Coronary artery disease, also called coronary heart disease, or simply, heart disease, is the No. 1 killer in America, affecting more than 13 million Americans.
Coronary artery disease is atherosclerosis of the coronary arteries, producing blockages in the vessels which nourish the heart itself. Atherosclerosis occurs when the arteries become clogged and narrowed, restricting blood flow. Without adequate blood flow from the coronary arteries, the heart becomes starved of oxygen and vital nutrients it needs to work properly.
Your coronary arteries are blood vessels on the heart. They are smooth and elastic, allowing blood to flow freely.
Before your teen years, fat can start to deposit in the blood vessel walls. As you get older, the fat builds up. This causes injury to your blood vessel walls. In an attempt to heal itself, the fatty tissues release chemicals that promote the process of healing but make the inner walls of the blood vessel sticky.
Then, other substances, such as inflammatory cells, proteins, and calcium that travel in your bloodstream start sticking to the inside of the vessel walls. The fat and other substances combine to form a material called plaque, which can narrow the flow of blood in the artery (atherosclerosis).
Some plaque deposits are hard on the outside and soft and mushy on the inside. Some plaque is fragile, cracking or tearing, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots accumulate on the injured vessel wall. This causes the artery to narrow even more. Sometimes, the blood clot breaks apart by itself, and blood supply is restored.
Over time, the inside of the arteries develop plaques of different sizes.
Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to supply enough oxygen-rich blood to the heart muscle.
In other cases, the blood clot may totally block the blood supply to the heart muscle, causing what is called an acute coronary syndrome. This is actually a name given to three serious conditions:
- Unstable Angina: chest pain that can often be relieved with oral medications, is unstable, and may progress to a heart attack. Usually more intense medical treatment or a procedure is required to treat this acute coronary syndrome.
- Non-ST Segment Elevation Myocardial Infarction (NSTEMI) or "Non-Q-Wave MI": This heart attack, or MI, does not cause typical changes on an electrocardiogram (ECG). However, chemical markers in the blood indicate that damage has occurred to the heart muscle.
- ST Segment Elevation Myocardial Infarction (STEMI) or "Q-Wave MI": This heart attack, or MI, is caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and causes changes on the ECG as well as chemical markers in the blood.
Some people have symptoms that tell them that they may soon develop an acute coronary syndrome, others may have no symptoms until something happens, and still others have no symptoms of the acute coronary syndrome at all.
When plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to meet your organ's needs, cramping of the muscle occurs. This is called ischemia.
Ischemia of the heart can be compared to a cramp in the leg. When someone exercises for a very long time, the muscles in the legs cramp up because they're starved for oxygen and nutrients. Your heart, also a muscle, needs oxygen and nutrients to keep working. If its blood supply is inadequate to meet the heart muscle's needs, ischemia occurs, and you may feel chest pain or other symptoms.
Ischemia is most likely to occur when the heart demands extra oxygen. This is most common during:
- Exertion (activity)
- Excitement or stress
- Exposure to cold
Coronary artery disease can progress to a point where ischemia occurs even at rest.
When ischemia is relieved in a short period of time (less than 10 minutes) with rest or medications, you may be told you have "stable coronary artery disease" or "stable angina."
The most common symptom is of coronary artery disease is angina, called or angina pectoris, or simply chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, numbness, fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.
Other symptoms that can occur with coronary artery disease include:
- Shortness of breath
- Palpitations (irregular heart beats, skipped beats, or a "flip-flop" feeling in your chest)
- A faster heartbeat
- Weakness or dizziness
Learn to recognize your heart disease symptoms and the situations that cause them. Call your doctor if you begin to have new symptoms or if they become more frequent or severe. If you or someone you are with experience chest discomfort, especially with one or more of the symptoms listed above, don't wait longer than a few minutes (no more than 5) before calling 9-1-1 to get help.
If you have angina and have been prescribed nitroglycerin, call your doctor or have someone take you to the nearest emergency room if pain persists after taking two doses (taken at five-minute intervals) or after 15 minutes.
Emergency personnel may tell you to chew an aspirin to help break up a possible blood clot, if there is not a medical reason for you to avoid aspirin.
Ischemia, and even a heart attack, can occur without any warning symptoms. This is called silent ischemia. It can occur among all people with heart disease, though it is more common among people with diabetes.
Your doctor can tell if you have coronary artery disease by:
- Talking to you about your symptoms, medical history, and risk factors.
- Performing a physical exam.
- Performing diagnostic tests, including an electrocardiogram (ECG or EKG), exercisestress tests, electron beam (ultrafast) CT scans, cardiac catheterization, and others. These tests help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart and the best form of treatment for you.
Treatment for coronary artery disease involves reducing your risk factors, taking medications, possibly undergoing invasive and/or surgical procedures, and seeing your doctor for regular health care follow up visits.
- Reduce your risk factors. This involves making lifestyle changes. If you smoke, you should quit. Your diet will likely need modifying to reduce your cholesterol, keep your blood pressure in check, and keep blood sugar in control if you have diabetes. Low fat, low salt, and low cholesterol foods are recommended. You should also get more exercise to help maintain a healthy weight and . But, check with your doctor before starting an exercise program.
- Medications. If making lifestyle changes isn't enough to control your heart disease, medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The drugs you are on depend on you and your specific heart problem.
- Surgery and other procedures. Common procedures to treat coronary artery disease include balloon angioplasty (PTCA), stent placement, and coronary artery bypass surgery. All of these procedures increase blood supply to your heart, but they do not cure coronary heart disease. You will still need to decrease your risk factors to prevent future disease.
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