Coronary Artery Disease (CAD)

UPDATED ON: 7 Mar 2024, 15:35 PM

Medically Reviewed by

Dr Ashish Agarwal

What is Coronary Artery Disease (CAD)?

Causes of Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is primarily caused by atherosclerosis, a condition where plaque builds up inside the coronary arteries, narrowing them and restricting blood flow, oxygen, and nutrients to the heart. This plaque is made up of cholesterol, waste products, calcium, and fibrin (which helps in blood clotting). It causes chest pain and puts you at risk of a heart attack.

Risk factors

Several factors can increase your risk of getting coronary artery disease, including:

1. Age

Advancing age is a significant risk factor for CAD. The risk increases with age, especially after 45 for men and 55 for women.

2. Gender

Men generally face a higher risk of CAD compared to premenopausal women. However, after menopause, the risk for women catches up and may even surpass that of men.

3. Hereditary

Individuals with a family history of CAD, are at a higher risk of developing the disease.

4. Smoking

Tobacco smoke contains various toxins that damage the blood vessels, leading to atherosclerosis and increasing the risk of CAD.

5. Hypertension

High blood pressure puts added strain on the heart and blood vessels, accelerating the development of atherosclerosis and increasing the risk of CAD.

6. High cholesterol

Elevated levels of LDL cholesterol (often referred to as “bad” cholesterol) in the blood can enter the coronary arteries, narrowing them and increasing the risk of CAD.

7. Diabetes

Individuals with diabetes are at a higher risk of CAD due to various factors, including insulin resistance, inflammation, and metabolic abnormalities.

8. Obesity and a sedentary lifestyle

Being overweight or obese, due to a lack of physical activity, contributes to the development of multiple risk factors for CAD, including hypertension, diabetes, and dyslipidemia.

9. Unhealthy diet

Diets high in saturated fats, trans fats, cholesterol, and refined carbohydrates contribute to the development of atherosclerosis and increase the risk of CAD.

10. Stress

Chronic stress can contribute to CAD in various ways, including increased blood pressure, inflammation, and unhealthy coping behaviours like overeating or smoking.

11. Vitamin D deficiency

Lack of vitamin D in your body is linked with an increased risk of heart disease, including high blood pressure, CAD, and heart failure.

12. Alcohol and tobacco

Consumption of alcohol and tobacco (even secondhand smoke) significantly elevates the risk of cardiovascular diseases.

Key Facts About Coronary Artery Disease (CAD)

Major Symptoms	Chest pain Shortness of breath (especially during physical activity or stress) Fatigue or weakness Dizziness Palpitations or irregular heartbeats Nausea Sweating Indigestion Abdominal pain
Necessary Health Tests	Medical history Physical examination Electrocardiogram (ECG or EKG) Echocardiogram Exercise stress test Blood test Nuclear stress test Heart CT scan Cardiac catheterization and angiogram
Treatment	Lifestyle changes, such as: Following a healthy diet Performing regular exercise Maintaining a healthy weight Quitting smoking Managing stress Medications, such as: Antiplatelet agents such as aspirin or clopidogrel Statins Beta-blockers Nitroglycerin and other vasodilators Surgery, such as: Percutaneous coronary intervention (PCI) Coronary artery bypass grafting (CABG)

Symptoms of Coronary Artery Disease (CAD)

Coronary artery disease (CAD) demonstrates various symptoms, often indicating underlying heart issues. Chest pain, known as angina, is a hallmark symptom, typically felt as pressure, tightness, or squeezing in the chest. This discomfort may radiate to the arms, neck, jaw, or back. Apart from this, one may experience:

• Shortness of breath (especially during physical activity or stress)
• Fatigue or weakness
• Dizziness
• Palpitations or irregular heartbeats
• Nausea
• Sweating
• Indigestion
• Abdominal pain

In severe cases, a heart attack can occur, which may cause a few symptoms such as intense chest pain, sweating, nausea, and shortness of breath. It is important to note that symptoms can vary widely among individuals, and some might not experience any until a significant event like a heart attack occurs.

Diagnosis of Coronary Artery Disease (CAD)

The diagnosis of Coronary Artery Disease involves a comprehensive assessment that includes a medical history, a physical examination, and various blood tests. Here’s a detailed breakdown:

1. Medical history

The initial step to diagnosing CAD involves gathering information about the patient’s risk factors, such as family history, smoking habits, diet, exercise routine, and any existing medical conditions like hypertension or diabetes.

2. Physical examination

A thorough physical examination may reveal signs and symptoms such as high blood pressure, abnormal heart sounds, or signs of peripheral vascular disease.

3. Electrocardiogram (ECG or EKG)

An ECG records the electrical activity of the heart and can reveal abnormalities suggestive of CAD, such as irregular heart rhythms or signs of previous heart attacks.

4. Echocardiogram

This non-invasive test uses sound waves to create images of the heart, allowing doctors to assess heart structure and function, including the pumping capacity and any areas of reduced blood flow.

5. Exercise stress test

Stress tests evaluate how well the heart functions during physical stress. This can be done through exercise stress tests, where the patient walks on a treadmill while connected to an ECG machine, or pharmacologic stress tests.

6. Blood test

Blood tests help assess lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), glucose levels (for diabetes screening), and markers of inflammation (such as C-reactive protein) that can indicate an increased risk for CAD.

7. Nuclear stress test

This test is quite similar to the exercise stress test but adds images to the ECG recordings. It shows how blood moves to the heart muscles at rest and during stress.

8. Heart CT scan

A CT scan of the heart is done to see the calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries, increasing the risk of CAD.

9. Cardiac catheterization and angiogram

This invasive procedure involves injecting contrast dye into the coronary arteries to visualise any blockages or narrowing using X-ray imaging. It provides precise information about the location and severity of CAD.

Treatment of Coronary Artery Disease (CAD)

Treatment for coronary artery disease (CAD) aims to alleviate symptoms, reduce the risk of complications, and improve overall heart health.

1. Lifestyle changes

Patients are advised to adopt a heart-healthy lifestyle, including a balanced diet low in saturated fats and cholesterol, regular exercise, maintaining a healthy weight, quitting smoking, and managing stress. These lifestyle changes can help prevent the further progression of CAD and reduce the risk of complications.

2. Medications

Various medications are prescribed to manage CAD symptoms and reduce the risk of complications:

• Antiplatelet agents such as aspirin or clopidogrel help prevent blood clot formation.
• Statins lower cholesterol levels and reduce the risk of plaque buildup in the arteries.
• Beta-blockers help control blood pressure and heart rate, reducing the workload on the heart.
• Nitroglycerin and other vasodilators help widen heart arteries, improving blood flow to the heart muscle.

3. Surgery

In cases where lifestyle changes and medications are not sufficient, surgeries and other procedures may be necessary to restore blood flow to the heart:

• Percutaneous coronary intervention (PCI), commonly known as angioplasty, involves inserting a catheter with a balloon at the tip into the blocked artery to widen it and placing a stent to keep it open.
• Coronary artery bypass grafting (CABG) involves creating a new pathway for blood to bypass the blocked artery using a healthy blood vessel from another part of the body.

Remeber, patients with CAD require regular follow-up appointments with their healthcare providers to monitor their condition!

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