Coronary heart disease is a condition in which your coronary arteries can’t supply your heart with adequate blood, nutrients, and oxygen. The most common cause of coronary heart disease is cholesterol deposition in your coronaries and plaque formation. These plaques may cause a complete or partial blockage of the arteries. Your body will try destroying these plaques by sending white blood cells to engulf them, which causes more inflammation and narrowing and finally damage to your coronaries.
You are at risk of coronary heart disease if you are more than 45 years old (if male) or 55 (if female), or you have a positive family history of coronary heart disease. Also, your unhealthy lifestyle habits, such as smoking, unhealthy food, abnormal sleep, and stress, may make you at a higher risk of coronary heart disease. Irregular sleep and anxiety are also risk factors.
Hypertension, Diabetes Mellitus, and high LDL cholesterol also increase the risk. Coronary heart disease is more common in males in the obstructive type, while the non-obstructive is more common in females.
Coronary heart disease takes time to develop, So the symptoms differ from one person to another. If you have asymptomatic coronary heart disease, you will know only when you have a heart attack. Chest pain is the most common presenting symptom. This pain may occur in the arms, shoulders, back, or epigastric area. You will feel like compressing or squeezing pain during the attack. The doctors call this attack angina, which may be stable or unstable.
Unstable angina may develop myocardial infarction, which is a fatal condition. So, your doctor should be able to differentiate between angina and myocardial infarction. In addition to chest pain, you may have shortness of breath, cold sweat, nausea, weakness, fatigue, and dizziness. If you don’t have early treatment, you may develop cardiogenic shock, heart failure, arrhythmia, or sudden death. The symptoms in women are a little different; they may come at first with fatigue, sleep disturbance, and shortness of breath. So, the women are difficult to diagnose with coronary heart disease.
Your doctor depends on some factors to diagnose you. At first, he will ask you about your family and medical history. Then, he will ask if you have any symptoms or risk factors of coronary heart disease. Your doctor will ask you to do some diagnostic tests like blood tests, ECG, stress tests, echocardiogram. Also, your doctor may ask for cardiac MRI (magnetic resonance imaging) and coronary CT (computed tomographic angiography).
During treatment, your doctor will make a healthy lifestyle plan that replaces your unhealthy lifestyle habits with healthy ones, such as stopping smoking, healthy food, enough sleep, stress relief, and physical activity. Your doctor will use some medications to control the risk factors and causes. These medications are efficient in managing coronary heart disease. If the medical treatment fails to manage your condition, your doctor may need some surgical procedures.
These procedures are like percutaneous coronary intervention (PCI) and coronary artery bypass grafting. These procedures are helpful for the treatment of severe cases that do not respond to medical treatment. You can avoid or decrease the risk of coronary heart disease by having healthy lifestyle habits and early screening.
Now, let’s see this disease in more detail and answer the following questions:
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- What are the coronary arteries?
- What is the pathophysiology of plaque formation?
- What causes this disease, and who is at risk of it?
- What are its symptoms, signs, and complications?
- How will your doctor diagnose and confirm if you have this disease?
- How can your doctor manage this disease, and what are the treatment options?
- Can you prevent coronary heart disease, and how can you do this?
- How can you live with coronary heart disease?
Coronary arteries:
Before talking about coronary heart disease, you should know about coronary arteries to understand this disease. Coronary arteries deliver the blood and nutrients to your heart to pump well. There are two main branches for coronary: right and left coronaries. So, any disease that affects these arteries can reduce the blood supply to the heart muscles.
Pathophysiology of coronary heart disease:
Cholesterol, fatty material, and calcium deposit inside your coronaries and form a plaque. This plaque blocks the artery and prevents blood from supplying your heart muscles with oxygen and nutrients.
Your body attacks the plaque to destroy it and restore the arterial patency. But unfortunately, white blood cells may lead to more inflammation and accelerate the development of coronary heart disease. Platelets aggerate, forming a clot that may increase the obstruction of the artery. This clot may propagate to small vessels of the heart, causing microvascular coronary heart disease.
Causes of coronary heart disease:
Causes of coronary heart disease vary from one to another depending on the types of coronary heart disease: obstructive, non-obstructive, or microvascular disease.
Obstructive coronary heart disease:
The most frequent cause of coronary heart disease is fatty materials deposition inside your coronaries. So, the artery becomes narrow, which reduces the amount of blood that reaches the heart muscles to work. The obstruction must be more than 50% to cause the disease and become complete in some cases.
Non-obstructive coronary heart disease:
Any problem with the heart vessels may cause coronary heart disease. Chronic inflammation, hypertension, and diabetes Mellitus may cause damage to the blood vessel wall, which causes coronary spasms. This spasm narrows the coronary, and the blood can’t reach the heart during spasms. Also, the aging process may affect the arterial wall.
