Coronary Artery Disease
Coronary artery disease results of plaque buildup in the coronary arteries, a condition called atherosclerosis that leads to blockages. The arteries, which start out smooth and elastic, become narrow and rigid, restricting blood flow to the heart. The heart becomes starved of oxygen and the vital nutrients it needs to pump properly.
What Is Ischemia?
Cardiac ischemia occurs when plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to meet the heart’s needs.
Heart attacks can occur with or without chest pain and other symptoms.
Ischemia is most commonly experienced during:
- Exercise or exertion
- Excitement or stress
- Exposure to cold
Coronary artery disease can progress to a point where ischemia occurs even at rest. And ischemia can occur without any warning signs in anyone with heart disease, although it is more common in people with diabetes.
How Does Coronary Artery Disease Develop?
From a young age, cholesterol-laden plaque can start to deposit in the blood vessel walls. As we get older, the plaque burden builds up, inflaming the blood vessel walls and raising the risk of blood clots and heart attack. 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 some cases, a blood clot may totally block the blood supply to the heart muscle, causing heart attack. If a blood vessel to the brain is blocked, usually from a blood clot, an ischemic stroke can result. If a blood vessel within the brain bursts, most likely as a result of uncontrolled hypertension (high blood pressure), a hemorrhagic stroke can result.
What Are the Symptoms of Coronary Artery Disease?
The most common symptom of coronary artery disease is angina or chest pain. Angina can be described as a 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 the chest)
- A faster heartbeat
- Weaknessor dizziness
How do we prevent Coronary Artery Disease?
Multifactorial risk factor modification and control, especially interventions designed to reduce total cholesterol, systolic blood pressure, smoking prevalence, overweight/obesity, diabetes mellitus, and physical inactivity, can have a profound and favorable impact on decreasing the incidence of initial and recurrent cardiovascular events.
Psychological risk factors such as depressive symptoms, anxiety, and vital exhaustion may worsen or exacerbate the development of CAD through associated unhealthy behaviors and physiological responses that may lead to clinical consequences, including myocardial ischemia, threatening ventricular arrhythmias, vulnerable plaque, and increased thrombosis potential and inflammation.
Patients with clinical depression are at least 3 times more likely to die during the first year after AMI than are patients without depression.
Prevention can be divided into 3 types:
- Primordial (prevention of risk factors)
- Primary (treatment of risk factors)
- Secondary (prevention of recurrent cardiovascular events)
Much of the success in reducing CAD in recent years has been through the latter 2 methods; however, additional emphasis on primordial prevention is needed going forwards.
Importance of Diet:
Dietary intervention is a key component of primordial prevention of dyslipidemia. Reduced intake of saturated fat and cholesterol in the diet has been shown in numerous studies to be associated with lower total and low-density lipoprotein cholesterol. Overall control of calories and restriction of added sugar also are important in the prevention of hypertriglyceridemia.