What is Coronary Artery Disease?

Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Because of presence of some irritative substance in blood, the (endothelium) innermost layer of blood vessels gets damaged and cholesterol (lipid – LDL) and sometimes calcium gets deposited (plaque) in your artery (mainly coronary artery) which causes inflammation in coronary artery.

When plaque builds up, it narrows your coronary arteries, decreasing blood flow to your heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.

Coronary artery disease often develops over decades; you might not notice a problem until you have a significant blockage or a heart attack. But there’s plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact.

 

Symptoms

If your coronary arteries gets narrow, they can’t supply enough oxygen-rich blood to your heart — especially when it’s beating hard, such as during exercise. At first, the decreased blood flow may not cause any symptoms. However, as plaque continues to build up in your coronary arteries, you may develop signs and symptoms, including:

Chest pain (angina): You may feel pressure or tightness in your chest, as if someone is crushing or as if someone has put some heavy weight on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be felt in the neck, (left) arm or back.

Shortness of breath: If your heart can’t receive enough blood, it can’t pump out enough blood to meet your body’s needs. In such condition, you may develop shortness of breath or difficulty in breathing on exertion or extreme fatigue with exertion.

Heart attack: A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Sometimes a heart attack occurs without any apparent signs or symptoms.

Age: Simply getting older increases your risk of damaged and narrowed arteries.

Sex: Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.

Family history: A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. (Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65)

Smoking: People who smoke have a significantly increased risk of heart disease. Exposing others to your secondhand smoke also increases their risk of coronary artery disease.

Alcohol use: Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease.

High blood pressure: Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow. High blood cholesterol levels. High levels of cholesterol in your blood can increase the risk of formation of plaque (atherosclerosis). High cholesterol can be caused by a high level of low-density lipoprotein (LDL) cholesterol, known as the bad cholesterol. A low level of high-density lipoprotein (HDL) cholesterol, known as the good cholesterol, can also contribute to the development of atherosclerosis.

Diabetes: Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure. Overweight or obesity. Excess weight (especially around waist) typically worsens other risk factors.

Physical inactivity: Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well. High stress. Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease.

Unhealthy diet: Eating too much fatty food, salt and sugar can increase your risk of coronary artery disease.

 

EECP Treatment for Coronary Artery Disease.

Enhanced external counterpulsation (EECP) is a mechanical form of treatment for angina. While several clinical studies appear to show that this treatment can be helpful in reducing symptoms of angina in patients withcoronary artery disease (CAD). EECP was approved by the US Food and Drug Administration in 1995 for the treatment of coronary artery disease (CAD).

Several studies suggest that EECP can be quite effective in treating ischemic heart disease. EECP significantly improved both the symptoms of angina (a subjective measurement) and exercise tolerance (a more objective measurement) in patients with CAD. EECP also significantly improved “quality of life” measures, as compared to placebo therapy.

Are All Heart Blockages Harmful?

 

Arterial supply of the heart

There are three arteries that run over the surface of the heart and supply it with blood (see the diagram above). There is one artery on the right side, and two arteries on the left side. The one on the right is known as the right coronary. On the left side, which is the main side, we have the left anterior descending (LAD) that runs down the front of the heart and supplies the front and main wall, and then the left circumflex that supplies the sidewall. If you look carefully, a major artery called the left main artery supplies the LAD and the circumflex.

 

Mild coronary artery disease

Heart blockage less than 40% is classified as mild coronary artery disease. Such blockages are clearly not causing restriction to blood flow and therefore very unlikely to be causing symptoms. It is important to note, however, that there is clear evidence here of progressive coronary artery disease and such patients need aggressive attention paid to risk factors for coronary disease (cholesterol, diabetes, smoking, blood pressure etc.), appropriate medicines, and healthy lifestyle changes such as exercise, weight loss and dietary modification. Paying close attention to these things can prevent progression of heart blockage and help to stabilize it.

 

MODERATE CORONARY ARTERY DISEASE

A moderate amount of heart blockage is typically that in the 40-70% range. Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms. Moderate coronary artery disease is treated much in the same way as mild disease, basically attention to risk factors, medications, and healthy lifestyle modification. Occasionally, heart blockage at the higher end of the moderate range (50-70%) may require additional testing to see if it is significant or not and may be responsible for symptoms.

 

SEVERE HEART BLOCKAGE

Severe heart blockage is typically that in the greater than 70% range. This degree of narrowing is associated with significantly reduced blood flow to the heart muscle and can underlie symptoms such as chest pain and shortness of breath. The severe heart blockage causes symptoms and are treated with placement of a stent  or sometimes bypass surgery is required in the setting of multiple severe blockages.

 

TOTALLY HEART BLOCKAGE.

 

100% blockage in coronary artery stopping blood flowing any further and, of course, leading to a heart attack. Such a heart blockage is typically accompanied by major symptoms, and treatment needs to be given in a very timely manner.  If the treatment for this isn’t done within good time (usually the first few hours, the sooner the better), then the heart muscle may die, and once dead, cannot usually recover, which results in reduced heart pumping function and heart failure.