What is coronary artery disease ?
Coronary artery disease is the narrowing or blockage of the coronary arteries , usually caused by atherosclerosis. Atherosclerosis ( sometimes called "hardening" or " fouling " of the arteries) is the accumulation of cholesterol and fatty deposits ( called plaques ) on the inner walls of arteries. These plaques can restrict blood flow to the heart muscle by blocking the physically or by causing your artery and abnormal artery function .
Without adequate blood supply , the heart becomes starved of oxygen and essential nutrients it needs to function properly. This can cause chest pain called angina . If the blood supply to part of the heart muscle is completely cut off , or if the energy demand of the heart become much larger than its blood supply , heart attack ( damage to the heart muscle) may occur.
What causes the coronary arteries to narrow ?
Your coronary arteries are hollow tubes through which blood can flow freely . The muscular walls of the coronary arteries are normally smooth and elastic and are covered with a layer of cells called the endothelium. The endothelium provides a physical barrier between the blood and the walls of the coronary arteries , while the regulation of the function of the artery by releasing chemical signals in response to various stimuli .
Coronary artery disease begins when you are very young. Before your teen years , the walls of blood vessels begin to show streaks of fat. As you get older , the fat accumulates , causing a minor injury to your blood vessel walls . Other substances that pass through the blood, such as inflammatory cells, cellular waste products , calcium and proteins begin to stick to the vessel walls. The grease and other substances are combined to form a material called plate .
Over time, the arteries expand plates of different sizes. Many of the plaque deposits are soft inside with a "plug" hard fibrous covering the outside. If cracks or tears hard surfaces , soft, fatty inside is exposed. Platelets ( disc shaped particles in the blood coagulation aid ) from the region , and blood clots are formed around the plate . The endothelium can also become irritated and does not work properly, which causes the muscle to tighten artery at inopportune times . This causes the artery to narrow even more .
Sometimes the blood clot breaks, and the blood supply is restored. In other cases , the blood clot ( coronary thrombus) may suddenly block the blood supply to the heart muscle ( coronary occlusion) , causing one of three serious conditions known as acute coronary syndromes
What are the acute coronary syndromes ?
Unstable angina : This may be a new symptom or a change of stable angina . The angina may occur more frequently , occur more easily at rest , feel more severe or last longer. Although this can often be relieved by oral medications, it is unstable and can lead to a heart attack. Usually more intense medical treatment or procedure is necessary to treat unstable angina.
Non -ST-elevation myocardial infarction segment : This type of heart attack, or MI , does not cause major changes on an electrocardiogram (ECG) . However , chemical markers in the blood indicate that damage has occurred to the heart muscle . In NSTEMI , the blockage may be partial or temporary , such that the extent of the damage is usually relatively small.
ST-segment elevation myocardial infarction : This type of heart attack, or MI , is caused by a prolonged period of blocked blood supply period . It affects a large area of the heart muscle , resulting in changes of the ECG as well as levels of blood chemical markers key .
Although some people have symptoms that indicate they may soon develop acute coronary syndrome , some may have no symptoms until something happens , and still others have no symptoms of coronary syndrome acute at all.
All acute coronary syndromes require assessment and emergency treatment.
What is ischemia ?
Ischemia is a condition described as " heart muscle cramps . " Occurs when the ischemia narrowed coronary artery reached a point where it can not supply enough oxygen-rich blood to meet the needs of the heart . Cardiac muscle becomes" starved " for oxygen.
Ischemia of the heart can be compared with a cramp in the leg . When someone exercises for a very long time , the leg muscles contract because they are starved for oxygen and nutrients. Your heart is also a muscle, needs oxygen and nutrients to keep working. If the blood supply to the heart muscle is insufficient to meet its needs , ischemia occurs, and you may feel chest pain or other symptoms .
Ischemia is most likely to occur when the heart demands extra oxygen . This is more common during exercise (activity) , food, excitement or stress, or exposure to cold .
When ischemia is relieved in less than 10 minutes with rest or medications you may be told that you have " stable disease coronary artery " or " stable angina . " Coronary artery disease may progress to a point where ischemia occurs even at rest.