Microvascular coronary heart disease:
The disease occurs in the small heart vessels, and it may be obstructive or non-obstructive. Small plaque may escape to reach small arteries and block them. Also, inflammation may involve small arterioles, causing spasms.
Risk factors of coronary heart disease:
You are at risk of coronary heart disease if you have one of the following:
Old age:
In males, the risk of coronary heart disease increase after 45 years old. Females have a low risk before menopause, which increases after menopause due to the low estrogen level.
Positive family history:
If one of your family has coronary heart disease, you will be at a higher risk.
Unhealthy lifestyle habits:
The following unhealthy habits put you at a higher risk of having coronary heart disease:
- Smoking
- An unhealthy diet with too much fat may lead to high blood LDL, obesity, and plaque formation.
- Stress
- Irregular sleep: you should sleep enough to keep your heart healthy.
Other diseases
Some diseases increase the risk of coronary heart disease, such as:
- Chronic kidney disease
- Diabetes Mellitus
- Hypertension
- Congenital heart disease
- Inflammatory bowel disease (like ulcerative colitis)
- High LDL blood level
Work environment:
Exposure to radiation, stress, and working for a long time raises the risk of coronary disease.
Symptoms of coronary heart disease:
Symptoms of coronary heart disease vary from one to another, depending on arterial obstruction degree. Some people are asymptomatic, while others have severe symptoms.
1-Angina:
Angina is chest pain due to low blood flow to the heart muscles. It is a warning sign that you may have a heart attack. According to the frequency and duration of the anginal attack, angina may be stable, unstable, microvascular, or variant angina.
Stable angina has a regular frequency, course, and severity, while unstable angina is irregular. Its leading cause is atherosclerosis (buildup of plaques inside the coronary arteries). Microvascular angina is due to obstruction of small vessels of the coronaries. Variant angina occurs at rest. The patient with angina may feel pressure, heaviness, tightness, or burning chest pain. Also, he may complain of heartburn, weakness, sweating, nausea, and Mal-digestion.
The females may complain of vomiting, abdominal pain, shortness of breath, and fatigue. The frequency, course, and severity of angina depend on its type. You can relieve the anginal chest pain of angina by the rest.
2- Dizziness:
It is the sensation of being unbalanced and fearing to fall because the brain doesn’t receive enough blood. So, you may feel faint, lightheaded, and nauseous.
3- Shortness of breath:
occurs due to a decreased amount of oxygen that reaches your tissues. You will feel tightness, suffocation, difficulty catching the breath, and rapid breathing.
4- Fatigue:
You feel tired and don’t have the energy to do anything.
5- Nausea:
You will feel that you want to vomit to relieve this feeling.
6- Cold sweat:
You will sweat without working out or in hot weather due to the stress during the attack.
7- Sleep disturbance:
You will notice disruption of your sleep time and quality.
Complications of coronary heart disease:
1) Arrhythmia
You will feel irregular heartbeats. In healthy people, they don’t feel their heartbeats because it’s regular all over time. They can feel it only with palpitation. There are many subtypes of arrhythmia, but the basic types are tachycardia and bradycardia.Tachycardia means a rapid heart rate of more than 100 beats per minute, while bradycardia means a heart rate slower than 60 beats per minute. You may feel fluttering, fast or slow heartbeats, shortness of breath, fatigue, sweating, and anxiety.
2) Myocardial Infarction
The blood flow to the heart muscles decreases then completely stops. At this time, the heart muscle dies (myocardial infarction). It occurs due to blockage of the artery that supplies the heart muscles. A myocardial infarction may be transmural or subendocardial.
Transmural infarction includes all thicknesses of the heart wall, while subendocardial infarction involves a part of the heart wall. The most common cause of myocardial infarction is thrombosis on top of atherosclerosis.
In myocardial infarction, you will have chest pain, which you can differentiate from anginal pain. This pain is more severe and prolonged, and the rest doesn’t relieve it. If you have diabetes, you may have a silent myocardial infarction, which is more dangerous. In addition to chest pain, you may feel shortness of breath, nausea, palpitation, sweating, and dizziness.
