Coronary Artery Disease (Ischemic Heart Disease)
Coronary Artery Disease (CAD), also known as Ischemic Heart Disease (IHD), is a condition where the coronary arteries, which supply blood to the heart muscle, become narrowed or blocked due to atherosclerosis. This leads to reduced oxygen supply to the heart, potentially causing chest pain (angina), heart attacks (myocardial infarction), and heart failure.
Causes and Risk Factors
CAD is primarily caused by atherosclerosis, a chronic inflammatory process that involves the buildup of plaques composed of fat, cholesterol, and other substances on the artery walls. Major risk factors include:
Modifiable Risk Factors:
- High blood pressure (hypertension)
- High cholesterol levels (hyperlipidemia)
- Smoking
- Diabetes mellitus
- Obesity and sedentary lifestyle
- Unhealthy diet
- Stress
Non-Modifiable Risk Factors:
- Age (risk increases with age)
- Family history of heart disease
- Male gender (higher risk compared to women before menopause)
Symptoms to Pay Attention To
Stable Angina:
Chest pain triggered by exertion and relieved by rest.
Unstable Angina:
Chest pain occurring at rest or with minimal exertion, potentially leading to a heart attack.
Myocardial Infarction (Heart Attack):
Severe chest pain, often radiating to the left arm, jaw, or back, accompanied by shortness of breath, nausea, and sweating.
Heart Failure:
Chronic fatigue, swelling in the legs, and shortness of breath due to a weakened heart.
Diagnosis
Diagnosis of CAD involves a combination of clinical evaluation and tests such as:
Electrocardiogram (ECG):
Electrocardiogram (ECG):
To detect abnormal heart rhythms and ischemic changes.
Echocardiography:
Echocardiography:
To assess heart function.
Stress Testing:
Stress Testing:
To check heart function under exertion.
Coronary Angiography:
Coronary Angiography:
Gold standard imaging technique to visualize coronary artery blockages.
CT Coronary Angiography:
CT Coronary Angiography:
Non-invasive imaging for detecting significant arterial stenosis.
Treatment
Lifestyle Modifications:
- Healthy Diet: Low in saturated fats, sugars, and high in fiber.
- Regular Exercise: At least 150 minutes of moderate-intensity exercise per week.
- Smoking Cessation
- Weight Management
- Stress Reduction
Medications
- Antiplatelets (Aspirin, Clopidogrel) – Prevent blood clot formation.
- Statins – Lower cholesterol levels and stabilize plaques.
- Beta-Blockers – Reduce heart workload and control blood pressure.
- ACE Inhibitors/ARBs – Lower blood pressure and protect the heart.
- Nitrates – Help relieve angina symptoms.
Interventional and Surgical Treatments
- Coronary Angioplasty and Stenting (PCI): A procedure to open blocked arteries using a balloon and stent.
- Coronary Artery Bypass Grafting (CABG): Surgical creation of a new way for blood to bypass blocked arteries.
Prevention
Controlling risk factors with lifestyle changes and medications.
Regular medical checkups for early detection.
Conclusion
CAD is a major cause of morbidity and mortality worldwide. Early detection and management through lifestyle changes, medications, and, if necessary, procedures like PCI or CABG can significantly improve quality of life and reduce complications.
Information resources recommended
1. American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Chronic Stable Angina
1. American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Chronic Stable Angina
2. European Society of Cardiology Guidelines on the Management of Acute Coronary Syndromes
2. European Society of Cardiology Guidelines on the Management of Acute Coronary Syndromes
3. ACC/AHA Guidelines on the Management of Acute Coronary Syndromes
3. ACC/AHA Guidelines on the Management of Acute Coronary Syndromes
https://www.ahajournals.org/doi/10.1161/cir.0000000000000134
https://pubmed.ncbi.nlm.nih.gov/25260718/
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029
https://pubmed.ncbi.nlm.nih.gov/25249586/
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
https://pubmed.ncbi.nlm.nih.gov/25260718/
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029
https://pubmed.ncbi.nlm.nih.gov/25249586/
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines