What is coronary artery disease?
Coronary Artery Disease (CAD) also termed as coronary heart disease. In the United States (US), it is considered to be a common sort of heart condition. One of the major sources of death for both men and women in the United States (US) is Coronary Heart Disease.
Yearly approximately 785,000 Americans suffer from a fresh CAD condition whereas approximately 470,000 have a repeat condition of CAD. In the United States (US), one individual is suffering from Coronary Artery Disease (CAD), every 25 seconds and every second one individual dies from Coronary Artery Disease (CAD). This condition is more often observed among men than women. It is seen that to develop the chance of CAD i.e. risk factors among men is 49% and women are 32% after the age of 40 years.
One of the major causes of death due to coronary artery diseases is among chronic kidney disease patients. 50% of the patients with End-Stage Renal Disease (ESRD), that need dialysis or kidney transplant in the US die from heart diseases. The very first indication of CAD (Coronary Heart Disease) is a heart attack.
The most important muscle on which the whole body relies is the heart muscle. Heart muscle like other muscles relies on the supply of blood that supplies with important nutrients and oxygen. The supply of blood to the heart is by the coronary arteries. So once the coronary arteries get clogged, becomes narrower or fully blocked the heart will not be supplied with its required nutrients and oxygen that is needed for survival. The arteries get narrowed due to the build-up of plaque (consists of cholesterol, fats, and calcium) in the arterial walls resulting in atherosclerosis (arteries get hardened). If the plaque separates, the blood clot will again develop rapidly in the artery resulting in myocardial infection (area of the heart muscle dies due to improper supply of blood by coronary artery disease), resulting in a heart attack.
This results in the heart to get weak, leads to a heart attack or completely stops working. “This blockage, narrowing or obstruction is known as Coronary Artery Disease.”
Risk of CAD among the Indians
The threat of CAD among the Indians is almost higher by 3 to 4 times as compared to the whites, and almost higher by 6 times as compared to the Chinese and almost higher by 20 times as compared to the Japanese.
It is observed that Coronary Artery disease occurs 5-20 years faster than other parts of the world. Other medical conditions like diabetes, Impaired Glucose Intolerance, abdominal obesity, and dyslipidemia are also wide-spread among the Indians.
Causes of Heart Disease
CAD results from a mix of genetic and environmental causes. These are also termed as “risk factors.”
The causes which cannot be controlled (uncontrollable) are:
Age: Increase in the risk, with an increase in age.
Gender: Above the age of 55 years, the risk of heart disease increases.
Once the women crossed menopause the risk of heart disease equals that of the men.
Heredity: If a nearby family member i.e. parents or brother or sister form disease of the heart before 55 years of age and in terms of relatives if the female, before menopause.
Ethnicity: African and Asian individuals are at a higher chance of getting any sort of heart condition.
Modifiable Factors or causes (These can be controlled by us)
- Smoking: Smoking causes the heart to be affected because it contains nicotine which leads to narrowing of the heart. The cigarettes release gas called carbon monoxide, which affects the arterial wall leading to fat build-up in the walls. Smoking also results in high LDL levels, Low HDL Levels, increases the rate of heart and blood pressure. There are also chances of a second attack if smoking continues after a heart attack or angioplasty. The advantages of stopping smoking could be seen with-in twenty minutes of the last smoking and chances of a heart attack, reduces by 50%. Support is very important while the process to quit smoke as it shows better results.
- Excess weight, majorly around the waist size. Body Mass Index (BMI) should be between the range of 18.5-22.9 kg/m2. Waist size for women below 88 cm and men below 102 cm. Individuals with fat around the abdomen resulting in an increased risk of heart illness and diabetes.
- High Blood Pressure levels should be ideally 120/80 mm Hg. Hypertension results in the hard becoming hard, affects the blood vessel functioning, plaque build-up increases. If hypertension is controlled it decreases the progress of heart illness and decreases the chances of stroke (decreased blood supply to the brain). Ways to manage it: maintain a healthy weight with proper BMI (kg/m2), being physically fit and active, avoid smoking, taking medications on time, follow a proper healthy nutrition diet related to your heart.