Ischemia, and even a heart attack can occur without warning signs and is called "silent" ischemia. Silent ischemia can occur in all people with heart disease , although it is more common in people with diabetes.
What are the symptoms of coronary artery disease ?
The most common symptom of coronary artery disease is angina ( also known as angina ) . Angina is often referred to as chest pain. It is also described as chest discomfort , heaviness, tightness , pressure , aching , burning , numbness , fullness , or compression. 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 time or a feeling of " flip - flop " in the chest)
• A rapid heartbeat
• Dizziness
• Nausea
• The extreme weakness
• sweating
If you experience any of these symptoms, it is important to call your doctor, especially if they are new symptoms or if they become more frequent or severe .
If any of these symptoms occur, it is important to get medical help right away - call 108 or have someone take you to the nearest emergency room.
What should you do if you have symptoms :
• If you or someone you are with has chest, left or back pain that lasts more than 5 minutes, with one or more of the symptoms listed above arm , call 108 to get emergency aid . DO NOT WAIT ! Prompt treatment of a heart attack is very important to reduce the amount of damage to your heart.
• Aspirin : After calling 108 , emergency personnel may tell you to chew one full turn ( 325 mg) aspirin slowly, so you do not have a history of allergy to aspirin or bleeding active . Aspirin is especially effective if taken within 30 minutes after the onset of symptoms . Do not take aspirin for symptoms of a stroke.
• If your symptoms go away completely in 5 minutes, always call your doctor to report your symptoms.
• Call your doctor if this is the first time you have experienced these symptoms so you can be evaluated.
• Learn to recognize your symptoms and the situations that cause them.
• Call your doctor if you have new symptoms or if they become more frequent or severe.
How is coronary heart disease diagnosed?
Your doctor diagnosed coronary artery disease by talking about your symptoms, review your medical history and risk factors, and perform a physical exam.
Diagnostic tests , including blood tests, an electrocardiogram (ECG), stress tests or cardiac catheterization may be necessary to properly diagnose and treat coronary artery disease . These tests allow your doctor to assess the extent of your coronary artery disease , its effect on the functioning of your heart, and the best form of treatment for you.
Research on new test procedures as CT coronary angiography (CTA ) can change the way coronary artery disease is diagnosed in the future.
Procedures to treat coronary artery disease
1.Interventional procedures(PTCA)
Common interventional procedures to treat coronary artery disease include balloon angioplasty ( PTCA) and stent or stent drug eluting . These procedures are considered non-surgical , because they are made by a cardiologist ( heart doctor ), which accesses the heart with a long, thin tube (catheter) that is inserted into a blood vessel, rather by a surgeon through an incision . Several types of balls and / or catheters are available for treating plaque buildup within the vessel wall . If you need an interventional treatment, your doctor will determine which type is best for you based on your individual needs.
2.Coronary artery bypass graft (CABG )
One or more blocked coronary arteries are bypassed by a blood transplant to restore normal blood flow to the heart vessel. These grafts are usually from own arteries and veins located in the patient's chest, arm or leg. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood flow to the heart .
When these traditional treatments are not options for you, doctors may suggest other less traditional treatments, such as the strengthening of external counterpulsation ( EECP ) .
Enhanced external counterpulsation ( EECP )
For patients who have persistent symptoms of angina and have exhausted standard treatments without positive results, EECP may stimulate the openings or formation of small branches of blood vessels ( collaterals ) to create a natural bypass around narrowed or blocked arteries. EECP is a noninvasive for people who have angina chronic stable treatment ; who do not receive adequate relief of angina taking nitrate-based drugs ; and who are not eligible for a procedure such as bypass surgery , angioplasty or stenting .
Important Note:
These procedures increase the blood supply to the heart, but they do not cure coronary artery disease. You will still need to reduce the risk factors by making lifestyle changes , taking prescribed medications and following the recommendations of your doctor to reduce the risk of future disease development .
Follow-up care
Your cardiologist will want to see you on a regular basis for a physical examination and may perform diagnostic tests. Your doctor will use the information obtained from these visits to monitor the progress of your treatment. Check with your cardiologist to know when to schedule your next appointment .
