Coronary artery disease

Angina or chest pain is the most common symptom of CAD. Angina develops when excessive plaque deposits inside the arteries, narrowing them.

Angina may cause symptoms such as:

• Heaviness
• Pressure
• Tightening
• Burning
• Indigestion
• Heartburn
• Sweating

For many individuals, a heart attack is the first indication that they have CAD. Some symptoms of a heart attack include:

• Chest pain or angina
• Weakness
• Nausea
• Cold sweat
• Discomfort in the arms or shoulder
• Shortness of breath or trouble breathing
• Heart palpitations

Over time, CAD can weaken the heart muscle, potentially leading to heart failure, a life-threatening condition where the heart cannot pump blood effectively.

Are you confused between angina, heartburn, and heart attack? Learn the difference.

Atherosclerosis or gradual buildup of plaque in coronary arteries (the major blood vessels in the body that supply blood to the heart) causes coronary artery disease.

Over time, this plaque, which is composed of:

• Cholesterol
• Waste products
• Calcium
• Fibrin (which aids in blood clotting)

narrows or blocks the coronary arteries. This impairs their ability to supply sufficient blood, oxygen, and nutrients to the heart, leading to chest pain and increasing the risk of a heart attack.

Multiple risk factors can lead to coronary artery disease. They are broadly divided into non-modifiable and modifiable factors:

I. Non-modifiable risk factors

• Hereditary: Genetic factors are a significant risk factor for CAD. People with a family history of CAD are more prone to develop this condition.
• Age: The risk of CAD significantly increases after 35 years of age in both men and women.
• Gender: Men are more likely to have CAD compared to women. Evidence has shown that lipoprotein (a), a cardiovascular risk factor, seems to be elevated in men more than in women.

II. Modifiable risk factors

• Hypertension (High Blood Pressure): High blood pressure is a major risk factor for coronary artery disease, characterized by blood pressure in the arteries greater than 185/115 mm Hg. Is your blood pressure under control? Explore our wide range of BP monitors to check your BP in the comfort of your home. Click To Shop
• Abnormal cholesterol profile: An abnormal cholesterol profile, or dyslipidemia, characterized by excessive bad cholesterol (triglycerides and LDL) and low good cholesterol (HDL), is a significant risk factor for CAD. The excess cholesterol circulating in the bloodstream forms plaque that blocks the arteries, depriving the heart of oxygen-rich blood.
• Diabetes mellitus: Diabetes is a condition in which blood glucose levels remain consistently above normal. The risk of heart disease is 2.5 times higher in men and 2.4 times higher in women with diabetes compared to those without. Note: India is the diabetes capital of the world. Diabetes predisposes individuals to heart disease and a plethora of other long-term complications. Watch our expert discuss diabetes, its complications, and prevention.
• Obesity: Obesity increases the development and progression of coronary artery disease (CAD). The majority of individuals with coronary heart disease (CHD) are overweight or obese, which is the root cause of a wide range of diseases, including heart disease. Click to read more
• Lack of physical activity: A sedentary lifestyle predisposes individuals to obesity, high blood pressure, high bad cholesterol, and diabetes, all of which are major risk factors for CAD.
• Diet rich in unhealthy fats: A diet loaded with saturated fats, trans fats, and packaged foods increases the risk of obesity and high bad cholesterol significantly. This results in excessive plaque formation in coronary arteries, leading to CAD.
• Vitamin D deficiency: Moderate to severe vitamin D deficiency is associated with an increased risk of cardiovascular diseases, including high blood pressure, CAD, and heart failure. Read about various causes of Vitamin D and when to get tested for optimum levels.
• Excessive alcohol intake: Drinking too much alcohol can raise blood pressure levels and the risk of heart disease. It is recommended that women should have no more than one drink a day and men should have no more than two drinks a day.
• Tobacco: The use of tobacco and exposure to secondhand smoke significantly increases the risk of heart diseases. Smoking increases plaque deposition in arteries and reduces the blood's capacity to carry oxygen, predisposing individuals to CAD. Looking to quit smoking? Try our range of smoking cessation products and detach yourself from this deadly habit. Buy Now
• Periodontitis: This severe gum infection can lead to tooth loss. Research suggests that periodontitis can expose the body to oral bacteria, leading to plaque buildup in blood vessels and coronary heart disease.
• Chronic kidney disease (CKD): Patients with CKD exhibit an elevated risk of coronary artery disease due to accelerated aging of the cardiovascular system.
• Air pollution: Breathing poor-quality air allows pollutants to travel deep into the bloodstream, increasing the risk of heart and circulatory diseases. Long-term exposure to air pollution can lead to premature aging of blood vessels and rapid calcium buildup in coronary arteries, predisposing individuals to plaque formation and CAD.

