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What Is Coronary Artery Disease?

Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart.

What Are The Causes Of Coronary Artery Disease?

An excess of cholesterol, inflammation and vascular damage cause plaque build-up, narrowing the blood vessels and causing blockage and ischemia.

What Are The Signs And Symptoms Of Coronary Artery Disease?

The disease is gradual and begins with angina, a slow blockage which can present with shortness of breath and chest pain or pressure upon exertion. Extreme cases can cause a Myocardial Infarction (Heart Attack), which is a complete blockage of the coronary vessel that presents with crushing chest pain, diaphoresis (sweating), and pain radiating to the left arm.

What Are The Risk Factors Of Coronary Artery Disease?

Common causes of Coronary Artery Disease are age, Smoking, Diabetes, Hypercholesterolemia, Hyperlipidemia, Hypertension, Obesity, and Family History.

Other causes and contributing factors include chronic kidney disease, metabolic syndrome, preeclampsia, premature menopause, an inflammatory disease especially rheumatoid arthritis, psoriasis, and HIV.

How Is Coronary Artery Disease Diagnosed?

Advanced CAD can be diagnosed with an electrocardiogram analyzed by a Cardiologist. Earlier detection is possible by an echocardiogram, Coronary Calcium Score, Coronary Angiogram, and most commonly by a Stress Test.

What Are The Possible Treatments For Coronary Artery Disease?

Cholesterol and lipid-reducing medications can help reduce plaque and inflammation, Beta-blockers and blood pressure medications may reduce stress on the heart. Low-dose Aspirin and other antiplatelet agents can also help with reducing inflammation and the risk of clot.
In extreme cases when a heart attack ensues, the treatment is a cardiac catheterization to open the blockage or open heart surgery with bypass grafts to bypass the blockage . If the heart is too damaged then heart transplant may be the final viable option.

Are There Preventative Steps Or Measures To Avoid Coronary Artery Disease?

Daily exercise (especially complex aerobic activity like running, dancing, or swimming) and being physically active is essential to optimal cardiovascular health. At least 30 minutes of some kind of daily activity greatly improves blood pressure, lowers cholesterol and reduces stress. A daily 30-40 minute morning workout routine before work can make a big difference.

Healthy eating is also important. Eating mostly plant-based foods that are not processed is a key component of better cardiovascular health. Try a diet plan, like ketotarian, Whole30, Mediterranean, or Paleo, and stick to it it daily. Having three or four meals planned out weekly and rotating them on a schedule can help you adhere to healthy eating. Sometimes just being mindful of your eating can help you make better food choices, so keeping a food log is a good habit. Fasting daily, a liquid fast from 14-20 hours, may also be a great way to get healthy by losing weight and forcing your body to use stored fat.

Stress management may also be a crucial factor. While it is not ideal (nor possible) to have no stress in your life, excessive stress can lead to increased heart rates, blood pressure, inflammation, and abnormal heart rhythms, which negatively affect cardiovascular health. Daily exercise is a great way to help manage stress. Mindfulness practices like cognitive behavioral therapy and breathing techniques may also be useful. If you are fortunate enough to live by some green spaces, taking a walk in nature can often help manage stress.

Stop drinking and smoking. Alcohol is a direct cardiotoxin and is bad for your heart. It can lead to abnormal heart rhythms, weakening of the heart and can increase inflammation. It does not matter in what form the alcohol comes in – the end result is damage to the heart and to the vascular system. Smoking causes inflammation and damage to all vascular beds and is a major cause of heart attacks and strokes. Study after study has shown that smoking cessation is one of the most important things you can do to ensure better cardiovascular health.

What Are The Risks If Coronary Artery Disease Is Left Untreated?

Coronary Artery Disease can have a variety of harmful complications, but the largest risk is death due to a heart attack.

What Happens During A Heart Attack?

A network of blood vessels known as coronary arteries surround the heart muscle and supply it with blood that is rich in oxygen and nutrients. The heart muscle needs this continuous supply of oxygen and nutrients to function.

A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it.

When fat builds up inside your arteries it causes slight injury to your blood vessel walls. In an attempt to heal the blood vessel walls, the cells release chemicals that make the blood vessel walls stickier. Other substances traveling through your bloodstreams, such as inflammatory cells, cellular waste products, proteins, and calcium, begin to stick to the vessel walls. The fat and other substances combine to form a material called plaque.

Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are soft on the inside with a hard fibrous “cap” covering the outside. If the hard surface cracks or tears, the soft, fatty inside is exposed. Platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque.

If a blood clot totally blocks the blood supply to the heart muscle, called a coronary thrombus or coronary occlusion, the heart muscle becomes “starved” for oxygen and nutrients (called ischemia) in the region below the blockage. Within a short time, an acute coronary syndrome can occur.

Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery: unstable angina, Non-ST segment elevation myocardial infarction or heart attack (NSTEMI), or ST segment elevation myocardial infarction or heart attack (STEMI).

Each coronary artery supplies blood to a region of the heart muscle. If an artery is occluded (blocked) there is no blood supply to that region.

The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.

Are There Other Related Conditions To Coronary Artery Disease?
Related conditions include Atherosclerosis, Arrhythmias, Anginas (Stable, Unstable), Aneurysms, renal arterial disease, peripheral arterial disease.

Key Takeaways

Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart. If not treated, coronary artery disease can lead to death from a heart attack. It can be treated by preventive medications and cardiac catheterization or bypass surgery. The biggest potential complication CAD can cause is sudden cardiac death due an acute plaque rupture leading to ventricular arrhythmias and necrosis of cardiac tissue.

Recommended Next Steps

If you are above age 40 or have a strong family history of Coronary artery disease or other aforementioned risk factors, it is important that you go see a cardiologist for a complete cardiovascular screening.

Importance Of A Heart-Healthy Lifestyle

It is important for you to be committed to leading a heart-healthy lifestyle to reduce your risk of a heart attack. Your health care team can help you achieve your goals, but it is up to you to take your medications as prescribed, make dietary changes, quit smoking, exercise regularly, and keep your follow-up appointments.

Meet Manhattan Cardiology

Amnon (Ami) Beniaminovitz, MD, FACC, FASE, CBNC, RPVI is a multi board-certified cardiologist, with a special focus on cardiovascular diseases, imaging, and nuclear cardiology. His credentials include board certifications in Nuclear Cardiology by the American Society of Nuclear Cardiology (ASNC), Echocardiography and Stress Echocardiography by... Learn More »