Coronary artery disease (CAD) – sometimes also called coronary heart disease or CHD - is where blood flow to the heart muscle is slowed down or blocked, reducing the amount of oxygen the heart needs to make it function normally.
The typical cause of CAD happens gradually over many years, where the walls of the heart arteries slowly become ‘furred up’ with deposits of fatty substances, called atheroma. This process is called atherosclerosis and the atheroma is often known as ‘plaques’. These plaques can build up and cause the vessels to become inflamed and damaged, causing a partial or complete blockage, and conditions like angina, heart attacks and heart failure may follow as a result. CAD develops over a lengthy period of time – usually years or decades – which can mean it takes time before symptoms develop. Some damage can be repaired with lifestyle changes and medication, surgery may be suggested in some cases, but some damage may be permanent.
Many factors can cause atherosclerosis including high cholesterol levels, diabetes, obesity, high blood pressure, smoking and drinking too much alcohol.
Narrowing of the blood vessels reduces the blood flow, as blood supplies oxygen to the cells and is vital for functioning. Lack of this can cause a number of symptoms that develop over time, although you may have no warning signs that your arteries are in poor shape.
The main symptom of CAD is chest pain (angina) where you feel pain or tightness in the chest, typically in the centre or to the left but it may also be felt in the jaw or down the arm. It can also cause shortness of breath, feeling faint, nausea and general fatigue. However, not everyone with CAD has symptoms and if they do, the symptoms are individual to them.
Angina is usually triggered by exercise, exertion or stress and typically stops after resting. It's important to note that if pain occurs, this may be experienced differently by different people.
If there is complete blockage of a heart blood vessel, this can cause a heart attack. This is often a crushing central or left-sided chest pain, which can radiate to the neck or arms, and can be associated with sweating, shortness of breath or nausea. (In women and diabetics, the symptoms may not be typically classical.)
The cause is unknown but there are many factors that put you at increased risk of developing coronary artery disease. It’s easiest to divide these into things that you have control over, and factors that you have no control over.
You can't change your family history - if people in your family (siblings or parents) have a history of cardiovascular disease like heart attacks before the age of 65, then this increases your risk of developing CVD yourself. Similarly, your ethnicity can’t be changed, and CAD is more common in people of African, Caribbean or South Asian descent. The risk increases with increasing age (especially after the age of 50) and men are more likely to develop CAD than women.
You can take control of some factors in your life to minimise risk or reduce damage once diagnosed. The biggest of these is smoking, which can lead to damaged and narrowed arteries, significantly increasing your risk of a heart attack or other CAD events. Similarly, excessive alcohol can cause damage to the arteries of your heart.
Many cardiovascular disease risk factors go hand in hand – diabetes, high cholesterol and high blood pressure all increase levels of plaque in arteries and make them narrower and more constricted. Obesity is a risk factor in itself, and also contributes to developing and continuing diabetes, hyperlipidaemia and hypertension.
There are lots you can do to look after the health of your arteries, and your heart overall. Start small, aiming to follow a healthy diet that’s low in fat, sugar and salt, exercise regularly and maintain a healthy weight – or lose weight if you’re overweight or obese.
It’s really important if you smoke, to stop smoking as soon as possible. This is best done with the help of NHS smoking cessation services or your doctor. It’s also important to keep a check on the amount of alcohol you drink: drink no more than 14 units a week, and remember to take at least two or three alcohol-free days every week.
It’s important to keep up to date with GP appointments so it’s a good idea to book in with your GP surgery for a free NHS health check if you’re over the age of 40 or new to the practice. They screen for a number of health markers, including those for cardiovascular disease, by taking blood tests, blood pressure and weight.
Clinical suspicion of CAD is based on the symptoms you describe, your own particular set of risk factors and health conditions, and an examination of your heart and lungs. Your doctor may then send you for further tests, including blood tests, an ECG that looks at the electrical activity of your heart, and an echocardiogram which examines the structure of your heart. They may also order an exercise stress test, which is like an ECG but done whilst exercising.
If your doctor identifies any abnormalities or risk factors, they may start you on medication. They may suggest statins to lower your cholesterol level, aspirin to thin the blood, or tablets to reduce your blood pressure or treat any diabetes that may be present.
Depending on the results of your cardiac investigations, a cardiology team may see you and do a procedure called cardiac catheterisation and angiogram. This is where they insert a tube into an artery under local anaesthetic - usually the femoral artery in your groin - and pass it up the body towards the heart. A dye can then be injected into the circulation and images taken to outline it to see if there are any blockages or obstructions in these blood vessels.
If any obstructions are identified, a balloon can be passed through the tube and passed to the vessel to open it up and improve blood flow, then a mesh tube (stent) can be used to keep it open - this is called angioplasty. If you’ve had a heart attack then this is likely to increase your chances of survival more than by using clot-busting (thrombolytic) drugs.
Coronary artery bypass surgery is considered in certain cases, where a substitute vessel is used to create a bypass in the heart around a blocked vessel.
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