Coronary artery disease
- Article
- 2021-02-04
Also known as coronary artery disease, coronary microvascular disease, coronary syndrome X, ischemic heart disease, non-obstructive coronary artery disease, obstructive coronary artery disease
Heart disease is a collective term for a variety of conditions that affect the structure and function of the heart. Coronary artery disease is a type of heart disease that results when the arteries of the heart cannot deliver enough oxygenated blood to the heart. It is the leading cause of death in the United States.
Coronary artery disease is often caused by the build-up of plaque, a waxy substance, in the lining of larger coronary arteries. This build-up can partially or completely block blood flow in the great arteries of the heart. Some types of this condition can be caused by a disease or injury that affects how the arteries in the heart work. Coronary microvascular disease is another type of coronary artery disease. It occurs when the heart's small blood vessels don't work normally.
Symptoms of coronary artery disease can vary from person to person, even if they have the same type of coronary artery disease. However, because many people don't have symptoms, they don't know they have coronary artery disease until they have chest pain, a heart attack, or sudden cardiac arrest.
If you have coronary artery disease, your doctor will recommend heart-healthy lifestyle changes, medications, surgery, or a combination of these approaches to treat your condition and prevent complications.
Symptoms
An acute coronary event, such as a heart attack, can cause the following symptoms:
- Angina, which can feel like pressure, squeezing, burning, or tightness during physical activity. The pain or discomfort usually starts behind the sternum, but can also occur in the arms, shoulders, jaw, throat, or back. The pain can feel like indigestion.
- Cold sweats
- Dizziness
- Light-headedness
- Nausea or a feeling of indigestion
- Neck pain
- Shortness of breath, especially with activity
- Sleep disturbances
- Weakness
Women are slightly less likely to have chest pain than men. Instead, they are more likely to:
- Dizziness
- Fatigue
- Nausea
- Pressure or tightness in the chest
- Stomach ache
Women are also more likely than men to have no symptoms of coronary artery disease.
Chronic (long-term) coronary artery disease can cause the following symptoms:
- Angina
- Shortness of breath with physical activity
- Fatigue
- Neck pain
Symptoms can get worse as plaque buildup continues to narrow the coronary arteries. Chest pain or discomfort that does not go away or occurs more often or while you are resting could be a sign of a heart attack. If you don't know if your chest pain is angina or a heart attack, call 9-1-1 immediately. All chest pain should be monitored by a doctor.
Therapy
Your treatment plan will depend on how severe your illness is, the severity of your symptoms, and any other health problems you have. Possible treatments for coronary heart disease include heart-healthy lifestyle changes, medications, or procedures such as coronary artery bypass transplantation or percutaneous coronary intervention.
Your doctor will consider your 10-year risk assessment when deciding how best to treat your coronary artery disease.
Heart-healthy lifestyle changes
Your doctor may recommend that you make lifelong heart-healthy lifestyle changes, including:
- Strive for a healthy weight. Losing only 3% to 5% of your current weight can help control certain risk factors for coronary heart disease, such as high blood cholesterol and diabetes. Larger amounts of weight loss can also improve blood pressure readings.
- Being physically active. Routine exercise can help control risk factors for coronary heart disease, such as high blood cholesterol, high blood pressure, or being overweight and obese. Before starting an exercise program, ask your doctor what level of physical activity is right for you.
- Heart-healthy eating, diet plan (Dietary Approaches to Stop Hypertension). A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, trans fats , sodium (salt), added sugars and alcohol.
- Deal with stress. Learning to manage stress, relax, and deal with problems can improve your emotional and physical health.
- Quit smoking. Visit Smoking and Your Heart and Your Guide to a Healthy Heart from the National Heart, Lung and Blood Institute. While these resources focus on heart health, they provide basic information about how to quit smoking. For free help and support in quitting smoking, call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Talk to your doctor if you are vaping. There is scientific evidence that nicotine and flavorings found in vape products can damage your heart and lungs.
- Get plenty of good quality sleep. The recommended amount for adults is 7 to 9 hours of sleep per day.
Medicines
Your doctor may recommend medications to control your risk factors or to treat underlying causes of coronary artery disease. Some medicines can reduce or prevent chest pain and treat other medical conditions that may be contributing to your coronary artery disease.
- ACE inhibitors and beta blockers to help lower blood pressure and reduce the workload on the heart.
- Calcium channel blockers to lower blood pressure by relaxing blood vessels.
- Medicines to control blood sugar, such as empagliflozin, canagliflozin, and liraglutide, to reduce the risk of complications if you have coronary artery disease and diabetes.
- Metformin to control plaque buildup if you have diabetes.
- Nitrates, such as nitroglycerin, to widen your coronary arteries and relieve or prevent chest pain from angina pectoris.
- Ranolazine for the treatment of coronary microvascular disease and the chest pain it can cause.
- Statins and / or non-statin therapies to control high blood cholesterol. Your doctor may recommend statin therapy if you have a higher risk of coronary artery disease or stroke or if you have diabetes and are between the ages of 40 and 75. Non-statin therapies can be used to lower cholesterol if statins do not lower or cause cholesterol enough. side effects. Your doctor may prescribe non-statin drugs, such as ezetimibe, bile acid sequestrants, alirocumab or evolocumab to lower cholesterol or omega-3 fatty acids, gemfibrozil or fenofibrate to reduce triglycerides.
Procedures
You may need surgery or heart surgery to treat more advanced coronary artery disease.
- Percutaneous coronary intervention (PCI) to open coronary arteries that are narrowed or blocked by atherosclerotic plaque build-up. A small mesh tube called a stent is usually implanted after PCI to prevent the artery from narrowing again.
- Coronary artery bypass transplant (CABG) to improve blood flow to the heart by using normal chest wall arteries and leg veins to bypass blocked arteries. Surgeons typically use CABG to treat people with severe obstructive coronary artery disease in multiple coronary arteries.
- Transmyocardial laser revascularization or coronary endarterectomy is the treatment of severe angina associated with coronary heart disease when other treatments are too risky or have not worked.
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