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with coronary disease

Living with coronary disease: What is it?

You are looking for information about coronary artery disease, but you do not know where to start? Here, you will be able to find relevant material, starting with precise definitions to give you a sense of context, then moving on to insights about the disease itself.

What is coronary artery disease?

As its name suggests, coronary artery disease is a disease involving coronary arteries. So, let us focus first on coronary arteries.

Like most arteries, coronary arteries are blood vessels that carry oxygenated blood expelled by the heart to organs and tissues, where oxygen and nutrients are delivered. The territory irrigated by coronary arteries is the heart itself, which demands an abundant supply of oxygen to function.

Coronary arteries carry oxygenated blood from the aorta back to the heart tissues.

  1. Aorta
  2. Right Coronary Artery
  3. Left Anterior Descending Coronory Artery
  4. Circumflex Coronary Artery
  5. Left Main Coronary Artery

Therefore, it is easy to understand that if the coronary arteries get damaged, the heart function is likely to be impaired, which explains why the coronary artery disease is also called the coronary heart disease.1

What happens to the coronary arteries in coronary artery disease?

Over time, a fatty, waxy substance can accumulate in your heart arteries. It forms deposits that keep building up, forming the so-called atheromatous plaque (or atheroma), which narrows your arteries little by little, like a clog in a pipe. This progressive process, called atherosclerosis, goes undetected at first, and often take decades until it ends up restricting the blood flow to your heart muscle.

Atherosclerosis: as plaque builds up, the blood flow becomes restricted.2

When the plaque buildup becomes too important and arteries too narrow, the heart muscle cannot receive enough blood, oxygen and nutrients, and coronary artery disease symptoms can appear.1,2

What are the symptoms of coronary artery disease?

When the blood flow becomes insufficient and cannot provide your heart with the oxygen it needs, coronary artery disease can trigger chest pain, also known as angina, which is therefore more likely to appear when exercising, or in stressful situations. Your heart might also become less efficient, with decreased oxygen delivery throughout your body, which could cause both fatigue and shortness of breath.

Variations in the symptoms can be observed, especially between women and men. If men are more likely to feel intense chest pain episodes, women could only feel some discomfort, somewhat similar to indigestion. In severe angina attacks, the pain (angina) in the center of the chest sometimes involves the arms, neck, jaw, back or stomach. While angina is often triggered by physical exercise or stressful situations, the duration of the symptoms does not usually exceed 10 minutes.

Still, the symptoms can be very different from one patient to the other, and some people diagnosed with coronary artery disease may have not shown any symptom before.

Ultimately, if plaque breaks off, the sudden formation of a blood thrombus can occur, which can block the lumen of the artery and generate a heart attack.2-4

Is coronary artery disease a common condition?

Yes, it is a very common condition: all over the world, it comes on top when the number of years lost due to ill-health is considered.5 It is also a major cause of death and disability in developed countries, being responsible for one-third of all deaths in people older than 35 years of age in the USA.6

What are the causes for coronary artery disease? Are there any risk factors?

As we have seen before, coronary artery disease is caused by atherosclerosis, the build-up of the atheromatous plaque on the walls of the coronary arteries that keeps narrowing them.

Hence, the risk factors for coronary heart disease are those that increase the risk of atherosclerosis:

  • Age: getting older increases the risk of narrowed, damaged arteries;
  • Smoking: chemicals in cigarette smoke can damage the lining of the coronary arteries, promoting the plaque deposits. Furthermore, nicotine and carbon monoxide both contribute to make the heart work faster, which increases stress. Secondhand smoke also increases risks;
  • Hypertension can favor coronary artery disease by putting a strain on your heart, hardening and thickening arteries;
  • Hypercholesterolemia can lead to coronary artery disease, because of its essential role in atherosclerosis;
  • The lack of exercise;
  • Diabetes may thicken the lining of blood vessels, further restricting blood flow.

Other risk factors for atherosclerosis include being overweight, unhealthy eating habits (eating high amounts of saturated fats, trans fats, salt and sugar), or having a family history of coronary artery disease.8,9

How is coronary artery disease diagnosed?

We have seen that symptoms can be very variable, so symptoms alone will not allow a proper diagnosis. If physicians suspect coronary artery disease, they will ask about your medical and family history, check your blood pressure and ask for a blood test to assess your cholesterol level. Your physician will also ask about your lifestyle, your physical activity, and whether you smoke.

Further tests are needed to confirm a suspected coronary artery disease. They could among others include an electrocardiogram, exercise stress tests, blood tests, and a variety of imaging tests (X-rays, coronary angiography, echocardiogram, MRI scans, CT-scans…).10

References:

  1. Boyette LC, Manna B. Physiology, Myocardial Oxygen Demand – StatPearls – NCBI Bookshelf. 2019.
  2. CDC. Coronary Artery Disease – Causes, Diagnosis & Prevention. 2015. Available at https://www.cdc.gov/heartdisease/coronary_ad.htm Accessed on 08 July 2019.
  3. WebMD. How Heart Disease Affects Your Body. 2019. Available at https://www.webmd.com/heart-disease/ss/slideshow-heart-disease-affects-body Accessed on 08 July 2019.
  4. NHS. Coronary heart disease – Symptoms. 2017. Available at https://www.nhs.uk/conditions/coronary-heart-disease/symptoms/ Accessed on 08 July 2019.
  5. Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25.
  6. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016 Jul;4(13):256.
  7. Supplement to Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25.
  8. NHS. Coronary heart disease – Causes. 2017. Available at https://www.nhs.uk/conditions/coronary-heart-disease/causes/ Accessed on 08 July 2019.
  9. Mayo Clinic. Coronary artery disease – Symptoms and causes. 2018. Available at https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613Accessed on 08 July 2019.
  10. NHS. Coronary heart disease – Diagnosis. 2017. Available at https://www.nhs.uk/conditions/coronary-heart-disease/diagnosis/ Accessed on 08 July 2019.