Causes and risk factors:
Coronary artery disease begins in childhood and adolescence. The coronary arteries are the blood vessels which supply blood, oxygen and nutrients to the heart muscle. The inner lining of the blood vessels is called endothelium, which facilitates smooth functioning and flow of blood to the heart. Gradually the inner walls of the blood vessels gets lined by streaks of fat, over a period of time the accumulation of fat goes on increasing. Apart from the fatty deposits, the inflammatory cells, proteins and calcium contribute to the depositions. These deposits along with fat are termed as plaques. The plaques causes blockage or narrowing of the arteries, as a result the blood supply to the heart is hampered leading to development of ischemia Certain predisposing factors which lead to formation of plaques are smoking, excess of alcohol intake, diabetes mellitus, high blood pressure and high levels of cholesterol in the blood. Sedentary lifestyle, high levels of stress, intake of fatty food, obesity as well as radiation therapy used for treatment for various cancers of the thoracic region leads to development of plaques which ultimately results in CAD.A familial history of heart diseases and advance age increases the risk for coronary artery diseases.
Clinical presentations:
Pain in chest region is the characteristic feature of coronary artery disease. The patient experiences heaviness, tightness and pressure feeling in the chest. This is known as angina, angina pectoralis. The angina is of various types some patients also complain of burning sensation in chest which often leads to wrong perception of indigestion or acidity. The pain is usually felt in the chest and it radiates to the left shoulder, arms, neck, jaw or back. Sweating, rapid beating of the heart, difficulty in breathing are the other complaints seen. Dizziness and extreme weakness are the other associated symptoms. Complete blockage of the arteries lead to heart attack. Coronary artery diseases manifest itself in the form of ischemia, acute coronary syndrome, and myocardial infaction. It can lead to complication like heart failure and even death.
Diagnosis and investigations:
Symptoms narrated by the patient along with examination carried out by the doctor will help in confirming the diagnosis. Reviewing of the medical history is necessary. For proper diagnosis and treatment planning routine blood test, ECG, stress test, Color Doppler test, and 2D echo are to locate blockages imaging tests are done like non invasive CT angiography and Radio isotope intake etc. and invasive investigations like cardiac catheterization (angiography) are the diagnostic investigations. Along with this routine blood test, specialized cardiac markers in blood, urine test, blood sugar levels, lipid profile, and renal and liver function profile are also advised.
Treatment:
Aspirin medications content are the first line of treatment. Within first 30 minutes of development of symptoms the drugs needs to be administered for effective results. Anti clotting medications, beta blocker or ACE inhibitors are started. Surgical intervention is necessary for treatment of CAD. Angioplasty or Coronary artery bypass grafting is done. Lifestyle modification is necessary. Smoking, tobacco and alcohol intake should be avoided. Changes in the diet are essential. It is must to adopt well balanced and nutritious diet intake. High cholesterol and fatty food should be avoided. In cases of obesity weight reduction is necessary. Regular exercises must be done. Relaxation therapy for managing stress needs to implement. Cardiac rehabilitation after surgery, which comprises of exercises training, education and counseling is advised to the patient.
Recent update:
A few studies determined that calcium supplements were associated with an increased risk of CHD. An article in New England journal of medicine reports that inflammation plays a key role in coronary artery disease.
