Coronary artery disease

Symptoms Of Coronary Artery Disease 

Angina or chest pain is the most common symptom of CAD. Angina develops when too much plaque deposits inside the arteries and narrows them. 

Angina may cause symptoms like-

• Heaviness 
• Pressure 
• Tightening 
• Burning 
• Indigestion
• Heartburn 
• Sweating 
  

For many people, a heart attack is the first clue that they have CAD. A few symptoms of a heart attack include-

• Chest pain or angina 
• Weakness 
• Nausea 
• Cold sweat
• Discomfort in the arms or shoulder 
• Shortness of breath or trouble breathing
• Heart palpitations

Over time, CAD can weaken the heart muscle. This may lead to heart failure, a life-threatening condition where the heart cannot pump blood the way it should.

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Types Of Coronary Artery Disease 

The different forms of coronary artery disease include:

1. Obstructive coronary artery disease

This is the most common type of coronary artery disease. It develops when coronary arteries gradually narrow due to plaque buildup. As artery narrowing progresses, it can eventually block blood flow to the heart. 

2. Nonobstructive coronary artery disease

This is not the result of plaque buildup but occurs due to other coronary artery problems, such as

1. Constriction at inappropriate times 

2. Malfunctioning in smaller artery branches 

3. Damage to the artery lining

Note: This form of CAD is more common in females than males. 

3. Spontaneous coronary artery dissection (SCAD)

SCAD occurs when a tear in the wall of the coronary artery partially or completely blocks the blood flow. This form can unexpectedly present as a heart attack. 

Causes Of Coronary Artery Disease 

Atherosclerosis or gradual buildup of plaque in coronary arteries (the major blood vessels in the body that supply blood to the heart) causes coronary artery disease. 

Over time, this plaque which is made up of cholesterol, waste products, calcium, and fibrin (which helps in blood clotting) narrows or blocks the coronary arteries. This affects their function to supply enough blood, oxygen and nutrients to the heart. It leads to chest pain and puts you at the risk of a heart attack.

Risk Factors For Coronary Artery Disease 

Multiple risk factors can lead to coronary artery disease. They are broadly divided into non- modifiable and modifiable factors:

I. Non-modifiable risk factors

1. Hereditary: Genetic factors are a significant risk factor of CAD. People with a family history of CAD are more prone to develop this condition.

2. Age: The risk of CAD significantly increases after 35 years of age in both men and women.

3. Gender: Men are more likely to have CAD as compared to women. Evidence has shown that lipoprotein (a) which is a cardiovascular risk factor seems to be elevated in men more than in women.

II. Modifiable risk factors

1. Hypertension (High Blood Pressure): High blood pressure Is a major risk factor for coronary artery disease. It is characterized by blood pressure in the arteries and other blood vessels greater than 185/115 mm Hg.

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2. Abnormal cholesterol profile

An abnormal cholesterol profile or more precisely dyslipidemia. ie. Excessive bad cholesterol (triglycerides and LDL) and less good cholesterol (HDL) in the blood is a major risk factor for the development of CAD. The extra cholesterol circulating in the bloodstream forms the basis for plaque blocking the arteries, robbing the heart of oxygen rich blood supply. 

3. Diabetes mellitus 

Diabetes is a condition in which the blood glucose levels in the body stay consistently above normal. The risk of heart disease is 2.5 times higher in men and 2.4 times higher in women in diabetic individuals as compared to those without diabetes. 

Note: India is the Diabetes capital of the world. Diabetes not only predisposes to heart disease but a plethora of other long-term complications.
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4. Obesity: Obesity increases the development and progression of coronary artery disease (CAD). The majority of individuals with CHD are overweight or obese.

Being overweight or obese is the root cause of a wide range of diseases including heart disease. 
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5. Lack of physical activity: A sedentary lifestyle predisposes obesity, high blood pressure, high bad cholesterol, and diabetes, which are all major risk factors for CAD.

6. Diet rich in unhealthy fats: A diet loaded with saturated fats, trans fats, and packaged food increases the risk of obesity and high bad cholesterol by many folds. This results in excessive plaque formation in coronary arteries, leading to CAD.


7. Vitamin D deficiency: Moderate to severe vitamin D deficiency is associated with an increased risk of cardiovascular diseases including high blood pressure, CAD, and heart failure. 

