The coronary arteries are the blood vessels that supply your heart with blood. Your heart needs this blood to work properly. Every day, your heart pumps about 3,000 gallons of blood through your body.
Coronary artery disease is the narrowing or blockage of the coronary arteries. This condition is usually caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by clogging the artery or by causing damage to the arteries.
If the heart does not get enough blood, it cannot get the oxygen and nutrients it needs to work properly. This can cause chest pain called angina. If the blood supply to an area of the heart muscle is completely blocked, or if the heart can’t work as hard as it needs to because it lacks blood, you can have a heart attack.
Healthy coronary arteries are smooth and elastic. The insides of these muscular hollow tubes are lined with a layer of cells called the endothelium. The endothelium helps protect the vessel walls and keep the arteries working properly. Blood can flow freely.
Coronary artery disease starts when you are very young. Before your teen years, the blood vessel walls start to show streaks of fat. As you get older, the fat builds up, causing minor damage to your blood vessel walls. With time, other substances that move through your bloodstream, such as inflammatory cells, cellular waste products, proteins and calcium, stick to the vessel walls. These substances combine with the fat to form plaque.
Plaque deposits of different sizes collect inside the arteries. Many are soft on the inside with a hard, fibrous “cap” covering the outside. If the hard surface cracks or tears, the soft, fatty inside is exposed. Platelets (disc-shaped particles in the blood that help form clots) move to the area, and blood clots form around the plaque. The endothelium can also become irritated and stop working properly, which causes the artery to squeeze at the wrong times. This causes the artery to narrow even more.
Sometimes, the blood clot breaks apart and blood can flow through the area again. Other times, the blood clot (coronary thrombus) suddenly blocks the blood supply to the heart muscle (coronary occlusion), causing one of three serious conditions known as an acute coronary syndrome.
Some people have symptoms before they develop an acute coronary syndrome, but it is possible to not have symptoms until the condition occurs. Some patients never have any symptoms.
If you have an acute coronary syndrome, you need to get emergency treatment!
As the blockage in a coronary artery gets bigger and if it occurs slowly, new blood vessels may form to reroute blood around the blockage. This is called collateral circulation. These new blood vessels may not be able to carry enough blood to the heart when there is extra activity or stress.
Ischemia is described as “cramping of the heart muscle.” It is similar to a cramp in the leg after exercising a long time. The muscles in the legs cramp up because they need oxygen and nutrients. Your heart, which is also a muscle, needs oxygen and nutrients to keep working. If the heart muscle can’t get enough blood because the coronary artery is too narrow, it causes ischemia. When this happens, you may feel chest pain or other symptoms.
Ischemia happens most often when the heart needs extra oxygen, such as when you are active, eating, excited, stressed, exposed to cold.
If rest or medications relieve symptoms of ischemia within 10 minutes and your symptoms are not getting worse, you may be told you have “stable coronary artery disease” or “stable angina.” However, the problem can get worse and you may have symptoms even when you are resting.
It is possible to have ischemia, or even a heart attack, without having any symptoms. This is called “silent” ischemia. Although anyone with heart disease can have silent ischemia, it is more common in people with diabetes.
The most common symptom of coronary artery disease is angina. Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw.
Other symptoms of coronary artery disease include:
If you have symptoms of coronary artery disease, it is important to call your doctor, especially if they are new symptoms or have become worse or more frequent.
Women often have different symptoms of coronary artery disease than men. For example, many women who have a heart attack have:
If any of these symptoms occur, it is important to get medical help right away. Call 999 or have someone take you to the nearest emergency room.
What you should do if you have symptoms
If you or someone you are with has pain in the chest, left arm or back that lasts more than five minutes, with one or more symptoms of a heart attack or coronary artery disease, call 999. DO NOT WAIT to get help. Quick treatment during a heart attack is very important to minimize heart damage. If you are a smoker, it is very important that you DO NOT smoke to relieve your stress. Smoking can make symptoms of a heart attack worse.
