Coronary Artery Disease

Coronary artery disease (CAD), also called coronary heart disease or ischemic heart disease, is the most common type of heart disease. It occurs when the coronary arteries—the blood vessels that supply oxygen-rich blood to the heart muscle—become narrowed or blocked by a buildup of plaque (atherosclerosis).

When the coronary arteries are narrowed or blocked, the heart muscle doesn't get enough blood and oxygen, which can cause chest pain (angina) or lead to a heart attack. Coronary artery disease is the leading cause of death worldwide, but it can often be prevented and treated.

Coronary artery disease may develop slowly over many years. Some people have no symptoms until they experience a heart attack. When symptoms do occur, they may include:

Common Symptoms:

• Chest pain (angina): Pressure, tightness, or squeezing in the chest
• Shortness of breath: Especially with exertion
• Fatigue: Feeling unusually tired
• Heart attack symptoms: Severe chest pain, pain in arm or jaw, shortness of breath, nausea, sweating

Angina Types:

• Stable angina: Predictable chest pain with exertion, relieved by rest
• Unstable angina: Chest pain at rest or with minimal exertion
• Variant angina: Caused by coronary artery spasm

Call Emergency Services (112 in Sweden) immediately if you have:

• Severe chest pain or pressure
• Pain radiating to arm, neck, jaw, or back
• Shortness of breath
• Nausea, vomiting, or dizziness
• Sweating
• Rapid or irregular heartbeat

These could indicate a heart attack requiring emergency treatment.

Lifestyle changes are crucial for managing coronary artery disease:

1. Heart-Healthy Diet:

   • Limit saturated and trans fats
   • Increase fruits, vegetables, and whole grains
   • Choose lean proteins
   • Limit sodium
   • Control portion sizes

2. Regular Exercise:

   • As approved by your doctor
   • Aim for 150 minutes of moderate activity per week
   • Start slowly and build gradually
   • Stop if you experience chest pain

3. Quit Smoking:

   • Smoking damages blood vessels
   • Increases risk of heart attack
   • Get support to quit

4. Manage Stress:

   • Practice relaxation techniques
   • Get adequate sleep
   • Find healthy coping mechanisms

5. Take Medications as Prescribed:

   • Don't skip doses
   • Don't stop without doctor's approval
   • Report side effects
   • Keep list of all medications

6. Monitor Symptoms:

   • Track chest pain episodes
   • Note what triggers symptoms
   • Keep symptom diary

• Severe chest pain or pressure
• Chest pain with shortness of breath
• Pain radiating to arm, neck, or jaw
• Suspected heart attack
• Unstable angina (new or worsening)

• New or worsening chest pain
• Chest pain with exertion
• Questions about medications
• Need to adjust treatment plan
• Concerns about symptoms

• Stable symptoms
• Following treatment plan
• Regular follow-up appointments scheduled
• No new or worsening symptoms

Diagnosing coronary artery disease involves:

1. Medical History and Physical Exam:

   • Assessment of symptoms
   • Risk factor evaluation
   • Family history
   • Physical examination

2. Electrocardiogram (ECG/EKG):

   • Records heart's electrical activity
   • Can show signs of heart attack or damage
   • Detects rhythm problems

3. Stress Test:

   • Exercise or medication stress
   • Monitors heart during activity
   • Shows how heart responds to stress

4. Echocardiogram:

   • Ultrasound of heart
   • Shows heart function
   • Detects areas of poor blood flow

5. Blood Tests:

   • Cholesterol levels
   • Cardiac enzymes (if heart attack suspected)
   • Blood sugar
   • Other markers

6. Coronary Angiography:

   • Invasive test using contrast dye
   • Shows blockages in coronary arteries
   • May be combined with treatment (angioplasty)

7. CT or MRI:

   • Non-invasive imaging
   • Can show coronary artery calcification
   • Assesses heart structure

Treatment aims to reduce symptoms, prevent complications, and improve quality of life:

1. Lifestyle Changes: Foundation of treatment

   • Heart-healthy diet
   • Regular exercise
   • Quit smoking
   • Weight management
   • Stress management

2. Medications:

   • Cholesterol-lowering drugs: Statins to reduce plaque buildup
   • Aspirin: Reduces blood clot risk
   • Beta-blockers: Lower heart rate and blood pressure
   • ACE inhibitors or ARBs: Help heart work more efficiently
   • Nitroglycerin: Relieves chest pain
   • Other medications as needed

3. Procedures (if needed):

   • Angioplasty and stenting: Opens blocked arteries
   • Coronary artery bypass surgery: Creates new routes for blood flow

4. Cardiac Rehabilitation:

   • Supervised exercise program
   • Education and support
   • Lifestyle counseling

5. Regular Monitoring:

   • Follow-up appointments
   • Medication adjustments
   • Symptom monitoring

Prevent coronary artery disease by:

• Don't Smoke: Or quit if you do
• Control Blood Pressure: Take medications as prescribed
• Manage Cholesterol: Through diet and medications
• Control Diabetes: Keep blood sugar controlled
• Maintain Healthy Weight: BMI 18.5-24.9
• Exercise Regularly: At least 150 minutes per week
• Eat Heart-Healthy Diet:
  • Limit saturated and trans fats
  • Increase fruits and vegetables
  • Choose whole grains
  • Limit sodium
• Manage Stress: Find healthy coping mechanisms
• Get Regular Check-ups: Early detection and treatment
• Limit Alcohol: Moderate consumption only

Coronary artery disease develops when:

1. Plaque Buildup: Cholesterol and other substances accumulate in artery walls
2. Atherosclerosis: Arteries become narrowed and stiff
3. Reduced Blood Flow: Less oxygen-rich blood reaches heart muscle
4. Angina: Chest pain when heart needs more oxygen
5. Heart Attack: Complete blockage causes heart muscle damage

Risk Factors:

• High cholesterol
• High blood pressure
• Diabetes
• Smoking
• Family history
• Age (risk increases with age)
• Sedentary lifestyle
• Obesity
• Stress

• More common with age
• May have multiple risk factors
• May need careful medication management
• Higher risk of complications
• May have atypical symptoms

• Most common age for diagnosis
• Lifestyle factors very important
• Early intervention crucial
• May have family history

• Diabetes significantly increases risk
• High blood pressure increases risk
• Managing these conditions is crucial
• May need coordination of multiple treatments

While you can't completely reverse it, lifestyle changes and medications can slow or stop progression, and in some cases, improve blood flow. Early intervention is key.

Angina is chest pain from reduced blood flow that typically resolves with rest or medication. A heart attack involves complete blockage and permanent damage to heart muscle.

Not everyone needs surgery. Many people manage CAD with medications and lifestyle changes. Surgery is considered when medications aren't sufficient or for severe blockages.

Yes, but it depends on your condition. Your doctor will recommend appropriate exercise. Cardiac rehabilitation programs provide supervised exercise that's safe and beneficial.

Control risk factors: don't smoke, maintain healthy weight, exercise regularly, eat heart-healthy diet, manage blood pressure and cholesterol, and get regular check-ups.