Coronary artery disease is the narrowing or blockage of the coronary arteries , usually caused by atherosclerosis. Atherosclerosis ( sometimes called "hardening" or " fouling " of the arteries) is the accumulation of cholesterol and fatty deposits ( called plaques ) on the inner walls of arteries. These plaques can restrict blood flow to the heart muscle by blocking the physically or by causing your artery and abnormal artery function .
Without adequate blood supply , the heart becomes starved of oxygen and essential nutrients it needs to function properly. This can cause chest pain called angina . If the blood supply to part of the heart muscle is completely cut off , or if the energy demand of the heart become much larger than its blood supply , heart attack ( damage to the heart muscle) may occur.
What causes the coronary arteries to narrow ?
Your coronary arteries are hollow tubes through which blood can flow freely . The muscular walls of the coronary arteries are normally smooth and elastic and are covered with a layer of cells called the endothelium. The endothelium provides a physical barrier between the blood and the walls of the coronary arteries , while the regulation of the function of the artery by releasing chemical signals in response to various stimuli .
Coronary artery disease begins when you are very young. Before your teen years , the walls of blood vessels begin to show streaks of fat. As you get older , the fat accumulates , causing a minor injury to your blood vessel walls . Other substances that pass through the blood, such as inflammatory cells, cellular waste products , calcium and proteins begin to stick to the vessel walls. The grease and other substances are combined to form a material called plate .
Over time, the arteries expand plates of different sizes. Many of the plaque deposits are soft inside with a "plug" hard fibrous covering the outside. If cracks or tears hard surfaces , soft, fatty inside is exposed. Platelets ( disc shaped particles in the blood coagulation aid ) from the region , and blood clots are formed around the plate . The endothelium can also become irritated and does not work properly, which causes the muscle to tighten artery at inopportune times . This causes the artery to narrow even more .
Sometimes the blood clot breaks, and the blood supply is restored. In other cases , the blood clot ( coronary thrombus) may suddenly block the blood supply to the heart muscle ( coronary occlusion) , causing one of three serious conditions known as acute coronary syndromes
What are the acute coronary syndromes ?
Unstable angina : This may be a new symptom or a change of stable angina . The angina may occur more frequently , occur more easily at rest , feel more severe or last longer. Although this can often be relieved by oral medications, it is unstable and can lead to a heart attack. Usually more intense medical treatment or procedure is necessary to treat unstable angina.
Non -ST-elevation myocardial infarction segment : This type of heart attack, or MI , does not cause major changes on an electrocardiogram (ECG) . However , chemical markers in the blood indicate that damage has occurred to the heart muscle . In NSTEMI , the blockage may be partial or temporary , such that the extent of the damage is usually relatively small.
ST-segment elevation myocardial infarction : This type of heart attack, or MI , is caused by a prolonged period of blocked blood supply period . It affects a large area of the heart muscle , resulting in changes of the ECG as well as levels of blood chemical markers key .
Although some people have symptoms that indicate they may soon develop acute coronary syndrome , some may have no symptoms until something happens , and still others have no symptoms of coronary syndrome acute at all.
All acute coronary syndromes require assessment and emergency treatment.
What is ischemia ?
Ischemia is a condition described as " heart muscle cramps . " Occurs when the ischemia narrowed coronary artery reached a point where it can not supply enough oxygen-rich blood to meet the needs of the heart . Cardiac muscle becomes" starved " for oxygen.
Ischemia of the heart can be compared with a cramp in the leg . When someone exercises for a very long time , the leg muscles contract because they are starved for oxygen and nutrients. Your heart is also a muscle, needs oxygen and nutrients to keep working. If the blood supply to the heart muscle is insufficient to meet its needs , ischemia occurs, and you may feel chest pain or other symptoms .
Ischemia is most likely to occur when the heart demands extra oxygen . This is more common during exercise (activity) , food, excitement or stress, or exposure to cold .
When ischemia is relieved in less than 10 minutes with rest or medications you may be told that you have " stable disease coronary artery " or " stable angina . " Coronary artery disease may progress to a point where ischemia occurs even at rest.
