Imagine that you are driving your car in two traffic lanes that has to merge into one due to construction. The traffic is still moving but at a slower rate and you are wondering what is the hold up. As you continue ahead, you noticed some huge potholes in the road and then the traffic stops. Cleveland Clinic defines Coronary artery disease (CAD) as "a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart." In the United States, coronary artery disease is referred to as the most common type of heart disease, and it's also known as a "silent killer." This plaque-building disease, causes blood clots development which can reduce the blood flow to the heart. Many individuals may not experience any symptoms for years, until it sneaks up on them and cause a heart attack. This article on CAD is going to dive deep into the cause, symptoms, diagnosis, risks, and treatments for this disease.
So, what are the possible symptoms and causes of this silent but deadly disease? In terms of symptoms, sometimes people may not experience them, but that does not mean you should ignore it. According to Mayo Clinic, the symptoms that people may experience are:
Chest pain (angina). You may feel pressure or tightness in your chest. Some people say it feels like someone is standing on their chest. The chest pain usually occurs on the middle or left side of the chest. Streneous activities or strong emotions can create triggers with angina. The pain usually goes away within minutes after the triggering event ends. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back.
Shortness of breath. You may feel like you can't catch your breath.
Fatigue. If the heart can't pump enough blood to meet your body's needs, you may feel unusually tired.
Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack includes crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. Women may have less typical symptoms, such as neck or jaw pain, nausea and fatigue. Some heart attacks doesn't cause any noticeable signs or symptoms.
The main cause of CAD deals with a condition known as atherosclerosis, which is a gradual build up of plaque in the inner walls of the arteries. According to Cleveland Clinic, "Plaque consists of cholesterol, waste products, calcium and fibrin (a substance that helps your blood to clot)." As the plaque gradually builds up, it constricts the blood flow, which results in the arteries becoming more narrow. Mayo Clinic says, "The plaque can also cause a bursting episode, leading to blood clots." It is highly important for us to be aware of these main symptoms and leading causes of CAD.
How do doctors conclude that someone has coronary artery disease? Doctors can diagnose patients with CAD by doing a physical exam and completing further tests. Cleveland Clinic explains how providers conduct their physical exams for diagnosing CAD as follows:
Measuring the patient's blood pressure.
Listening to the heart with a stethoscope.
Asking what symptoms the client is experiencing and for how long.
Asking patients about their medical history.
Inquiring about the patient's lifestyle, for instance, do they exercise, drink, smoke and their nutritional/dietary practices.
Obtaining information about a patient's family history. It's important to know about presence of heart disease among each biological parents and siblings.
Healthcare providers may do more than one of these test to determine if a person have CAD. The Mayo Clinic mentions some of the tests and or examinations completed by doctors to diagnose CAD. Some of the tests mainly used with helping doctors to diagnose or monitor coronary artery disease includes:
Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. It is used to show the pace of how fast or slow the heart is beating. Your provider can look at signal patterns, to determine if someone's having or had a heart attack.
Echocardiogram. This test uses sound waves to create pictures of the beating heart. An echocardiogram shows how blood moves through the heart and heart valves. Parts of the heart that moves weakly may be caused by a lack of oxygen or a heart attack. This may be a sign of coronary artery disease or other conditions.
Exercise stress test. If the presence of signs and symptoms occur often during exercise or exertion, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. If an echocardiogram is done while you do these exercises, the test is called a Stress Echo. If you can't exercise, you might be given medications that stimulate the heart to function as it would while exercising.
Nuclear stress test. This test is similar to an Exercise Stress test but adds images to the ECG recordings. A Nuclear Stress test shows how blood moves through the heart muscle at rest and during stress. A radioactive tracer is given by IV. The tracer helps the images of the heart arteries to show more clearly.
Heart (cardiac) CT scan. A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries. Sometimes dye is given by IV during this test. The dye helps create detailed pictures of the heart arteries. If dye is used, the test is called a CT Coronary Angiogram.
