Coronary artery disease
Ischaemic heart disease
A reduction of the heart's blood supply due to atheroma — a fatty substance that builds up in the coronary arteries
What causes coronary artery disease?
Coronary artery disease (CAD)is also known as coronary heart disease or angina. Coronary artery disease is caused by a narrowing or blocking of the blood vessels that carry blood and oxygen to the heart. This is the result of a build-up of fatty material and plaque inside the blood vessels - known as atherosclerosis - and can be brought on by high blood pressure, high cholesterol or diabetes.
Inflammation of the blood vessels is one of the main causes of atherosclerosis, and both types of diabetes make it worse. High blood sugar affects the cells lining blood vessels by increasing the production of molecules called free radicals that cause premature cell death. It also reduces the ability of blood vessels to relax and blood flow to increase.
What are the symptoms of coronary artery disease?
If your coronary arteries are constricted, they can't supply enough oxygen-rich blood to your heart. This is particularly true when your heart is beating harder than normal, such as during exercise. This decreased blood flow may not cause any symptoms at first, however as plaque continues to build up in your arteries, you may begin to experience the following coronary artery disease signs and symptoms:
- Chest pain (angina)
- Shortness of breath
- Chest tightness
- Feeling faint
- Feeling sick (nausea)
Not everyone has the same symptoms, and some people may not have any symptoms at all before coronary heart disease is diagnosed.
Women may experience different signs and symptoms of a heart attack, such as neck or jaw pain, although they may also have other symptoms such as shortness of breath, fatigue and nausea.
If you think you may be having a heart attack, then call emergency services immediately.
Coronary Artery Disease risk factors
A risk factor is something that increases your chances of developing a disease, and different diseases have different risk factors. You can control certain risk factors by making changes to your lifestyle. For example, giving up smoking reduces your risk of many diseases, including lung cancer, whilst losing weight (if you are obese) reduces the risk of heart disease. However, some risk factors - such as age, ethnicity or family history - cannot be changed.
The risk factors for coronary artery disease include:
- Age: getting older increases your risk of damaged and narrowed coronary arteries
- Family history: a family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55, or if your mother or a sister developed it before age 65
- Sex: generally speaking, men are at greater risk of coronary artery disease, although the risk for women also increases after menopause
- Smoking: people who smoke have a significantly higher risk of heart disease. Breathing in second-hand smoke also increases your risk
- High blood pressure: uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow
- High blood cholesterol levels: high levels of cholesterol in your blood can increase the risk of atherosclerosis, the narrowing and blocking of blood vessels
- Diabetes: diabetes is associated with an increased risk of CAD. Type 2 diabetes in particular shares similar risk factors with coronary artery disease, such as obesity and high blood pressure
- Being overweight or obese: being overweight typically worsens other risk factors associated with coronary artery disease
- Eating an unhealthy diet: if your diet is rich in saturated fats, trans fats (also known as hydrogenated fats; these are found in low levels in meat and dairy products, and also in some packaged cakes, doughnuts and pastries), salt and sugar, then your risk of CAD is higher
- Physical inactivity: a lack of exercise is also associated with CAD
- High levels of stress: research shows that unrelieved stress may damage your coronary arteries, as well as worsening other risk factors for coronary artery disease.
Risk factors often occur together and one may trigger another. For example, An unhealthy diet and lack of exercise can lead to obesity, which can in turn lead to type 2 diabetes and high blood pressure.
When grouped together, certain risk factors increase your likelihood of developing coronary artery disease. For example, metabolic syndrome - a group of conditions that includes high blood pressure, low HDL (‘good’ cholesterol), high insulin levels and excess body fat around the waist - increases the risk of coronary artery disease.
Need to know
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Coronary artery disease diagnosis icon plus
If your doctor feels you may be at risk of coronary artery disease, they will carry out a full assessment, to find out about your medical and family history and your lifestyle.
Your doctor will also carry out a physical examination, which will include:
- Blood pressure check: high blood pressure is often related to coronary heart disease
- BMI: this stands for body mass index, and measures whether you are a healthy weight for your height. High BMI (being overweight or obese) is related to coronary artery disease
- Measurement of your waist: men with a waist size over 37in and women with a waist size over 31.5in are at high risk of coronary artery disease.
