Coronary artery disease is a very serious heart condition that can be fatal if left untreated. It is the result of a long and complicated process in which excess cholesterol in the bloodstream attaches to the walls of the coronary arteries, causing them to become narrow and stiff.
As time passes, these deposits — called "plaques" — rupture, creating blood clots that block the artery and prevent blood from reaching the heart. Since it needs the oxygen and nutrients supplied through the blood to survive, the heart’s "fight or flight" response is triggered, and it pumps harder and harder to get the blood it needs. The results are weak heart muscles, heart attacks, and heart failure. Thankfully, this can all be treated and avoided.
Coronary artery disease: Signs and symptoms
Coronary artery disease takes years to develop. Plaques don’t rupture the minute they are formed, so atherosclerosis can stay silent inside the coronary arteries for years. Because of that, people can have coronary artery disease for a decade without knowing it.
Signs and symptoms of coronary artery disease don't always show up, but when they do they can include:
- Angina. This is the medical term for chest pain. It’s important to note that people experience angina differently: some describe it as immense pressure, while others say it feels like a squeeze. Angina is generally classified depending on its predictability. Stable angina can be predicted, as it generally occurs when you’re performing an activity for which the heart needs more oxygen (like when you’re exercising), and it doesn’t usually last more than five minutes. Unstable angina can strike at any time, whether you’re exercising or resting, and an episode can be as long as half an hour.
- Shortness of breath as a coronary artery disease symptom. It’s also known as dyspnea and occurs when the heart isn’t able to pump as much blood as it needs, so not enough air is going into your lungs. Sometimes, shortness of breath can be a sign of an emergency, but other times, you can keep it under control with a few breathing and posture exercises.
- Heart attack. Plaque leads to the formation of blood clots, which are basically plugs that prevent blood from flowing smoothly through the coronary arteries. When the coronary arteries are blocked, you may start to experience severe chest pain, and numbness in the shoulders and arms, but sometimes they may have no symptoms at all.
Coronary artery disease: Causes and risk factors
Since coronary artery disease begins with damage to the inner lining of the artery walls, it’s important to consider all the conditions that could pose a threat to your health, such as high cholesterol, hypertension, or diabetes.
Several risk factors increase a person's odds of coronary artery disease:
- Aging. Older people are more likely develop artery damage, as high cholesterol becomes more and more likely since the liber is no longer as capable of eliminating cholesterol from the bloodstream.
- Smoking. One of the most common causes of heart disease, smoking is bad news and second-hand smokers are no exception.
- Hypertension. Blood pressure is the force that blood exerts on the walls of the arteries. A person with elevated blood pressure is more likely to suffer artery damage, leaving the path for plaques open.
- Hypercholesterolemia is the number one enemy of a healthy heart. The human body already produces the amount of cholesterol it needs for hormone growth and muscle health, which means that dietary sources will provide excess cholesterol in the bloodstream. As this happens, the excess cholesterol sticks to the inner lining of the coronary arteries, forming plaques. This leads to atherosclerosis, which is a risk factor for coronary artery disease.
- Diabetes shares a lot of risk factors with coronary artery disease, which links these two conditions together.
- Obesity. When you have excess cholesterol in your bloodstream, it means you are not eating properly. Consuming foods that are rich in fat, calories, and cholesterol put you at risk of becoming overweight and obese.
- Sedentary lifestyle. People who don’t include exercises in their weekly routine are at risk of heart problems. Exercises help keep the heart’s muscles healthy.
When left untreated, coronary artery disease can lead to complications such as heart failure, heart attacks, arrhythmia (which is an abnormal heart rhythm), and chest pain.
Coronary artery disease: Diagnosis and tests
A series of tests can help determine if a person has a blocked or a narrow artery that prevents blood from reaching the heart. Sometimes, something as simple as a blood test or a lipid panel to look at cholesterol levels can determine if you are at risk of coronary artery disease. For instance, if your total cholesterol levels exceed the healthy threshold, the doctor may order more tests to check if there’s something wrong with the coronary arteries.
