, and most importantly smoking cessation.

2. Medical treatment includes:

a) Anticoagulants

b) Angiotensin converting enzyme (ACE) inhibitors

c) Beta blockers

d) Diuretics

e) Calcium channel blockers 

f) Statins to reduce high cholesterol levels

g) Nitrates to stop the chest pain

3. Surgical treatment that includes:

a) Coronary artery bypass surgery (CABG)

b) Angioplasty and stent placements

c) Percutaneous coronary interventions

 

 

Complications include:

1. Heart attack

2. Heart failure

3. Abnormal rhythm or arrhythmias

 

 

1. Monitoring and treatment of underlying chronic conditions such as hypertension can help prevent development of CAD.

2. Quit smoking

3. Maintain a healthy lifestyle with nutritious diet and regular medication

4. Regular exercise and activities can help reduce stress

5. Follow-up may ensure better prognosis

6. A weight control program with diet modifications can go a long way in reducing the risk of CAD.