Depending on the results of your physical examination, you may be referred for further tests, including:
Blood tests: these provide information about your heart muscle by measuring the enzymes, cholesterol and proteins in your blood
Electrocardiogram (ECG): in this test, sensors are attached to your chest and the rate, rhythm and electrical activity of your heart are measured. It is a painless test which usually only takes a few minutes to complete
Exercise ECG (also known as a cardiac stress test): this is an ECG which is carried out whilst you are walking on a treadmill, to see how your heart responds to moderate exercise. This test usually takes around half an hour, and you will be monitored by a consultant throughout. You blood pressure will also be recorded
Coronary angiogram (also known as cardiac catheterisation): during this procedure a small, flexible tube is inserted into your artery, at the top of your leg or in your arm, and a fine wire is guided along the arteries of your heart. A dye is then injected and a series of X-rays are taken, so that the consultant can see whether your coronary arteries are narrowed or blocked. An angiogram is a non-surgical procedure which is carried out under local anaesthetic. If blockages are detected in your coronary artery, they may carry out a coronary angioplasty (see below)
Coronary angioplasty: this is when a balloon is used to inflate a narrowed artery, which is then held open by a stent (a small wire tube). This procedure can be used to treat the symptoms of coronary artery disease, angina and also as an emergency treatment following a heart attack
Imaging tests: these include MRI, CT scans and PET scans, which provide high-definition images of your heart and surrounding arteries.
Your doctor will decide which tests are most appropriate for you.
If you are worried about coronary artery disease and would like to speak to a GP, HCA offers same-day and next-day private GP appointments.
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Potential treatment options for coronary artery disease icon plus
If you think you may have coronary heart disease, then it’s extremely important to see your doctor and get a diagnosis as soon as possible. The right treatment can significantly relieve the symptoms of CAD, as well as decreasing the risk of a heart attack or a stroke.
If you are diagnosed with CAD, there are several different treatment options available. They include:Lifestyle
In addition to medication and surgical options, your doctor will recommend making some lifestyle changes to treat your coronary heart disease. These will include:- Eating a healthy diet and maintaining a healthy weight (losing weight if necessary)
- Cutting down on alcohol
- Giving up smoking
- Trying to avoid stress
- Taking regular exercise: you will need to start slowly and build up your activity level gradually. Ask your doctor for advice before starting a new exercise regime.
Medication
GTN: most people with stable coronary artery disease will be prescribed a medicine called glyceryl trinitrate (GTN), which comes in spray form, or as tablets which dissolve under your tongue. GTN works by dilating your arteries, reducing pressure on the heart muscle
Beta blockers: these are sometimes prescribed to prevent angina attacks caused by coronary artery disease. Beta blockers slow down the heart by reducing the amount of adrenaline your body produces
ACE (Angiotensin-converting enzyme) inhibitors: these drugs reduce blood pressure by helping to relax your veins and arteries
Angiotensin II receptor blockers: some people experience unpleasant side effects from ACE inhibitors, so they are prescribed Angiotensin II receptor blockers (ARBs) instead. These help relax your veins and arteries, to lower your blood pressure and make it easier for your heart to pump blood around the body
Calcium channel blockers: these prevent calcium from entering your arteries and heart, helping the blood vessels to relax and reducing blood pressure
Low dose aspirin: this helps to thin the blood and prevent heart attacks and strokes in people with CAD
Statins, like atorvastatin: these are used to lower blood cholesterol, which helps prevent blockages in the blood vessels
Diuretics: these are medicines that make you pass more urine and help relieve the symptoms of coronary heart disease by flushing excess water and salts from your body.
If your coronary artery disease is very serious, or if medication does not relieve symptoms, then your doctor may recommend surgery.
Procedures
There are two main types of medical procedure to treat coronary artery disease. These are:
Coronary Artery Bypass Graft (CABG): in this surgical procedure, an artery from another part of your body (usually in the chest, leg or arm), is attached above and below the blocked section of the coronary artery, to divert the blood flow (this is known as a graft). The operation is carried out under general anaesthetic and lasts for between 3 and 6 hours. You may need more than one graft, depending on how severe your coronary artery disease is.
Coronary angiogram and a stent insertion: a tiny balloon is used to inflate a narrow artery, which is then held open by a stent (a small wire tube). This procedure can be used to treat the symptoms of coronary heart disease, and also as an emergency treatment following a heart attack.
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