Read about various causes of Vitamin D and when to get tested for its optimum levels.
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8. Excessive alcohol intake: Drinking too much alcohol can raise blood pressure levels and the risk of heart disease. It has been recommended that women should have no more than 1 drink a day and men should have no more than 2 drinks a day. 

 
9. Tobacco: The usage of tobacco and exposure to secondhand smoke significantly increases the risk of heart diseases. Smoking increases plaque deposition in arteries and reduces the capacity of blood to carry oxygen, predisposing to CAD.

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10. Periodontitis: It is a severe gum infection that can lead to tooth loss. Research has suggested that periodontitis can expose the body to oral bacteria which can lead to the development of plaque buildup in blood vessels and coronary heart disease.

11. Chronic kidney disease (CKD): Patients with chronic kidney disease (CKD) exhibit an elevated risk of coronary artery disease due to accelerated aging of the cardiovascular system.

12. Air pollution: When a person breathes poor-quality air, the pollutants can travel deep into the bloodstream, through the lungs, to the heart. This increases the risk of developing heart and circulatory diseases. 

A study has found that long-term exposure to air pollution can lead to premature aging of blood vessels. This contributes to the rapid buildup of calcium in the coronary arteries, predisposing to plaque formation and CAD.

Diagnosis Of Coronary Artery Disease 

CAD is usually diagnosed through physical examination and relevant diagnostic tests. Suppose a person already has symptoms like chest pain, shortness of breath, and cold sweat; in that case, the doctor will examine the heart's electrical activity rate and the heartbeat's regularity and send the individual for further diagnosis. 

I. Physical examination and medical history 

• A medical practitioner usually diagnoses CAD through a physical examination and medical history. 

• The doctor will check parameters like blood pressure and ask about medical history, lifestyle, and family history (to check whether heart disease is among your biological parents and siblings).

• The symptoms of chest pain and pain in the jaw, neck, left arm, or back is assessed. Shortness of breath is evaluated during rest and in case of activity.

II. Imaging tests 

The medical practitioner may recommend one or more tests to assess heart function and diagnose CAD:

1. Non-Invasive tests 

• Chest X-ray : This test uses a small amount of radiation to create images of the chest, including your heart.
  
  
• Electrocardiogram (ECG): ECG is a cost-effective and readily available test for the evaluation of coronary artery disease. This test helps record the heart's electrical activity. 
  
  
• Echocardiography: Echocardiography is an ultrasound of the heart. This noninvasive test translates sound waves from your chest into pictures of your heart. It allows the doctor to check the heartbeat and pumping of blood. 
  
  
• Stress test: Stress test is used to check how well your heart and blood vessels are working under stress. In this, your heart may be put under stress with medicine or exercise. The images from the ultrasound show your heart structure and how well your heart muscles are pumping blood.
  
  
• Computed tomography (CT) scan : It is a diagnostic imaging procedure that uses a fusion of X-rays and computer technology to produce images of the inside of the body. The scan looks in the coronary arteries for plaque buildup. 
  
  
• Magnetic Resonance Imaging (MRI) scan : An MRI scan is a painless test that produces very clear images of the organs and structures inside your body using radio and computer-generated radio waves. This test helps in detecting tissue damage or problems with blood flow in the heart or coronary arteries. 
  
  
• Cardiac positron emission tomography (PET) scanning: A PET scan of the heart is a noninvasive nuclear imaging test that uses radioactive tracers to produce pictures of the heart. This test can detect areas of the heart muscle which are receiving insufficient blood due to heart damage.
  
  
• Coronary Calcium Scoring: This test measures the amount of calcified plaque (calcium) inside the walls of the heart’s arteries. This information obtained can help evaluate whether a person is at increased risk of a heart attack.
  
  
• Nuclear ventriculography: This test is a noninvasive procedure that uses radioactive materials called tracers to show the heart chambers. The tracers attach to the red blood cells and pass through the heart. The movement of the tracers helps detect any anomaly in the heart. 
  
  

2. Invasive tests 

• Coronary angiography : This test, also called cardiac catheterization, is a gold standard test for diagnosing CAD. This test is performed under local anesthesia and involves injecting a contrast dye into the coronary arteries via tubes called catheters. It shows the extent and severity of heart blockages.
  
