Overview of Coronary Artery Disease (CAD)
Coronary Artery Disease or blockage in the heart is one of the most common diseases that people across the world develop. The main risk factors for developing coronary artery disease are age or getting older, tobacco use, high blood pressure (BP), diabetes and cholesterol. When these conditions develop, they cause problems with the heart arteries or the coronary arteries.
The artery, when all of us are born, is nice and open without any type of blockage. When you develop these risk factors over time and not regulate them properly, the artery starts developing a blockage in the heart by depositing cholesterol deposits or plaque along the side of the arteries. This causes the artery to narrow down and slowly decrease the blood supply over time. In most patients, this early blockage is not known and does not cause any symptoms. But over time if the blockage gets worse and starts restricting the blood supply, the patient starts developing symptoms.
Most commonly patients develop chest pain or shortage of breath.
But if the blockage is complete or sudden, patients can develop more serious conditions such as heart attack. For these reasons, it is important to try to treat these problems before you get to this stage by – making sure that you don’t smoke, your BP is under control, your cholesterol levels are maintained and that your diabetes condition, if you do have, is as controlled as possible.
Contents of this Article
What is CAD?
Coronary Artery Disease or CAD is a disease that occurs when the blood vessels or coronary arteries that carry blood to your heart harden. A fatty substance called plaque builds up inside the walls of the arteries and narrows it down, eventually blocking blood flow to your heart. This blockage could cause angina (squeezing pain or pressure in your chest), a heart attack, or even death.
What are the symptoms of CAD?
At first, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, you may develop signs and symptoms including:
Chest pain (angina)
Pressure or tightness that usually occurs on the middle or left side of the chest. In women, this pain may be felt suddenly or sharply in the neck, arms or back. It is usually triggered by physical activity and relieved during rest.
Shortness of breath
Shortness of breath or extreme fatigue with exertion takes place if your heart cannot pump enough blood to meet your body’s needs.
A heart attack occurs when the coronary artery is completely blocked. You may feel a pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. A heart attack may occur even without any apparent signs or symptoms.
Neck or jaw pain
What are the causes of CAD?
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Inactive lifestyle
What can CAD lead to?
Coronary artery diseases can lead to the following:
Chest pain (angina)
When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest. This can cause chest pain (angina) or shortness of breath.
If a plaque ruptures, a blood clot may form and this causes complete blockage fo the heart artery. This may trigger a heart attack. The damage caused to the heart muscle due to the lack of blood flow partly depends on how quickly you receive treatment.
It is a condition when your heart becomes too weak to pump enough blood to meet your body’s demands. This happens when some areas of your heart are severely deprived of oxygen due to reduced blood flow.
Abnormal heart rhythm (arrhythmia)
How is the diagnosis of CAD done?
Your medical history is analysed and a physical exam and blood test are done. Some other diagnostic procedures include:
Used to record electrical signals that travel through your heart and shows evidence of a previous or present heart attack.
Used to produce images of your heart using sound waves to determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. An echocardiogram is also used during stress tests.
Done to view blood flow through your heart by injecting a special dye into your coronary arteries.
Computerized tomography (CT) technologies help identify calcium deposits in your arteries that narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.
What kind of lifestyle changes will I need to make if I have Coronary Artery Disease?
Treatment for coronary artery disease usually involves instructing the patient to incorporate heart-healthy changes in their life. Eliminating all risk factors and following a heart-healthy lifestyle can make a great impact on your heart and overall health. These are some of the changes you will have to make. You may have to:
- Stop smoking
- Start eating a healthy diet
- Exercise regularly
- Lose excess weight
- Reduce stress
What kind of medications will I have to take?
Besides lifestyle changes, treatment for coronary artery disease also involves taking medications. Various medications can be used to treat coronary artery disease. Some of them include:
Cholesterol regulating medications
Decreases the cholesterol level in the blood, especially the “bad” cholesterol.
Reduces the tendency of your blood to clot, which may help prevent obstruction of your arteries. Aspirin can help prevent future attacks. Ask your doctor before starting to take aspirin as there are cases where it is not suitable.
Decreases your heart’s demand for oxygen by slowing down your heart rate and decreasing your blood pressure. Beta-blockers reduce the risk of future attacks.
Calcium channel blockers
Help improve symptoms of chest pain. Depending on the effectiveness of this medication on the patient, it is prescribed with a beta blocker or instead of a beta blocker if you can’t take it.
Medications such as Ranolazine and Nitroglycerin help people with chest pain (angina). Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) prevent the progression of coronary artery disease by decreasing blood pressure.
