Coronary artery disease (CAD) is where blood flow to the heart muscle is blocked, reducing the amount of vital oxygen needed to make it function. Plaque (fatty deposits) can build up and cause the vessels to become inflamed and damaged, causing a partial or complete blockage. 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 or signs to develop. Some damage may be reparable with lifestyle modifications and medication, surgery may be suggested in some cases, but some damage may be irreversible.
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.
Angina is diagnosed after clinical examination and tests, and describes a pressure or tight feeling in the centre or left of the chest. It’s usually triggered by exercise, exertion or stress and it usually stops after resting up. It's important to note that this pain may be experienced differently by different people. Difficulty in breathing and shortness of breath can also lead to fatigue and tiredness.
Complete blockage of a vessel of the heart can cause a heart attack. In men, this is classically 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 are not typically classic.
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 is set, and CAD is more common in people of African, Caribbean or South Asian descent. Risk increases with age, especially those over 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 plaque in arteries and make them more narrow. Obesity is a risk factor in itself, and also contributes to developing and continuing diabetes, hyperlipidaemia and hypertension.
There’s lots you can do to look after the health of your arteries and your heart. Start small, aiming to follow a healthy diet that is low in fat, sugar and salt, exercising regularly and maintaining a healthy weight – or determinedly losing weight if you are 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 services. It is also important to keep a check on the amount of alcohol you drink: no more than 14 units a week, and taking alcohol-free days every week.
It’s important to keep up to date with GP appointments. Forewarned is forearmed, so it’s a good idea to book in with your GP surgery for a free NHS health check if you are 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 further tests, including blood tests, an ECG, looking at the electrics of your heart, and an echocardiogram, which examines the structure of your heart. They may order an exercise stress test is like an ECG but done whilst exercising.
If your doctor identifies any abnormalities or risk factors, they may start you on medications. They may suggest statins to lower your cholesterol level, aspirin to thin the blood, tablets to reduce blood pressure or tablets for diabetes.
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, usually the femoral artery in your upper thigh, and pass it towards the heart. A dye can be inserted and images can be taken to outline if there are any blockages or obstructions in these 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.
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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