Coronary artery disease

Coronary artery disease (CAD), also known as ischemic heart disease (IHD) or coronary heart disease (CHD), is a condition characterized by the narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle. This reduced blood flow can lead to chest pain (angina), shortness of breath, heart attack (myocardial infarction), and other symptoms. CAD is the leading cause of death worldwide.

CoronaryArtery Plaque

Causes

The primary cause of coronary artery disease is the buildup of fatty deposits called atherosclerosis on the inner walls of the coronary arteries. These deposits, known as plaques, can narrow the arteries and reduce blood flow to the heart muscle. Factors contributing to the development of atherosclerosis include:

• High levels of low-density lipoprotein (LDL) cholesterol
• High blood pressure
• Smoking
• Diabetes
• Obesity
• Family history of heart disease
• Physical inactivity
• Age
• Gender (males have a higher risk)
• Chronic inflammation
• High levels of homocysteine, an amino acid found in the blood

Symptoms

Coronary artery disease may not cause symptoms in its early stages. However, as the disease progresses, symptoms may include:

• Chest pain (angina), which can feel like pressure, heaviness, or tightness in the chest
• Shortness of breath
• Fatigue
• Dizziness
• Nausea
• Sweating
• Irregular heartbeat (arrhythmia)

In some cases, a heart attack (myocardial infarction) may be the first sign of coronary artery disease.

Diagnosis

Diagnosis of coronary artery disease typically involves a combination of medical history, physical examination, and various tests, which may include:

• Electrocardiogram (ECG)
• Echocardiogram
• Stress test (exercise or pharmacologic)
• Nuclear stress test
• Cardiac catheterization and angiogram
• Coronary computed tomography angiography (CCTA)
• Magnetic resonance angiography (MRA)

Treatment

Treatment for coronary artery disease may include lifestyle changes, medications, and medical procedures or surgery. The choice of treatment depends on the severity and extent of the disease, as well as individual patient factors. Options include:

• Lifestyle changes: Dietary modifications, regular exercise, weight loss, smoking cessation, and stress management
• Medications: Aspirin, beta blockers, calcium channel blockers, nitrates, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), cholesterol-lowering medications (statins), and antiplatelet drugs
• Medical procedures and surgery: Percutaneous coronary intervention (PCI), also known as coronary angioplasty, with stent placement; coronary artery bypass grafting (CABG); and enhanced external counterpulsation (EECP)

Prevention

Preventing coronary artery disease involves managing risk factors and adopting a heart-healthy lifestyle. Recommendations include:

• Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats
• Exercising regularly (at least 150 minutes of moderate aerobic activity per week)
• Maintaining a healthy weight
• Not smoking or using tobacco products
• Limiting alcohol consumption
• Managing stress
• Regularly monitoring blood pressure, cholesterol, and blood sugar levels

Also see

• Heart disease
• Atherosclerosis

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