If the severity of your condition is such that lifestyle changes and medications cannot moderate it, then you will have to undergo a procedure. A doctor will assess your risk factors and recommend a suitable procedure.
What kind of procedures does Total Cardiac Care do for CAD?
Sometimes more proactive procedures may need to be done to restore and improve blood flow. To help you prevent or slow the progression of coronary artery disease, Total Cardiac Care gives you the following options:
Angioplasty and stent placement (percutaneous coronary revascularization)
Angioplasty is a minimally invasive procedure done to open narrowed or blocked blood vessels that supply blood to the heart. A small metal mesh tube – called a coronary artery stent – is often placed in the artery during or quickly after angioplasty to keep it open.
It is an open type of surgery that is done to improve blood flow to the heart. It is used in severe cases when symptoms of coronary artery disease do not improve with medication, lifestyle changes, or minimally invasive procedures, such as angioplasty. In this procedure, the surgeon blood vessels from another part of your body and creates a graft to bypass blocked coronary arteries.
What can I do to prevent CAD?
What is done to naturally treat coronary artery disease can be done to help prevent it from happening in the first place. Leading a healthy lifestyle is the way to go as it keeps your arteries strong.
- Make an end to your smoking habit
- Control your blood pressure, cholesterol levels and diabetes (if you do have)
- Exercise and stay physically active
- Eat a diet that is low-fat, low-salt and rich in fruits and vegetables
- Maintain a healthy weight
- Avoid doing anything that causes too much stress
When and whom do I consult?
If you know you have symptoms of or risk factors for coronary artery disease – such as high blood pressure, high cholesterol, smoking habits, diabetes, a family history of heart disease or obesity – you need to consult a cardiologist (heart specialist). The doctor will assess you to understand the severity of your condition. If it seems worse and you need to undergo a procedure, you will be referred to a cardiac surgeon.
Coronary artery disease, in the early stage, often produces no symptoms. Therefore, until a routine checkup reveals you have high cholesterol or high blood pressure, you may not discover you’re at risk of coronary artery disease. That is why it is important to have regular checkups.
Care at Total Cardiac Care by Dr Mahadevan Ramachandran
Total Cardiac Care is a medical speciality care centre for heart problems such as congenital heart defects, coronary artery disease and heart failure. It is led by Dr Mahadevan Ramachandran (MBBS, MS, MCh (CVTS)), a cardiac surgeon with over 15 years of independent experience in the premier hospitals of Kerala.
Dr Mahadevan Ramachandran has experience in performing more than 5000 open heart surgeries with less than 0.5% mortality rates.
- He has worked in Amrita Institute of Medical Sciences in Cochin as a consultant and performed more than 10,000 open heart procedures.
- Performed the first open heart surgery in Malappuram district in Moulana Hospital, Perinthalmanna and thereafter performed 2000 open heart surgeries independently in that institute with very high success rates.
- He has also worked as Chief Consultant cardiac surgeon in NIMS Medicity Neyyattinkara where he has performed more than 1000 open heart procedures independently.
What are the services offered at Total Cardiac Care?
- Coronary Artery Bypass surgery (Off-pump as well as on-pump)
- Heart Valve Replacement (Mitral valve, Aortic valve, Tricuspid Valve)
- Valve Repair surgery for Rheumatic as well as for myxomatous mitral valve
- Aortic root Surgery (Bentall procedure, Aortic root widening, Valve-sparing aortic valve replacement)
- Aortic aneurysm surgery for Ascending aorta, Aortic arch aneurysms, Thoracic and abdominal aortic aneurysms.
- Peripheral arterial surgeries like Aortofemoral, Femoropopliteal bypass grafting, in situ vein grafting, Cross over femoral, axillofemoral bypass grafting.
- Thoracic Surgeries (Lung surgeries like Lobectomies, pneumonectomies, decortication, Bullae excision, and Chest wall and mediastinal tumour excisions)
- Congenital heart defects like ASD closures, VSD closures, PDA ligation, Coarctation repairs.
How can I contact Dr Mahadevan Ramachandran?
Dr Mahadevan Ramachandran is available 24 hrs and can immediately address patient queries and problems in the post-op period. To book an appointment, you can call him at 9895047985 or visit Total Cardiac Care at Diagnostic Services, opposite Medical college H.S School, Kumarapuram, Trivandrum.
Dr Mahadevan Ramachandran, a cardiac surgeon with over 15 years of independent experience in the premier hospitals of Kerala. He is currently working as Chief Consultant Cardiac Surgeon at the following hospitals:
Total Cardiac Care, Thiruvananthapuram
Cosmopolitan Hospital, Thiruvananthapuram
Azeezia Medical College, Kollam
NIMS Medicity, Neyyantinkara
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