  
• Electrophysiology Study: This is an invasive test to assess the heart's electrical system or is used to diagnose abnormal heartbeats or arrhythmia. The test is performed by inserting catheters and wire electrodes, which measure electrical activity, through the blood vessels that enter the heart.

III. Lab tests 

• Total  cholesterol : This test measures the total amount of cholesterol in the blood. A total cholesterol level of less than 200 mg/dL (5.17 mmol/L) is normal and cholesterol levels greater than 240 mg/dL (6.21 mmol/L) are high.
  
  
• Triglycerides (Tg): Triglycerides are a type of fat found in the blood. They come from extra calories that are not used immediately after eating and are stored in fat cells. High levels of TG can increase the risk of heart diseases like CAD. Triglyceride levels less than 150 mg/dL (1.7 mmol/L) are considered optimal.
  
  
• Low-density lipoprotein (LDL) cholesterol : LDL is bad cholesterol. Elevated levels of  LDL cholesterol causes plaque accumulation in the arteries, which reduces blood flow and increases the risk of heart diseases. The normal level of LDL should be less than 100 mg/dL and levels greater than 190 mg/dL are considered very high and pose a high risk of CAD. 
  
  
• High-density lipoprotein (HDL) cholesterol: HDL is good cholesterol. High levels of HDL reduce the risk of CAD by carrying away LDL and keeping the blood flow more easily. HDL levels greater than 60 milligrams per deciliter (mg/dL) are good for the heart and levels less than 40 mg/dL increase the risk of cardiovascular disease. 
  
  
• High sensitivity C reactive protein : A high level of CRP in the blood has been linked to an increased risk of heart diseases. It can also help to determine the risk before any symptoms appear.  
  
  
• Lipoprotein (a) : Lipoprotein (a) is a low-density lipoprotein attached to a protein called apo (a) that helps in  transporting cholesterol in the blood. High blood lipoprotein (a) levels may be indicative of a high risk of heart disease, blood clots, and stroke. The elevation of lipoprotein (a) is majorly caused by a genetic factor and runs in families.
  
  
• Troponin: This test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle is damaged and determine the risk of heart diseases. 
  
  
• Homocysteine: This test measures the amount of homocysteine, an amino acid in the body. Increased serum homocysteine levels are positively correlated with severity of CAD.
  
  
• B-type natriuretic peptide (BNP): BNP helps the body to eliminate fluids and relaxes blood vessels. In the case of heart damage, the body secretes high levels of BNP into the blood to ease the strain on the heart. BNP levels increase gradually as the number of diseased coronary arteries increases.
  
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Prevention Of Coronary Artery Disease 

The following tips can help in preventing or reducing the risk for coronary artery disease:

1. Consume a healthy diet

A healthy, balanced and wholesome diet plays a pivotal role in prevention of coronary artery disease. Here are some food items that you should prefer and the others you should avoid in your diet. 

Foods to prefer-

• Green leafy vegetables
• Legumes 
• Whole fruits
• Whole grains like wheat, brown rice, jowar, ragi and bajra
• Low-fat or fat-free milk or yogurt
• Unsalted nuts and seeds
• Eggs, fish, seafood, lean poultry
• Vegetable and nut oils like olive oil, canola oil

Foods to limit or avoid-

• Refined grains like white flour or white bread
• Table sugar
• Sugar-sweetened beverages
• Packaged foods
• Red and processed meats
• Butter, coconut, palm, cottonseed and palm kernel oils and other oils that congeal at room temperature 
• Alcohol consumption 
• High salt intake

A DASH diet or Dietary Approaches to Stop Hypertension diet is a novel concept that emphasizes on portion control of food, getting the adequate amount of nutrients, and to lower down the risk of hypertension and eventually CAD.

Read more about DASH

2. Indulge in physical activity 

Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. It has been noted that regular exercise makes your heart and blood circulatory system more robust, lowers your cholesterol level, and also keeps your blood pressure under control. 

Try these easy exercises to keep your heart in good health.Explore now

3. Avoid smoking 

Smoking is never a good idea for your heart's health. It has been researched that giving up on smoking significantly reduces the risk of developing coronary heart disease. 

Looking to quit smoking, but finding it very difficult? Read about some practical ways that will help you get rid of this unhealthy habit.Check Out

4. Manage your stress effectively

Stress, anxiety, and negative mental health are associated with an increased risk of heart disease and stroke. While stress is hands in glove with this fast-paced world, it can be detrimental to health. Hence we need to find ways to manage stress in ways that best suit us. 

Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.
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5. Get sound and sufficient sleep 

Poor sleep quality is associated with high blood pressure, and elevated cholesterol, which are major risk factors for CAD. A healthy diet, regular exercise, sleep hygiene and low stress may promote deep and restorative sleep essential for good cardiovascular health.

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6. Keep your blood pressure under control 

Always keep your blood pressure under control. Eat a healthy diet, exercise regularly, and, if needed, take prescribed medications to lower your blood pressure.

Read these practical tips that will help you keep your blood pressure in check.
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Doctor To Visit

The doctors that can be consulted for diagnosis and management of CAD include:

• Cardiologist

• Cardiac surgeon

A cardiologist is a physician who specializes in the treatment of disorders of the heart and the blood vessels. 

A cardiac surgeon specializes in performing surgeries on the heart and blood vessels to treat conditions including coronary artery disease.

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Treatment Of Coronary Artery Disease 

Treatment for coronary artery disease (CAD) involves managing the symptoms and reducing the risk of further problems. CAD can be managed effectively with a combination of lifestyle changes, medications, and, in a few cases, surgery.

I. Medications

The main aim of medications is to either reduce blood pressure or ease blood flow in arteries.

1. Blood thinners 

Blood thinners are a class of medicine that helps in reducing the risk of a heart attack by thinning the blood and preventing it from clotting.

Common blood thinners are

• Clopidogrel
• Rivaroxaban
• Ticagrelor
• Aspirin

2. Beta blockers 

These medicines are used to treat angina and high blood pressure. 
Common beta blockers are

• Atenolol
• Bisoprolol
• Metoprolol 

3. Statins 

This class of drugs works by blocking the formation of bad cholesterol (low-density lipoprotein, LDL). 
Common statins are

• Rosuvastatin
• Pravastatin
• Atorvastatin
  
  

4. Calcium channel blockers

This class of drug works by decreasing blood pressure by relaxing the muscles, which causes the arteries to become wider and reduces blood pressure. 
Common calcium blockers are

• Amlodipine
• Verapamil 
• Diltiazem

Note: Popping calcium supplements without consulting your doctor could increase the risk of plaque buildup in arteries. Learn more about this. 

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5. Nitrates 

Nitrates are referred to as vasodilators that are used to widen your blood vessels. They work by relaxing blood vessels, allowing more blood to pass through them and thus lowering the blood pressure.

Common Nitrates are

• Glyceryl trinitrate 
• Isosorbide mononitrate

These drugs are available in a variety of forms, like tablets, sprays, and skin patches 

6. Angiotensin-converting enzyme (ACE) inhibitors

This class of drug is used in the treatment of high blood pressure. This drug blocks the activity of a hormone called angiotensin-2, which causes the blood vessels to narrow.

Common ACE inhibitors are

• Ramipril
• Lisinopril

Note: Heart medications should never be stopped suddenly without consulting your doctor as there is a risk of making symptoms worse.

II. Surgery 

In case of narrowing blood vessels as result of a build-up of fatty deposits or no relief in symptoms by taking the prescribed medicines, surgery may be needed to open up or bypass blocked arteries.

• Coronary angioplasty
  This is also known as percutaneous coronary intervention (PCI), or balloon angioplasty. During the procedure, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards which allows the blood to flow more easily. Coronary angioplasty is either a planned procedure in cases of angina or is performed as an emergency treatment for a heart attack.
  
  
• Coronary artery bypass graft (CABG)
  CABG is also known as bypass surgery or a heart bypass. It is a procedure to restore blood flow to areas of your heart that are blocked, causing heart attacks and CAD. 
  
  
• Heart transplant
  When the heart is severely damaged and is unable to adequately pump blood around the body, a heart transplant may be needed.

Complications Of Coronary Artery Disease 

1. Chest pain (angina)

In the case of narrowed coronary arteries, the blood supply to the heart is not enough. This can lead to chest pain (angina) or shortness of breath.

2. Irregular heart rhythms (arrhythmias)

When the heart does not receive sufficient blood and oxygen due to CAD, the normal heart signaling can get altered leading to irregular heartbeats.

3. Heart failure

The narrowed arteries due to CAD makes the heart weak and difficult for the heart to perform its functions. Heart failure occurs when the heart can't pump blood well enough to meet the requirements of the body.