Electrocardiogram (EKG)
An EKG is the most common test to help determine the current status of the coronary arteries. During an EKG, patients will have tiny patches (electrodes) attached to their chest and/or limbs, which are connected to a monitor at the other end. The monitor will record the electrical signals that travel through the heart. This non-invasive test doesn’t last longer than a few minutes and can give your doctor information about how your heart is functioning at that specific moment.
Echocardiogram
An echocardiogram uses the power of sound waves to create digital images of the heart. It can help determine if there are any problems in the chambers and valves of your heart but can also tell if your shortness of breath or angina is caused by a heart problem.
There are four different types of echocardiograms, and your doctor will choose the one that will provide the information they need for a diagnosis:
- A transthoracic echocardiogram is the most common type of echocardiogram, in which a sonographer presses a transducer smeared with gel against your skin to determine the sound wave echoes of your heart.
- A transesophageal echocardiogram is performed when the doctor needs a better image of your heart. It involves inserting a flexible tube down your throat, with a transducer that will record sound wave echoes from your heart. Your throat will be numbed before the procedure.
- A stress echocardiogram is a very common test for patients who are suspected of having coronary artery disease. The purpose of the test is to record your heart activity while you’re resting, and then while you’re exercising. There are cases where heart problems are only noticeable when you’re performing physical activity, so the doctor will have you either ride a stationary bike or walk a treadmill. Patients who can’t do either of these will be injected with a medication that makes the heart pump faster.
Thallium (Cardiolyte) scan
A thallium (cardiolyte) scan ro diagnose coronary artery disease is a type of nuclear test with steps very similar to an EKG. The procedure is non-invasive and involves injecting two substances into your bloodstream. These substances will attach to the cells inside the body, and a monitor that you’re connected to (with electrodes) will show if there is any radioactivity.
The main benefit of ta thallium scan is that it can show the doctor the precise location of artery blockage. It is mostly performed in people who have stable angina, those who already take angina treatment and need to be monitored for improvement, but also to determine if the heart muscle is still viable beyond the point of artery blockage.
Magnetic resonance imaging (MRI)
MRIs aren’t just for scanning the brain; they can also provide valuable information about the structure of the heart. An MRI to diagnose coronary artery disease allows doctors to find out more about how blood flows through the largest vessels of your body.
Unlike the devices used for EKGs and echocardiograms, an MRI requires a more sophisticated piece of equipment and is performed mostly in hospitals, clinics, and imaging centers. During an MRI, you will lie down on a table that slides into a tube. The machine creates a magnetic field around the body, and if the technician places a small coil on a specific part of your body, the radio waves focus on that specific area. If the doctor wants to know how the blood flows through the coronary arteries, you will be injected with a contrast agent before the test. An MRI can last between 30 and 90 minutes.
Coronary artery calcium scan (CT)
Also known as a heart scan, this CT is similar to an X-ray test that gives the doctor images of your heart. The test is a combination of an EKG and an MRI, during which you will lie on a table that slides into a tube. However, unlike an MRI, a CT scan leaves your head outside the tube.
The technician may give you some pills that slow down your heat rate, so that the images rendered by the monitor are clearer. You will also have electrodes attached to your chest, which are connected to a monitor that displays digital images of your heart.
Dietary changes to help manage coronary artery disease
Since coronary artery disease is caused by high cholesterol and hypertension, you need to adopt a diet that doesn't add to them. Basically, a coronary artery disease diet is a low-cholesterol diet.
As complicated as it sounds, you can actually still enjoy plenty of delicious foods, as long as you follow some simple rules:
- Unhealthy fats are a major threat. If you eat a lot of trans and saturated fats, the risk of having high cholesterol is very high. Replace fat meat with lean cuts, as the goal is to consume meat which has less than 10 percent fat. Saturated fats can be replaced with unsaturated ones, such as olive oil, which is an important part of a heart-healthy diet.
- Replace grains with whole grains, because they are rich in fiber. Almost every type of grain-based product has a whole grain alternative: whole wheat flour, high-fiber cereal, whole grain pasta, whole wheat bread, etc.
