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Coronary Artery Disease: How Is It Diagnosed and Treated?

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Coronary artery disease, or also known as coronary heart disease or ischaemic heart disease, is the leading cause of death and premature mortality worldwide. It is estimated that half of all heart disease-related mortality cases in the world occur in Asian countries alone. This may be due to a lack of understanding on what is needed to maintain heart health combined with unhealthy eating habits and lifestyles. As a result, the prevalence of heart disease and heart-related deaths are on the rise.

World Heart Day falls on 29 September this year. Let’s find out what is coronary artery disease all about, and how can it be treated!

Epidemiology

According to the World Health Organization, cardiovascular diseases represent 31% of all global deaths in 2016. Among them, 85% are due to heart attack and stroke. It has been estimated that more than three quarters of these deaths take place in low- and middle-income countries. Moreover, out of 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2015, 37% were caused by cardiovascular diseases

Causes, risk factors

Risk factors for coronary artery disease include:

  • Age: Men above 45 and women above 55 years are at a higher risk.
  • Family history of heart disease.
  • Race: Asians generally have a lower level of high-density lipoprotein (HDL), also known as “good” cholesterol. South Asians appear to have a higher independent risk for cardiovascular disease as well.
  • Dyslipidemia: High levels of LDL cholesterol and low levels of HDL cholesterol in the bloodstream may predispose you to coronary artery disease.
  • Diabetes mellitus (particularly type 2 diabetes)
  • Smoking
  • Obesity
  • Physical inactivity
  • Metabolic syndrome
  • Mental stress and depression
  • Sleep disorders

Signs and symptoms

Common signs and symptoms of coronary artery diseases are:

  • Chest pain (angina): There will be a feeling of pressure or tightness in the chest, as if someone was standing on your chest. It usually occurs on the middle or left side of the chest and is generally triggered by physical or emotional stress. 
  • Shortness of breath: This may occur if the heart cannot pump enough blood to meet the body’s needs.
  • Heart attack: If the coronary artery is completely blocked, this condition will cause a heart attack. A heart attack may feel like a crushing pressure in the chest that radiates to the shoulder or arm and may be associated with shortness of breath and sweating.
  • Sweating
  • Increased restlessness or feeling of uneasiness.

Diagnosis

Along with a detailed medical history and clinical examination, the following tests may be required for diagnosing coronary artery disease:

  • Electrocardiogram (ECG): This test records electrical signals as they travel through the heart and can reveal evidence of a previous heart attack or one that may be in progress.
  • Echocardiogram: Sound waves are used to analyse the motions of the heart to determine whether all parts of the heart wall are functioning normally.
  • Exercise stress test: In this test, the doctor asks the patient to walk on a treadmill or ride a stationary bike during an ECG. Sometimes, an echocardiogram is also done while doing these exercises. This is called a stress echo. In certain scenarios, medication to stimulate the heart may be used instead of exercise.
  • Cardiac CT scan: A CT scan of the heart can help the doctor check for large amounts of calcium deposits in the arteries, which is an indication of coronary artery disease.

Treatment

The three pillars for the successful treatment of coronary artery disease are lifestyle modifications, medication, and medical procedures.

Lifestyle modifications

Modifiable risk factors of coronary artery disease should be controlled, such as:

  • Smoking cessation
  • Eating a healthy and balanced diet
  • Regular exercise
  • Losing excess weight
  • Reduction of stress

Medications

Various drugs can be used to treat coronary artery disease, including:

  • Cholesterol-modifying medications: They reduce (or modify) the cholesterol deposition in the coronary arteries to decrease bad cholesterol levels.
  • Blood-thinning medications: These drugs can reduce the tendency of our blood to clot, preventing obstruction in the coronary arteries.
  • Beta-blockers: They slow the heart rate and decrease blood pressure as well as the demand for oxygen in the heart. Beta-blockers also reduce the risk of future heart attacks.
  • Calcium channel blockers: They can be used together with or in replacement of beta-blockers to improve symptoms of chest pain.
  • Nitroglycerin: Nitroglycerin can be taken as tablets, sprays, or patches to control chest pain by temporarily dilating the coronary arteries and reducing demand for blood in the heart.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): They are used to decrease blood pressure and may help prevent the progression of coronary artery disease.

Procedures to restore and improve blood flow

  • Angioplasty and stent placement: A long, thin tube called a catheter is inserted into the narrowed part of the coronary artery. A wire with a deflated balloon is then passed through the catheter to the narrowed area, and the balloon is inflated to compress the deposits against the narrowed arterial walls.
  • Coronary artery bypass graft surgery (CABG): This is an open-heart surgery and thus is reserved for people who have multiple narrowed coronary arteries. A graft is placed to bypass blocked coronary arteries using a blood vessel from another part of the body to allow the blood to flow around the blocked or narrowed coronary artery. 

Complications

Complications of coronary artery disease include:

  • Stroke or blockage of blood supply to the brain
  • Pulmonary oedema or congested lungs
  • Atrial fibrillation or abnormal heartbeat
  • Heart failure or inability of the heart to pump
  • Sudden cardiac arrest or heart attack

Conclusion

With the growing problem of coronary artery disease worldwide, it is important to raise awareness of the disease and its complications. A healthy diet and active lifestyle should be adopted to prevent the development of coronary artery disease.

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