Coronary artery disease

Overview

Coronary artery disease (CAD) is a condition in which the arteries that supply the heart (coronary arteries) become narrowed or blocked by fatty plaques, resulting in inadequate blood and oxygen flow to the heart muscle. It is the leading cause of death in our country and worldwide.

Atherosclerosis (hardening of the arteries) in the artery wall progresses slowly. When the plaque ruptures or a clot forms, it can lead to a heart attack.

Symptoms

In early stages there may be no symptoms. As arteries narrow enough, symptoms appear:

• Angina pectoris: Chest pain, pressure, or tightness with exertion
• Pain radiating to the arm, shoulder, jaw, back
• Shortness of breath (especially with exertion)
• Extreme fatigue
• Palpitations, irregular heartbeat
• Cold sweat
• Nausea
• Dizziness

Different symptoms in women:

• Classic chest pain may be absent
• Back or jaw pain
• Extreme fatigue
• Digestive complaints
• Shortness of breath as the only symptom

Heart attack (emergency):

• Chest pain lasting more than 15-20 minutes
• Not relieved by rest
• Accompanied by cold sweat, nausea

Causes

The atherosclerosis process:

1. The inner artery surface (endothelium) is damaged
2. LDL cholesterol accumulates in the artery wall
3. Inflammation begins
4. Plaque forms
5. Plaque grows, narrowing the artery
6. If plaque ruptures, a clot forms and blocks the artery

Risk Factors

Non-modifiable:

• Age (men 45+, women 55+)
• Sex (more common in men)
• Family history (especially early-onset)
• Ethnicity

Modifiable:

• Smoking (most important)
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Diabetes
• Obesity, especially abdominal
• Sedentary lifestyle
• Stress
• Unhealthy diet
• Excessive alcohol
• Sleep apnea
• Chronic kidney disease

Complications

• Heart attack (myocardial infarction)
• Heart failure
• Arrhythmia (especially ventricular fibrillation)
• Sudden cardiac death
• Stroke

When to See a Doctor

Emergency:

• Severe chest pain (over 15 min)
• Radiating pain (arm, jaw, back)
• Cold sweat, nausea
• Shortness of breath
• Fainting

Scheduled:

• Chest pain, shortness of breath with exertion
• Increased fatigue
• Palpitations, irregular heartbeat
• Individuals over 40, in risk groups, not yet examined
• Family history of early heart disease

Diagnosis and Treatment

Diagnosis:

• ECG (rest and stress)
• Echocardiography
• Stress test or stress echocardiography
• Myocardial perfusion scintigraphy
• Coronary CT angiography
• Coronary angiography (gold standard)
• Blood tests: Lipid profile, troponin, BNP, HbA1c

Treatment:

1. Lifestyle changes (for every patient):

• Quit smoking
• Healthy eating
• Regular exercise
• Weight loss
• Stress management

2. Medication:

• Antiplatelet: Aspirin, clopidogrel (prevent clots)
• Statin: Lowers cholesterol, stabilizes plaques (atorvastatin, rosuvastatin)
• Beta blockers: Reduce heart workload
• ACE inhibitors / ARBs: Vascular protective
• Nitrates: For angina (nitroglycerin)
• Calcium channel blockers

3. Interventional treatments:

• Percutaneous coronary intervention (PCI / Stent): Vessel dilation and metal/drug-eluting stent placement during angiography
• Bypass surgery (CABG): Creating an alternate blood pathway around the blocked vessel — in multivessel disease

4. Cardiac rehabilitation:

• Supervised exercise program
• Education
• Psychological support

Prevention

Healthy nutrition:

• Mediterranean-style diet
• Plenty of vegetables, fruits
• Whole grains
• Fish (twice a week)
• Olive oil, nuts
• Less red meat, processed meat
• Less salt, less sugar
• Avoid saturated and trans fats

Exercise:

• At least 150 minutes of moderate aerobic activity per week
• Or 75 minutes of high-intensity
• 2 days of strength training per week

Other measures:

• Quit smoking (most important)
• Maintain a healthy weight (waist: men <94 cm, women <80 cm)
• Keep blood pressure under control (<130/80)
• Keep cholesterol under control (LDL <100 or <70 depending on target)
• Manage diabetes
• Limit alcohol
• Manage stress
• Get enough sleep (7-8 hours)
• Regular health check-ups (yearly over age 40)
• Have your risk calculated
• Get screened early if you have a family history