- Part of having a healthy heart is eating foods rich in omega 3 fatty acids, which are "the good kind" of fat. These are mostly found in fish, so replace two of your fatty steaks with servings of fish each week. You can also get omega 3 fatty acids from different nuts (such as walnuts or almonds) or flaxseed, but fish is the richest source of fatty acids.
- Protein is an important part of every diet, but when you have high cholesterol, you need to look for low-fat protein sources. Replace full-fat milk with low fat or skim milk, eat soy-based products, cook chicken without the skin, eat eggs, and avoid processed meats like bacon or sausages.
- Sugar raises triglycerides, another type of fat. Avoid sugar-rich foods and satisfy your sweet tooth by eating plenty of fruit (because it’s also rich in fiber and very healthy). When you feel like eating something sweet, combine some low-fat yogurt with fruits like kiwi or strawberries.
Medication for coronary artery disease
Aside from making changes to your diet and exercising to help manage coronary artery disease, your doctor might also prescribe medication to help you keep coronary artery disease under control. Since artery damage is most often caused by high cholesterol or high blood pressure, medication will include drugs that help fight these conditions:
- Medications to lower cholesterol are commonly prescribed in cases of coronary artery disease. Keep in mind that the fatty deposits on the inner lining of the artery walls trigger a chain reaction that ends with coronary artery disease. These medications include niacin, resins, fibrates, and statins.
- Drugs to lower your blood pressure may also play a role in treating coronary artery disease because high blood pressure damages the arteries and facilitates plaque formation. Some blood pressure meds prescribed in such a case include angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, beta blockers for coronary artery disease, and calcium channel blockers.
- Aspirin is a blood thinner, which means that it can also prevent your blood from clotting. Blood clots block the coronary arteries, causing blood flow restrictions to the heart. For people who suffered a heart attack, aspirin can prevent future ones. However, this medication is not recommended for people who are taking other blood thinners or have a bleeding disorder.
- Ranolazine may be offered to people who suffer chest pain as a symptom of coronary artery disease.
- Nitroglycerin is also useful in relieving angina-related pain, as it causes the coronary arteries to temporarily dilate, facilitating blood flow.
Surgical interventions for coronary artery disease
When dietary changes and medication treatments aren’t enough, doctors may choose a more aggressive approach to manage the blocked arteries. Two types of surgeries are usually considered.
Angioplasty (with or without stent placement)
When the walls of a coronary artery are very narrow, an angioplasty may be required. This invasive procedure looks to push the walls of the arteries further apart. The procedure involves inserting a catheter with a deflated balloon through the groin. When the catheter and the balloon have reached the narrow spot in the artery, the balloon is inflated, dilating the artery walls and making room for blood to circulate. The balloon is then deflated and the catheter removed.
There are situations where doctors might feel it’s best to place a stent inside the artery, in an angioplasty with stent placement procedure. A stent is a small wire mesh tube that will permanently stay inside the artery, to make sure that it doesn’t narrow again.
Coronary artery bypass graft surgery
When a coronary artery is permanently blocked by a blood clot, the blood supply to your heart is permanently restricted. Doctors can perform coronary artery bypass surgery, which uses a healthy artery from another part of your body to redirect the blood around the blocked point in these cases.
One end of the healthy artery is attached before the blockage, and the other one after it. This creates a new path for the blood to follow. However, coronary artery bypass surgery is a last resort, because it’s open-heart surgery that involves more risk than any other treatment method, and coronary artery bypass surgery recovery can take some time as well.
Conclusion
Coronary artery disease can be managed, but that requires proactive patient participation. People who have been diagnosed with this condition need to make dietary changes and incorporate regular exercise into their lives. In some cases, patients are also required to take medication their entire life.
The good news is that once you adopt a low-fat cholesterol diet, you won’t just be improving your heart health, you’ll also have a healthier liver, more energy, fewer lung problems (if you’re a smoker who has to quit because of a coronary artery disease diagnosis), and the list goes on.
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