CAD is usually diagnosed through physical examination and relevant diagnostic tests. If a person presents symptoms such as chest pain, shortness of breath, and cold sweat, the doctor will evaluate the heart's electrical activity and the heartbeat's regularity, followed by further diagnostic procedures.

I. Physical Examination and Medical History

A medical practitioner typically diagnoses CAD through a physical examination and medical history.

The doctor will check parameters such as blood pressure and inquire about:

• Medical history
• Lifestyle
• Family history (to determine if heart disease is present among biological parents and siblings)

The assessment includes symptoms of:

• Chest pain
• Pain in the jaw, neck, left arm, or back
• Shortness of breath during rest and activity

II. Imaging Tests

The medical practitioner may recommend one or more tests to assess heart function and diagnose CAD:

1. Non-Invasive Tests

• Chest X-ray: This test uses a small amount of radiation to create images of the chest, including the heart.
• Electrocardiogram (ECG): A cost-effective and readily available test that records the heart's electrical activity.
• Echocardiography: An ultrasound of the heart that translates sound waves into images, allowing assessment of the heartbeat and blood pumping.
• Stress Test: Evaluates how well the heart and blood vessels function under stress induced by exercise or medication. Images show heart structure and muscle pumping efficiency.
• Computed Tomography (CT) Scan: A diagnostic imaging procedure that uses X-rays and computer technology to produce images of the body, checking for plaque buildup in coronary arteries.
• Magnetic Resonance Imaging (MRI) Scan: A painless test that produces clear images of internal organs and structures, detecting tissue damage or blood flow issues in the heart or arteries.
• Cardiac Positron Emission Tomography (PET) Scanning: A noninvasive nuclear imaging test using radioactive tracers to produce heart images, identifying areas with insufficient blood supply.
• Coronary Calcium Scoring: Measures calcified plaque in the heart's arteries to evaluate the risk of a heart attack.
• Nuclear Ventriculography: A noninvasive procedure using radioactive tracers to show heart chambers and detect anomalies.

2. Invasive Tests

• Coronary Angiography: Also known as cardiac catheterization, this gold standard test involves injecting a contrast dye into coronary arteries to visualize blockages.
• Electrophysiology Study: An invasive test assessing the heart's electrical system, diagnosing abnormal heartbeats by measuring electrical activity through catheters.

III. Lab Tests

• Total Cholesterol: Measures the total cholesterol level in the blood; less than 200 mg/dL is normal, while greater than 240 mg/dL is high.
• Triglycerides (Tg): A type of fat in the blood; levels less than 150 mg/dL are optimal, with high levels increasing CAD risk.
• Low-Density Lipoprotein (LDL) Cholesterol: Elevated levels cause plaque accumulation in arteries; normal is less than 100 mg/dL, while greater than 190 mg/dL is very high.
• High-Density Lipoprotein (HDL) Cholesterol: High levels reduce CAD risk; levels greater than 60 mg/dL are beneficial, while less than 40 mg/dL increase cardiovascular disease risk.
• High Sensitivity C-Reactive Protein: Elevated levels are linked to increased heart disease risk and can indicate risk before symptoms appear.
• Lipoprotein (a): High levels indicate increased risk of heart disease and stroke, often influenced by genetic factors.
• Troponin: Measures troponin T or I levels in the blood, indicating heart muscle damage and risk of heart diseases.
• Homocysteine: Measures homocysteine levels; increased levels correlate with CAD severity.
• B-type Natriuretic Peptide (BNP): High levels indicate heart damage; BNP levels rise with the number of diseased coronary arteries.

The following tips can help in preventing or reducing the risk for coronary artery disease:

1. Consume a healthy diet
   A healthy, balanced, and wholesome diet plays a pivotal role in the prevention of coronary artery disease. Here are some food items that you should prefer and others you should avoid in your diet.
   Foods to prefer:
   • Green leafy vegetables
   • Legumes
   • Whole fruits
   • Whole grains like wheat, brown rice, jowar, ragi, and bajra
   • Low-fat or fat-free milk or yogurt
   • Unsalted nuts and seeds
   • Eggs, fish, seafood, lean poultry
   • Vegetable and nut oils like olive oil, canola oil
   Foods to limit or avoid:
   • Refined grains like white flour or white bread
   • Table sugar
   • Sugar-sweetened beverages
   • Packaged foods
   • Red and processed meats
   • Butter, coconut, palm, cottonseed, and palm kernel oils, and other oils that congeal at room temperature
   • Alcohol consumption
   • High salt intake
   A DASH diet or Dietary Approaches to Stop Hypertension diet emphasizes portion control, adequate nutrient intake, and lowering the risk of hypertension and eventually CAD.

