Coronary Artery Disease:Leading Cause Of Heart Attacks

Coronary artery disease (CAD) is a condition where the blood supply of the heart is affected. This condition occurs due to narrowing and hardening of the coronary arteries. Coronary arteries are blood vessels that carrying oxygen to the heart and supply nutrition to the heart so the heart can functioning normally.

CAD gives rise to a wide variety of clinical presentations from stable angina (chest pain that occur only during exertion) to acute coronary syndromes like myocardial infarction and unstable angina (chest pain at rest – also known as heart attacks).

CAD is caused by atherosclerosis. Atherosclerosis is a complex process characterized by the accumulation of lipid, cholesterol and other substances in arteries in the form of plaques.

EFFECTS OF ATHEROSCLEROSIS

• The plaques will narrow the blood vessels hence reduce the oxygen and nutrients supply to the heart.

• Blockage of arteries supplying the heart will lead to myocardial ischemia. It means the imbalance between supplies of oxygen to the demand by the heart muscle.

• Myocardial ischemia will cause angina (chest pain).

RISK FACTORS FOR CORONARY DISEASE
A. Non modifiable

• Age – risk of CAD increases with age

• Family history

• Male sex – Risk for coronary artery disease is higher for men compared to premenopausal women.

• Deletion polymorphism in the ACE (angiotensin converting enzyme) gene (DD)

B. Modifiable (potentially changeable with treatment)
Strong association

• High blood cholesterol

• High blood pressure (hypertension)

• Diabetes Mellitus

• Cigarettes Smoking
  

Weak association

• Obesity (overweight)

• Sedentary lifestyle

• Stress

• Personality

• Gout

• Soft water

• Lack of exercise

• Contraceptive pill

• Heavy alcohol consumption

LIFETSYLE CHANGES

• Healthy diet

• Reduce weight

• Exercise and maintain an active lifestyle

• Reduce stress

• Reduce alcohol intake

• Control blood pressure and blood sugar level

• Quit Smoking
  

Symptoms of heart attack

• Chest pain or chest discomfort (angina)

• Shortness of breath

• Pain in one or both arms, left shoulder, jaw, neck ad back

Treatment
1. Lifestyle changes
2. Medication
– Aspirin or ticlopidine (unless contraindicated)
– Lipid lowering agents (to reduce cholesterol)
- Sub lingual Glyceryl trinitrate (to relief the chest pain)
– Other drugs like -blockers, calcium channel blocker (to reduce heart rate and reduce oxygen demand to the heart muscle) 3. Surgery
– Percutaneous Transiluminal Coronary Angioplasty (PTCA) – to dilate the affected coronary artery using a ballon.
– Coronary artery bypass grafting (CABG) – this is where a vein graft (blood vessel from somewhere else in the body) is use to bypass the coronary artery obstruction.