Coronary Artery Disease (CAD)

Coronary artery disease can be attributed to a range of risk factors. These include non-modifiable risk factors such as age, gender, ethnicity and family history of heart disease.

Non-modifiable risk factors:

• Increased age. This is because arteries are more likely to be damaged or narrow as you get older
• Gender. While men face an overall higher risk of developing coronary artery disease, the risk for women increases significantly after menopause.
• Family history. If a close family member developed heart disease, especially at a young age, you face a higher risk of developing it too.
• Ethnicity. Statistics suggest that people of South Asian, African or Caribbean descent have a greater risk of developing cardiovascular disease.

Modifiable risk factors:

• Diabetes. High blood sugar can damage blood vessels of your heart. People with diabetes are also more likely to have other conditions that increase the risk for heart disease.
• High blood pressure. This can cause your arteries to thicken or harden, which narrows the arteries and reduces blood flow.
• High cholesterol. This can increase the risk of plaque formation and atherosclerosis.
• Obesity. Excessive body weight worsens the effect of other risk factors.
• Sedentary lifestyle or lack of exercise contributes coronary artery disease as well as several of its risk factors such as obesity.
• Smoking. The nicotine in cigarettes reduces the oxygen to your heart, increases your heart rate, and harms the inside of your blood vessels. People who smoke are 2 – 4 times more likely to get heart disease.
• Stress, if poorly managed, may damage your arteries and worsen the effect of other risk factors.

Unhealthy eating habits. A diet high in saturated fat, trans fats, salt and sugar increases the risk of developing coronary artery disease and contributes to risk factors such as obesity.

A common symptom of coronary artery disease is chest pain, also known as angina. Angina occurs when the heart muscle needs more blood that it is getting, for example, during any exercise or stressful situation. As coronary arteries become severely narrowed, it may allow just sufficient blood to reach the heart muscle at rest, but with physical exertion, the heart has to work harder and needs more oxygen. During this physical exertion, the demand for oxygen becomes greater than the supply of the oxygen, due to the narrowing of the coronary arteries.

Angina pain can manifest as tightness, heaviness of pressure in your chest. It may also involve an aching, burning or numb sensation. These sensations may radiate from the chest to your arms and fingers, or to your back, shoulders, neck or jaw. Other symptoms include:

• a general feeling of pressure or heaviness,
• sweating
• shortness of breath
• weakness
• dizziness
• nausea
• palpitations or rapid heartbeat

Some people may not experience any symptoms until they are on the verge of a serious cardiac event, such as a heart attack or heart failure. This is known as silent heart attack.

Women, older patients, and patients with diabetes may experience symptoms of coronary artery disease differently from men, and that their symptoms are less likely to be identified as being heart-related.

The common symptoms of coronary artery disease in women are:

• pain or pressure that travels to the arm or jaw
• burning sensation in the chest or upper abdomen
• shortness of breath
• irregular heartbeat
• dizziness
• fatigue
• nausea

To diagnose coronary artery disease, your doctor will need to ask about your family and medical history, and determine your risk factors such as smoking, dietary habits and physical activity. Several tests may also be recommended, which include:

• blood tests to check levels of cholesterol, triglycerides, sugar and other risk factors of coronary artery disease
• electrocardiogram (ECG)
• coronary calcium scan to measure the build-up of calcium in the walls of coronary arteries
• CT coronary angiogram. This is a non-invasive imaging test that looks at the coronary arteries that supply blood to your heart.
• exercise stress test, which involves running or walking on a treadmill, to determine how well your heart responds during exertion
• cardiac magnetic resonance imaging (cardiac MRI) produces detailed images of the beating heart. It allows the doctors to study the structure and function of the heart muscle, determine the cause of a patient’s poor heart function, or identify tissue damage from a heart attack.
• coronary angiography. This is an invasive procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.

Treatment for coronary artery disease will vary based on the severity of your condition and associated risk factors. You may be recommended one or more of the following:

Lifestyle changes to improve your heart health. These include:

• Getting regular exercise
• Maintaining a healthy body weight
• Consuming a healthy, balanced diet
• Quit smoking

Medication to help control blood pressure, cholesterol and diabetes. These include:

• Beta-blockers to reduce blood pressure and heart rate
• Angiotensin-converting enzyme inhibitors to reduce blood pressure
• Calcium channel blockers to reduce blood pressure and relieve angina
• Statins to reduce total cholesterol and LDL (bad cholesterol)
• Aspirin may be recommended for those at risk of heart attack

Surgery to improve coronary blood flow for those with severe cases of coronary artery disease. This may be recommended if lifestyle changes and medication are unable to improve symptoms and may include procedures such as:

• Coronary artery bypass surgery (CABG) is an open-heart surgery where an alternate route is created that goes around the blocked portion of the coronary artery. This involves using a blood vessel that comes from another part of the body.
• Coronary angioplasty. This is a procedure that opens narrowed or blocked coronary arteries. In this procedure, the doctor will widen your blocked artery with a balloon (balloon angioplasty). In many patients, a collapsed wire mesh tube (stent) mounted on a special balloon catheter is then moved and positioned over the blocked area. As the balloon is inflated, it opens the stent against the artery walls. The stent is placed in this position permanently and helps to keep the artery open.

Consult a cardiologist to determine the treatment method most suitable for your condition.

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There are many complications linked with coronary artery diseases including:

• Arrhythmia (irregular heart beats)
• Heart attack
• Heart failure

Other complications are linked with the bypass surgery which increase with age. You need to discuss these risks with your doctor:

• New blockages in the bypassed arteries
• Risk of infection or bleeding
• Risk of stroke, during and after the operation
• Risks linked with general anaesthesia