Ischemia, and even a heart attack can occur without warning signs and is called "silent" ischemia. Silent ischemia can occur in all people with heart disease , although it is more common in people with diabetes.
What are the symptoms of coronary artery disease ?
The most common symptom of coronary artery disease is angina ( also known as angina ) . Angina is often referred to as chest pain. It is also described as chest discomfort , heaviness, tightness , pressure , aching , burning , numbness , fullness , or compression. 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 time or a feeling of " flip - flop " in the chest)
• A rapid heartbeat
• Dizziness
• Nausea
• The extreme weakness
• sweating
If you experience any of these symptoms, it is important to call your doctor, especially if they are new symptoms or if they become more frequent or severe .
If any of these symptoms occur, it is important to get medical help right away - call 108 or have someone take you to the nearest emergency room.
What should you do if you have symptoms :
• If you or someone you are with has chest, left or back pain that lasts more than 5 minutes, with one or more of the symptoms listed above arm , call 108 to get emergency aid . DO NOT WAIT ! Prompt treatment of a heart attack is very important to reduce the amount of damage to your heart.
• Aspirin : After calling 108 , emergency personnel may tell you to chew one full turn ( 325 mg) aspirin slowly, so you do not have a history of allergy to aspirin or bleeding active . Aspirin is especially effective if taken within 30 minutes after the onset of symptoms . Do not take aspirin for symptoms of a stroke.
• If your symptoms go away completely in 5 minutes, always call your doctor to report your symptoms.
• Call your doctor if this is the first time you have experienced these symptoms so you can be evaluated.
• Learn to recognize your symptoms and the situations that cause them.
• Call your doctor if you have new symptoms or if they become more frequent or severe.
How is coronary heart disease diagnosed?
Your doctor diagnosed coronary artery disease by talking about your symptoms, review your medical history and risk factors, and perform a physical exam.
Diagnostic tests , including blood tests, an electrocardiogram (ECG), stress tests or cardiac catheterization may be necessary to properly diagnose and treat coronary artery disease . These tests allow your doctor to assess the extent of your coronary artery disease , its effect on the functioning of your heart, and the best form of treatment for you.
Research on new test procedures as CT coronary angiography (CTA ) can change the way coronary artery disease is diagnosed in the future.
Procedures to treat coronary artery disease
1.Interventional procedures(PTCA)
Common interventional procedures to treat coronary artery disease include balloon angioplasty ( PTCA) and stent or stent drug eluting . These procedures are considered non-surgical , because they are made by a cardiologist ( heart doctor ), which accesses the heart with a long, thin tube (catheter) that is inserted into a blood vessel, rather by a surgeon through an incision . Several types of balls and / or catheters are available for treating plaque buildup within the vessel wall . If you need an interventional treatment, your doctor will determine which type is best for you based on your individual needs.
2.Coronary artery bypass graft (CABG )
One or more blocked coronary arteries are bypassed by a blood transplant to restore normal blood flow to the heart vessel. These grafts are usually from own arteries and veins located in the patient's chest, arm or leg. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood flow to the heart .
When these traditional treatments are not options for you, doctors may suggest other less traditional treatments, such as the strengthening of external counterpulsation ( EECP ) .
Enhanced external counterpulsation ( EECP )
For patients who have persistent symptoms of angina and have exhausted standard treatments without positive results, EECP may stimulate the openings or formation of small branches of blood vessels ( collaterals ) to create a natural bypass around narrowed or blocked arteries. EECP is a noninvasive for people who have angina chronic stable treatment ; who do not receive adequate relief of angina taking nitrate-based drugs ; and who are not eligible for a procedure such as bypass surgery , angioplasty or stenting .
Important Note:
These procedures increase the blood supply to the heart, but they do not cure coronary artery disease. You will still need to reduce the risk factors by making lifestyle changes , taking prescribed medications and following the recommendations of your doctor to reduce the risk of future disease development .
Follow-up care
Your cardiologist will want to see you on a regular basis for a physical examination and may perform diagnostic tests. Your doctor will use the information obtained from these visits to monitor the progress of your treatment. Check with your cardiologist to know when to schedule your next appointment .