Introduction

Coronary artery disease (CAD) refers to a condition where the blood vessels that supply the heart with oxygen and blood become narrower or blocked as a result of plaque build-up. It is also called coronary heart disease (CHD) or ischemic heart disease (IHD).

 Key Data & Insights

Facts and figures about CAD

• In accordance with the Centers for Disease Control and Prevention (CDC), CAD is the most common type of heart disease in the United States of American, with more than 18 million adults affected by the disease.
• In 2021, more than 375,000 persons succumbed to CAD in the United States. This figure fell from over 380,000 deaths in 2020.
• In the UK, more than 2 million people are affected. Of these, around 800,000 are women.
• CAD  stands as the leading cause of death in the entire world.

 

 Understanding Causes

Fatty substances get deposited and accumulate inside of the arteries that supply the heart with blood. This leads to CAD developing.

Underlying medical conditions such as  diabetes and high levels of cholesterol can cause plaque to accumulate. Apart from cholesterol, plaque consists of other inflammatory products from cells .

When plaque accumulates, the resulting condition is called artherosclerosis. Plaque deposits make the arteries narrower  and can even lead to blockage.

 

Associated Risk Factors

Various factors play role as risk elements for the development of CAD. These are

• Diabetes.
• Obesity.

• Hypertension.
• Smoking.
• Sedentary lifestyle.
• Alcohol abuse
• Low levels of HDL (good) cholesterol.
• High levels of LDL (bad) cholesterol.
• Chronic kidney disease.

 

Non-lifestyle related risk factors:

• Aging. Males older than 45 years old or females above 55 years old.
• Family history. Having a biological family member (first degree relative) with heart disease.
• Early menopause.

 

 Symptoms & Types

Signs and symptoms of CAD

Signs and symptoms of CAD may fail to present for a long period of time. Usually, plaque builds up over several years.

Mild signs and symptoms can be observed as the arteries become narrower.

Symptoms of chronic CAD are:

• Shortness of breath.
• Stable angina. This is temporary chest pain with an unpredictable sequence.
• Signs and symptoms such as indigestion, nausea, dizziness and weakness can be caused by angina. Around the chest, angina causes tightening, heaviness and aching.

 

Other symptoms are:

• Nausea.
• Faintness.

 

Types

There are two main types of CAD. These are:

•  Stable ischemic heart disease.
•  Acute coronary syndrome.

 

 Diagnostic Methods

• Patient history -taking.  Review of symptoms, medical and family history, social history, drug and substance abuse history among other relevant histories.
• Physical examination:

1.  BP measurement and recording.
2.  Auscultation with a stethoscope.

• Tests to asses heart function:

1. Echocardiogram.
2. Electrocardiogram.
3. Chest X-ray.
4. Cardiac catheterization.
5. Computed tomography coronary angiogram.
6. Heart MRI.

 

Management & Treatment Options

Treatment strategies:

• Lifestyle modification.
• Management of risk elements.
• Medicines.
• Surgical procedures.

 

Further discussion;

Lifestyle modification

• Avoid smoking and vaping.
• Limit consumption of alcohol.
• Exercise regularly.

 

Management of risk elements

• This is aimed at slowing down disease progression. Some of the risk factors that are managed are:

1.  Hypertension.
2.  High cholesterol.
3.  Diabetes.
4. Hypertriglyceridemia.
5. BMI greater than 25.

 

Medicines

• These manage risk factors and treat signs and symptoms. They include medications that:

1.  Lower blood pressure (anti-hypertensive drugs).
2.  Treat stable angina, such as nitroglycerin.
3.  Lower cholesterol (hypolipidemic agents).
4.  Lower risk of blood clotting.

 

Surgical procedures

•  Coronary artery bypass grafting.
•  Percutaneous coronary intervention.

 

Complications & Challenges

• Coronary thrombosis. This refers to a condition where blood clots form within the coronary arteries of the heart.
• Heart failure.
• Heart attack. When plaques rupture, platelets cluster at that place forming a clot which can block an artery and lower or block flow of blood. This may lead to an occurrence of a  heart attack.
• Cardiac arrest.
• Cardiogenic shock.
• Abnormal heart rhythms such as atrial fibrillation.

 

 Strategies for Prevention

• Embracing a healthy lifestyle can reduce the risk of developing CAD.Various adjustments that can be employed may include:

1.  Consumption of healthy diets.
2.  Engaging in physical activities such as running, walking, jogging and swimming.
3. Maintaining a healthy weight and normal BMI range.
4.  Quitting smoking.