3) Heart Failure
The heart can’t pump blood as usual. Heart failure may be due to muscle diseases like myocardial infarction and cardiomyopathy. You may have one or more of the following:
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- Shortness of breath
- Syncope (temporary unconscious)
- Fatigue
- Hypotension
- Weak pulse
- Exertional cough
- Oliguria (urine volume less than 400 ml per day)
- Pleural effusion (accumulation of fluids in the pleura around the lungs)
- Pulmonary edema (accumulation of fluids in the lungs)
Also, you have the following:
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- Sweating without aggressive exercise
- Congested neck vein (destination of the jugular vein with blood)
- Edema of the lower limb
- Ascites (accumulation of fluids in your abdomen)
- Enlarged liver
- Git symptoms, like malabsorption and dyspepsia
4) Cardiogenic Shock
It is an emergency condition. Your heart can’t pump enough blood to your organs despite good blood volume. The leading cause of cardiogenic shock is a severe heart attack. In cardiogenic shock, you complin from chest pain, heartburn, difficulty breathing, cold sweating, irregular heartbeat, and generalized weakness.
Also, you may feel confusion, faintness, hypotension (low blood pressure), cold and pale skin, and a weak pulse.
5) Sudden Cardiac Arrest
The heart stops pumping blood suddenly. So, no blood reaches the brain and other vital organs. If you don’t have immediate treatment, the death will occur within a few minutes.
You may feel chest pain, fluttering, palpitation, weakness, and tachycardia before having a cardiac arrest. Your doctor will notice that you have no pulse, no breath, and are unconscious.
Diagnosis of coronary heart disease:
Your doctor will diagnose you, depending on many factors
1-Medical and family history:
Your doctor will ask you about your medical history because he will suspect coronary heart disease if you have disorders like hypertension and diabetes Mellitus. He will ask you about the risk factors like your diet and physical activity. Your doctor will also ask you about your family history if one of your family has a coronary heart disease before or not.
2- Diagnostic tests:
your doctor will order some investigations to confirm his suspected diagnosis. He will ask one or more of the following:
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- Blood tests: to detect cholesterol, lipoprotein levels, and C-reactive protein (that indicates that you have inflammation)
- Electrocardiogram (ECG): to monitor the heart rate and detect myocardial infarction
- Coronary calcium scan: to detect the amount of calcium that may deposit in your coronaries, forming a plaque
- Stress test: to detect how your heart deals with the stress. This stress may be physical exercise, or your doctor gives you medicine to make your heart work as you do exercise. Then, your doctor uses ECG to detect your heart rhythm during exercise.
- Cardiac enzymes: Necrotic tissues of the heart release some enzymes, which are a biomarker for infarction, like troponin and creatin phosphokinase-myoglobin (CPK-MB). Troponin is the most specific and sensitive marker of myocardial infarction. The initial rise of troponin is from 3 to 12 hours and returns to normal within a week. CPK-MB takes 4 to 8 hours to rise and return to normal within four days. Also, your doctor may ask you to do an ischemia-modified albumin (IMA) test. IMA indicates that you have a problem with your coronary blood flow.
- Cardiac MRI (magnetic resonance imaging): to detect if there is necrosis in your heart tissue or you have an obstruction in your coronaries
- Coronary angiography: your doctor will inject a dye in your coronaries, then through cardiac catheterization, he will see the blood flow in your coronaries.
Treatment of Coronary heart disease:
After your doctor confirms the diagnosis, he will depend on three lines to manage your condition.
1- Healthy lifestyle habits:
your doctor will ask you to replace your unhealthy habits with healthy ones. Your doctor will ask you to stop smoking, have enough good sleep, eat healthy food, and do physical exercise.
2- Medications:
your doctor will write some medicines to treat the underlying causes of coronary heart disease, such as:
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- Nitrates: it helps you relieve chest pain and dilate your coronary arteries.
- Calcium channel blocker: to treat hypertension and dilate blood vessels
- Angiotensin-converting enzyme (ACE) inhibitors: to control hypertension
- Metformin: to control high blood sugar (if you have)
- Statins therapy: your doctor prescribes it to lower high cholesterol levels in your blood. Statin drugs are like atorvastatin, Fluvastatin, and pitvastin.
3-Procedures:
If the medical treatment fails to make you better, your doctor will need to do some procedures to improve your case. These procedures like:
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- Percutaneous coronary intervention (PCI): your doctor will dilate your narrow coronaries then use a stent to keep it patent.
- Coronary artery bypass grafting (CABG): your doctor takes a graft from chest arteries or leg veins to bypass the stenosed segment and improve blood flow.
Prevention of coronary heart disease:
To prevent or decrease the risk of coronary heart disease, you should avoid the risk factors and do an early screening. When you are 20 years old, you should do regular examinations. You should learn about the warning sign that means you may have a heart attack.
Living with coronary heart disease:
- Follow-up care: you should do a routine examination and take your medicines regularly. Follow your doctor’s prescriptions, and revise him before any change.
- Cardiac rehabilitation: your doctor will ask you to do cardiac exercise.
- Prevent the complications:
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- You need to take a regular statin drug to decrease the high cholesterol level.
- If you have diabetes, check your blood sugar regularly and take your medicines as prescribed.