- Excess Cholesterol levels: Ideal Cholesterol levels should be: Total cholesterol: < 200 mg/dl, Triglyceride: <150 mg/dl, LDL: < 100 mg/dl, HDL: <50 mg/dl. As we know cholesterol is a wax-like product which is made in the liver and some of it is got from the food we eat. Different types of cholesterol are LDL and HDL. LDL Cholesterol takes the fat for future use to be stored in the body organs. It also results in a build-up of plaque or cholesterol on the arterial wall in the heart. This is considered to be “bad fats”, so this can be reduced by maintaining a healthy nutritious diet with lifestyle changes.
Cholesterol is which takes away the extra fat away from your body parts and eliminates or flushes it out. Higher the amounts of HDL, it is better to protect the heart from cholesterol and plaques. HDL can be increased by proper diet, quit smoking, physical activity, and overall lifestyle changes. This is considered to be “good fats.”Levels can be maintained by following a proper diet, including physical activity, maintaining a healthy body weight with proper BMI. Taking medications on time and reducing stress.
- Improper Physical Activity: Target for a minimum of approx. 30 to 60 minutes of exercise, majorly brisk walking on almost all days of the week.
- Diabetes or impaired blood sugar levels and Insulin Resistance: HbA1C: < 6.0%. Fasting Blood Sugars: 80-120 mg/dl and Post-Prandial: <140 mg/dl. In this condition, there is an uncontrolled increase the blood sugar levels that affect the circulatory system. This could affect the heart and damage it. Important ways to prevent blood sugars are to maintain a healthy and nutritious diet, attending diabetes educator program to learn about ways to manage diabetes, maintaining a proper blood sugar levels, work on physical activity and lifestyle changes, and take medication as prescribed by the doctors on time, Timely visits to the doctors as and when necessary.
- Metabolic Syndrome (Combination of number of medical illness)
- Increased stress levels: Manage stress by indulging in deep breathing, meditation or yoga.
- Depression
Signs of Coronary Artery Disease (CAD)
You could either have these signs/symptoms or no. If not then it is a silent CAD. It can be undetected until it results in heart attack, heart-beat being irregular or any other heart disease.
One of the main signs and symptoms of CAD is Angina i.e. Chest pain. In Angina, the blood supply to an area of the heart is appropriate, resulting in a lack of oxygen and nutrients. Pain or pressure is felt in the chest, jaw, shoulders or neck i.e. also termed angina. It will grow from one area to the other. There could also be a feeling of indigestion. Stress which is linked to emotions can also arise this pain.
- Feels tight, heavy, squeezing sort of feeling and burning sensations
- Sweating occurs
- Breathlessness (Dyspnoea)
- Vomiting or Nausea
- Pain in the Abdomen
- Dizziness, tiredness and faint sort of feeling
Diagnosis of Coronary Heart Disease:
This condition will be diagnosed by a Cardiologist. A cardiologist will study the factors, history of the family, symptoms, and cause in detecting CAD. Along with this, a cardiologist will also perform some of the diagnostic tests such as:
Stress Test: In this test, an exercise needs to be performed on the treadmill like jogging. This is done for the heartbeat to be increased. This shows whether the performance of the heart is good or no. This is along with “nuclear or echocardiographic imaging.”
Echocardiography: This utilizes the sound waves that make a heart image which depicts how efficiently it is working. This helps identify which parts of the heart are affected and having issues. It also helps find out if any harm to the heart.
Cardiac CT: When doing this angiogram, images taken are of the heart i.e. cross-sections and slices. This can go to the extent of even detecting the deposits of calcium in the coronary arteries.
Catheterization of the heart: This is a minor treatment that is invasive. This helps with the viewing of the coronary arteries and along with that helps the opening of the clogs with the help of a stent i.e. piece of a metal scaffold.
Chest X-Ray: To test for lungs, heart and blood vessels.
Electrocardiogram (EKG): This helps identify the symptoms for heart conditions, majorly because of CAD and symptoms of before and at present heart attack.