Aspirin: The 999 dispatcher may tell you to chew one full (325 mg) aspirin slowly, if you do not have a history of aspirin allergy or bleeding. Aspirin is most effective if taken within 30 minutes after the start of symptoms. Do NOT take an aspirin if you have symptoms of a stroke.
Call your doctor if:
Learn to recognize your symptoms and the situations that cause them.
If you have a prescription for Nitroglycerin
If you have symptoms of angina and you have a prescription for Nitroglycerin, stop what you are doing and rest. Take one dose (dissolve one tablet under your tongue or spray under your tongue). Wait five minutes. If you still have symptoms, call 999.
If you have chronic stable angina and you have symptoms, take one dose of nitroglycerin. Wait five minutes. If symptoms continue, take another dose. You can take three doses within 15 minutes. If symptoms continue after three doses, call 999.
If you think you are having a heart attack, call 999! Do not wait for your symptoms to stop.
The earlier you get treatment, the less damage will happen to your heart.
What’s the difference between angina and a heart attack?
Angina is a warning symptom of heart disease – but it is not a heart attack. The symptoms of a heart attack (also called myocardial infarction or “MI”) are similar to angina.
If you have symptoms that could be caused by coronary artery disease, your doctor will review your medical history and risk factors, do a complete exam, and order some tests. These can include blood work, an electrocardiogram (ECG/EKG), exercise stress tests, cardiac catheterization and coronary computed tomography angiogram (CTA). Testing is needed to find out how severe the disease is, how it is affecting your heart, and to help plan the best treatment for you.
Cardiovascular disease (CVD) causes one in every five deaths in the United Arab Emirates. One in every four people have modifiable risk factors, such as high blood pressure, high cholesterol, smoking and unhealthy eating habits. In addition, 81 percent of people in the United Arab Emirates do not get enough exercise to stay healthy. Cardiovascular disease is a problem around the world, but can be prevented in large part by making lifestyle changes.
There are several risk factors for coronary artery disease, including some you can’t control (non-modifiable). But, you do have control over many other risk factors (modifiable) The more risk factors you have, the greater your chance of heart disease. Your doctor can help you understand your individual risk factors and what you can do to lower your risk.
Non-Modifiable risk factors include:
Modifiable risk factors include:
Your doctor will talk to you about the best treatment plan for you. Following your treatment plan will help reduce your risk of problems like heart attack and stroke.
Reduce your risk factors
The first step in treatment for coronary artery disease is reducing your risk factors. This involves making changes in your lifestyle.
Your doctor may prescribe medication as part of your treatment plan for coronary artery disease. These can include medications to lower cholesterol levels and blood pressure or treat other health conditions you have. It is important to take all medications as prescribed. Ask your doctor if you have any questions about which medications you should take or how to take them.
Interventional procedures are not considered surgery. A cardiologist (not a surgeon) performs these procedures to reduce plaque build-up in the arteries and prevent blockages. Common procedures are balloon angioplasty (PTCA) and stenting. During an interventional procedure, a long, thin tube called a catheter is inserted into an artery through a small incision. The catheter is guided to the blocked area of the artery, and the plaque build-up is cleared. Your doctor will give you more information if you need an interventional procedure as part of your treatment.
Coronary artery bypass graft (CABG) surgery
Coronary artery bypass graft (CABG) surgery involves creating a new path for blood to flow when there is a blockage in the coronary arteries. In most cases, the surgeon removes blood vessels from the patient’s chest, arm or leg, and creates the new pathway to deliver oxygen-rich blood to the heart. Your doctor will give you more information if you need CABG surgery.
Other treatment options
If traditional treatment options are not successful, your doctor may recommend other treatment options, such as:
Important Note: These procedures increase blood supply to your heart, but they do not cure coronary heart disease. You still need to follow the other parts of your treatment plan to help prevent your condition from getting worse.
Regular visits with your cardiologist, along with any needed tests, are important. Follow-up care lets your doctor know how your treatment is working and if changes are needed.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
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