Causes, Treatment and Prevention of Coronary Artery Disease

illustration of coronary artery disease

Coronary artery disease may also be called CAD, coronary arteriosclerosis or coronary atherosclerosis. No matter the chosen terminology, it is the most common cause of death among men and women in the United States. It is the result of restricted blood flow to the heart muscle, preventing oxygen and necessary nutrients to properly flow to the heart. Chest pain (angina) or heart attack could follow.

Causes and Types of Coronary Artery Disease

The accumulation of cholesterol and plaque (unwanted fatty material and other substances) along the artery walls is called atherosclerosis. The most common cause of coronary artery disease, atherosclerosis can physically clog the artery or cause it to function abnormally. It can begin during childhood when streaks of fat appear in arteries. Chronic CAD is the slow build-up of plaque in arteries over time. The unwanted material in the arteries makes the heart work harder to get the blood they carry. The strain on the heart can cause arrhythmia (irregular heartbeat) or heart failure.

Acute coronary syndromes are caused suddenly. A blood clot could block the supply of blood to the heart muscle. This is called coronary occlusion and could cause one of three serious conditions. All three acute coronary syndromes require immediate medical attention.

Although angina is a result of chronic CAD, unstable angina is a sign of acute CAD. In this case, chest pain may occur more frequently, happen during periods of rest, and last for a longer period of time. Unstable angina can progress to a heart attack.

Non-ST segment elevation myocardial infarction (NSTEMI) is another acute syndrome. This is type of heart attack that 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, so the extent of the damage is usually relatively small.

ST segment elevation myocardial infarction (STEMI) is a heart attack caused by a sudden blockage in blood supply. It affects a large area of the heart and causes changes on the ECG as well as in blood levels of key chemical markers.

Who Is At Risk?

CAD risk increases among men over the age of sixty-five. Cigarette smoking, high blood pressure, family history of coronary issues, and an unhealthy diet also contribute. Additionally, uncontrolled diabetes, stress or anger increase risk. CAD appears more frequently among African- and Mexican-Americans, Native Americans, native Hawaiians and some Asian-Americans. Physical inactivity and high cholesterol also add to the possibility of CAD.

Treatment Options

A first step in treating CAD involves lifestyle changes. A better diet, more exercise and limiting alcohol consumption will help. Reducing stress and maintaining proper weight also reduce the risk of CAD.

Medications, including anti-platelet medicine, such as aspirin, beta blockers, like metoprolol, and anticoagulants like warfarin are among them.  Calcium channel blockers and cholesterol-lowering statins may also be prescribed.

Some cases could involve minimally invasive procedures or surgery. An interventional procedure is minimally invasive and allows a cardiologist to access the heart using a catheter inserted into a blood vessel.  Several types of balloons or catheters can be used to treat the plaque build-up within artery walls.

The non-invasive enhanced external counterpulsation (EECP) may stimulate the openings or formation of small branches of blood vessels to create a natural bypass around narrowed or blocked arteries.

If minimally invasive methods are not sufficient, coronary artery bypass graft (CABG) surgery may be required.  During this procedure, one or more blocked coronary arteries is bypassed by a blood vessel graft to restore normal blood flow.  This requires a 5-7 day hospital stay.

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