Cardiac catheterization and angiogram. During cardiac catheterization, a heart doctor (cardiologist) gently inserts a flexible tube (catheter) into a blood vessel, usually in the wrist or groin area. The catheter is gently guided to the heart. X-rays helps the physician with guiding the catheter. Dye flows through the catheter. The dye helps blood vessels show up better on the X-ray images and provide outlines of any blockages. If you have an artery blockage that needs treatment, a balloon on the tip of the catheter, can be inflated to open the artery. A mesh tube (stent) is typically used to keep the artery open."
The main risks that causes people to have CAD are being overweight, not being active, having a poor diet, smoking or having a family history of heart disease. These are the tests that healthcare providers will complete on their patients to know if they're having a CAD.
If someone is diagnosed with coronary artery disease, there are some steps that they can take to reduce the risk of CAD becoming more serious. The healthcare provider will discuss the best treatment options with their patient, whether it's making lifestyle changes, taking medications, or possibly surgery. According to Cleveland Clinic, there are some lifestyle changes that patients will need, if they are diagnosed with CAD.
Lifestyle changes play a big role in treating coronary artery disease. These changes include:
Don’t smoke, vape or use any tobacco products.
Eating heart-healthy foods low in sodium, saturated fat, trans fat and sugar. The Mediterranean diet is a proven way to lower your risk of a heart attack or stroke.
Exercising: Aim for 30 minutes of walking (or other activities) five days a week.
Limit alcohol consumption
Be sure to talk with your provider before starting any new exercise program. Your provider can also offer guidance on lifestyle changes tailored to your needs. They may recommend smoking cessation options or meeting with a dietitian to discuss healthy eating plans." According to the Mayo Clinic, "There are many medications and surgeries available to treat coronary artery disease, these includes some of the following:
Cholesterol drugs. These medications helps with lowering bad cholesterol and reducing plaque buildup in the arteries. Such drugs includes statins, niacin, fibrates and bile acid sequestrants.
Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in some people. It is noted that, daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Don't start taking a daily aspirin without talking to your health care provider.
Beta blockers. These drugs slows the heart rate. Beta blocker medications also lower blood pressure. If you've had a heart attack, beta blockers may reduce the risk of future attacks.
Calcium channel blockers. Calcium channel blocker medications may be recommended if you can't take beta blockers or if beta blockers does not work. Calcium channel blockers can help improve symptoms of chest pain.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Both of these medicines lower blood pressure. They are also used for preventing or keeping the coronary artery disease from getting worse.
Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain. Nitroglycerin is available as a pill, spray or patch.
Ranolazine. This medication may help people with chest pain (angina). It may be prescribed with or instead of a beta blocker.
Sometimes, surgery is needed to fix a blocked artery. Some options are:
Coronary angioplasty and stent placement. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). The heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow. A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents slowly release medication to help keep the arteries open.
Coronary artery bypass graft surgery (CABG). A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. CABG requires patients to have an open-heart surgery. It's usually done only for those with many narrowed heart arteries."
These are the main precedures or options that doctors will utilize for their patients if they have CAD and require surgery.
When it comes to coronary artery disease, it can be a "beast to navigate." Having symptoms like angina, shortness of breath, or feeling fatigued are some of the little red flags to be aware of as well as, a heart attack. It is important to notify your doctor and let them run a physical exam and other necessary exams to see if someone has CAD. If you are diagnosed with CAD, you have different options available that can help you. It is important to discuss the options with your doctor and see which plan is right for you. So don't let this CAD's symptoms or signs have you fooled, it's important to inform and consult with your doctor for guided medical help.
Sources:
1. Cleveland Clinic. “What’s Draggin’ Your Heart Down?” Cleveland Clinic, my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease. Accessed 26 Oct. 2023.
2. “Coronary Artery Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 May 2022, www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613.
3. “Coronary Artery Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 May 2022, www.mayoclinic.org/diseases-conditions/coronary-artery-disease/diagnosis-treatment/drc-20350619.
4. “Coronary Artery Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 July 2021, www.cdc.gov/heartdisease/coronary_ad.htm.
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