Blood Tests: To diagnose the values of fat, cholesterol, sugar along with proteins in the blood.
Various heart conditions occur due to Coronary Artery Disease (CAD)
Heart Attack: This occurs when the supply of blood and other nutrients does not reach a particular area of heart muscle causing death. This occurs when the plaque breaks down, the platelets latch to the injury site and come together to form a blood clot. If the size of the clot increases, it fully clogs the blood flow through coronary arteries. If this clogging is not taken care of, the area of the heart muscles which are provided nutrients and oxygen by the coronary artery starts to die.
Heart Failure: The body’s requirement to meet the nutrients may not be fulfilled as the heart is not able to provide enough blood. Heart failure does not mean death or heart not working. The signs and symptoms of heart failure result in breathlessness, tiredness, rapid gain in weight, swelling of the extremities and veins in the neck. This results due to the build-up of water in the body.
Arrhythmia: This is when the speed of the heartbeat is affected. In this, you see that heart is either beating too rapid or a beat is being skipped.
Treatment for Coronary Artery Disease
As such cure is not there for CAD, but the narrowing of the arteries can be slowed down. This can be done through diet, exercise, no smoking or alcohol and leading a healthy and active lifestyle. Apart from the health-care professionals may ask to take medicines, cardiac-related treatments or even rehabilitation to treat CAD.
- Medications recommended would be to reduce stress and decrease the symptoms related to CAD.
- The risk of heart issues can be decreased.
- Decrease issues such as heart problems/cholesterol and blood pressure.
- To prevent the formation of blood clots.
- There could be various medications used to treat CAD that includes anticoagulants (to prevent coagulation of the blood), aspirin (blood-thinner), calcium channel blockers, nitroglycerin, Beta Blockers, glycoprotein IIb-IIa, angiotensin-converting inhibitors, statins (to reduce cholesterol), fish oil or other omega-3 supplements as good for health.
Medical Treatments
There is a various medical procedure which is done such as:
Angioplasty: This method helps to “open” the clogged or narrowed arteries. A balloon is attached to the thin tube which is passed into the blood vessels till the time it reaches the clogged artery. The plaque which is attached to the artery wall is being pushed away by the balloon and this opens the artery wide. This increases the blood flow to the heart to decrease chest pain and decreases the risk of a heart attack.
CABG (Coronary Artery Bypass Graft): In this, the clogged artery is bypassed by creating a new way for arteries and veins to reach the heart i.e. to supply oxygen and nutrients to the body.
Rehabilitation
This is a new method which is a mix of medicines and surgery. This includes two categories:
Exercise Training: This helps cardiac patients with safe exercising, gaining strength of muscles, improving energy and stamina. This will help the heart to be active, more strength and healthy.
To educate, counsel and train: Education means will help the patients aware of certain things which they might be not aware or are curious to know related to the condition. This will also help you guide to formulate correct decisions for good health.
Counseling is done to help you overcome stress and treat lifestyle changes.
Healing Process
Various individuals suffer from a heart attack but once it is treated, they again lead a normal and happy life. The healing of the heart is happening and with each day an individual and his heart get active and strong. The healing duration post-heart attack depends on various reasons such as heart size and can stay from one to three months.
Top Healthy and Nutritious Suggestions
- Consume small frequent meals. This will help avoid long gaps between the meals and boost metabolism. Also, include a snack and mid-morning which is healthy.
- Include fruits and vegetables in your diet. At-least 5-6 servings per day. Include at-least 25-30 grams of fiber per day.
- Fresh food should be included. Cook food with a proper intake of salt.
- Choose healthy oils as much as possible.
- Avoid junk, processed, oily and bakery products.
- Also, choose low-fat milk and dairy products.
References
- https://www.ncbi.nlm.nih.gov/books/NBK2216/
- https://www.ncbi.nlm.nih.gov/books/NBK355313/
- http://atm.amegroups.com/article/view/10896/11530
- https://www.ncbi.nlm.nih.gov/books/NBK547760/
Sirisha B