4. Heart attack

Rupture of plaque in one of the coronary arteries can result in the formation of blood clots. This blood clot can stop the supply of blood and oxygen to the heart leading to a heart attack.

Home Care For Coronary Artery Disease 

Lifestyle changes are a cornerstone to improving your heart health. Staying physically active and making wise choices of foods to eat help in managing CAD. 

I. Engaging in physical activity 

Living with a heart condition can make you feel hesitant to exercise. Whether you have undergone heart surgery or are taking medication for a heart condition, don’t shy away from exercising. It is an important part of keeping your heart in good health. The following guidelines will help you in your exercising journey:

1. Doctor’s Consent: Always make sure to consult your doctor about which exercises are beneficial for you according to your health. Exercise programs, especially for patients with heart conditions, have to be tailored according to the individual’s exercise capacity and risk profile.

2. Aerobic exercises: Aerobic exercises are usually advised for individuals with CAD, as they help the heart to utilize oxygen better and improve blood circulation. You can choose an aerobic activity such as brisk walking, stretching, swimming, or light jogging. Do these for 15-20 minutes, 3-4 times a week. Always start slowly and gradually increase the pace.

3. Resistance training: Lifting weights increases muscle strength by making the muscles work against a weight or force. This training can be performed 2–3 days per week and includes one set of 8–10 exercises targeting all major muscle groups. Make sure to work out under the supervision of a professional trainer.

4. Warm up & cool down: Always perform a short warm-up session before starting the main exercise. After exercising, it is equally important to cool down.

5. Take a break when tired: Take a break of a few minutes in between sessions if you get too tired. Sip some water. If you continue to feel exhausted, stop exercising. Also, don’t overexert yourself if you are unwell or have a fever.

6. Wear the right clothing: Wear comfortable and breathable clothes that enable you to stretch easily while exercising.

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II. Making dietary changes amicable to heart health

After the diagnosis of CAD, making dietary changes can improve the condition of your heart and also reduce the risk of having further episodes. Quitting smoking and alcohol intake goes without saying.

Watch this informative video to learn about dietary modifications for improving your heart’s health. 

A special mention to these ‘Star nutrients’

1. Omega-3 fatty acids: Omega-3 fatty acids are “healthy fats” that support heart health. They help in reducing the inflammation and triglycerides, mildly lower blood pressure, and boosts immune functioning. 

Rich sources of Omega-3 fatty acids include:

• Nuts and seeds like flax seeds, chia seeds, and walnuts

• Plant oils such as flaxseed oil, soybean oil, and canola oil

• Fish, especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines and other seafood 

Supplements can be considered under the guidance of a healthcare provider.
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2. Vitamin D: Vitamin D is beneficial for reducing the risk of heart disease. Bask in the morning sunshine for optimum levels of this vitamin. You can also load your plate with foods rich in vitamin D like milk, eggs, fortified orange juice, tuna and soya milk.

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Alternative Therapies For Coronary Artery Disease

1. Yoga 

Yoga serves a vital role in maintaining and elevating the positive health of people suffering from CAD. Yoga significantly improves obesity, lipid profile, blood pressure, and diabetes mellitus.

Practicing yoga can keep your heart healthy.
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2. Acupuncture

Research has shown that acupuncture can be a viable complementary therapy for CAD as it can improve blood circulation throughout the body and within the heart.

Living With Coronary Artery Disease 

It's possible to lead a normal life after having heart surgery or problems like a heart attack. Here are a few tips that will help you in your journey of recovery from CAD:

1. Cardiac rehabilitation program
It is a major step for anyone recovering from a heart attack, heart failure, or other heart problem that requires surgery or medical care. This rehab program aims to improve the quality of life and prevent another cardiac event. A supervisor will guide you regarding 

• Physical activity 
• Healthy eating 
• Ways to relieve stress and improve mental health
  

2. Coordinate with your doctor
Keep in regular touch with your doctor. Make sure to consult your doctor in case of any health issues.

3. Follow a proper medication regimen
Take the medications prescribed by your doctor regularly without fail. It is also a good idea to consult your doctor when starting any medication for other medical conditions, to avoid interactions between different drugs.

4. Join support groups
If you have a heart condition you might find it useful to meet other people who are facing a similar situation. This gives a sense of motivation to live with your condition.