   Read more about DASH

2. Indulge in physical activity
   Combining a healthy diet with regular exercise is the best way to maintain a healthy weight. Regular exercise strengthens your heart and blood circulatory system, lowers cholesterol levels, and helps control blood pressure.
   Try these easy exercises to keep your heart in good health.
3. Avoid smoking
   Smoking is detrimental to heart health. Research shows that quitting smoking significantly reduces the risk of developing coronary heart disease.
   Looking to quit smoking? Read about practical ways to overcome this unhealthy habit.
4. Manage your stress effectively
   Stress, anxiety, and negative mental health are associated with an increased risk of heart disease and stroke. Finding ways to manage stress is essential for health.
   Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.
5. Get sound and sufficient sleep
   Poor sleep quality is linked to high blood pressure and elevated cholesterol, major risk factors for CAD. A healthy diet, regular exercise, sleep hygiene, and low stress can promote restorative sleep essential for good cardiovascular health.
   Struggling to fall asleep? Read about tips that will help you sleep better.
6. Keep your blood pressure under control
   Always monitor your blood pressure. Eat a healthy diet, exercise regularly, and take prescribed medications if needed to maintain healthy blood pressure levels.
   Read these practical tips to help keep your blood pressure in check.

Treatment for coronary artery disease (CAD) involves managing the symptoms and reducing the risk of further problems. CAD can be managed effectively with a combination of lifestyle changes, medications, and, in some cases, surgery.

I. Medications

The main aim of medications is to either reduce blood pressure or ease blood flow in arteries.

• Blood thinners: Blood thinners help reduce the risk of a heart attack by thinning the blood and preventing clotting. Common blood thinners include:
  • Clopidogrel
  • Rivaroxaban
  • Ticagrelor
  • Aspirin
• Beta blockers: These medicines are used to treat angina and high blood pressure. Common beta blockers include:
  • Atenolol
  • Bisoprolol
  • Metoprolol
• Statins: This class of drugs works by blocking the formation of bad cholesterol (low-density lipoprotein, LDL). Common statins include:
  • Rosuvastatin
  • Pravastatin
  • Atorvastatin
• Calcium channel blockers: These drugs decrease blood pressure by relaxing the muscles, causing the arteries to widen. Common calcium blockers include:
  • Amlodipine
  • Verapamil
  • Diltiazem

  Note: Taking calcium supplements without consulting your doctor could increase the risk of plaque buildup in arteries.

• Nitrates: Nitrates are vasodilators used to widen blood vessels. They work by relaxing blood vessels, allowing more blood to flow through and lowering blood pressure. Common nitrates include:
  • Glyceryl trinitrate
  • Isosorbide mononitrate

  These drugs are available in various forms, including tablets, sprays, and skin patches.

• Angiotensin-converting enzyme (ACE) inhibitors: This class of drug is used in the treatment of high blood pressure by blocking the activity of a hormone called angiotensin-2, which narrows blood vessels. Common ACE inhibitors include:
  • Ramipril
  • Lisinopril

  Note: Heart medications should never be stopped suddenly without consulting your doctor, as there is a risk of worsening symptoms.

II. Surgery

In cases of narrowed blood vessels due to a buildup of fatty deposits or lack of relief from prescribed medications, surgery may be needed to open up or bypass blocked arteries.

• Coronary angioplasty: Also known as percutaneous coronary intervention (PCI) or balloon angioplasty, this procedure involves inserting a small balloon to push fatty tissue in the narrowed artery outward, allowing blood to flow more easily. It can be planned for angina or performed as emergency treatment for a heart attack.
• Coronary artery bypass graft (CABG): Also known as bypass surgery or heart bypass, this procedure restores blood flow to areas of the heart that are blocked, causing heart attacks and CAD.
• Heart transplant: When the heart is severely damaged and unable to adequately pump blood, a heart transplant may be necessary.

Lifestyle changes are a cornerstone to improving your heart health. Staying physically active and making wise choices of foods to eat help in managing CAD.

I. Engaging in Physical Activity

Living with a heart condition can make you feel hesitant to exercise. Whether you have undergone heart surgery or are taking medication for a heart condition, don’t shy away from exercising. It is an important part of keeping your heart in good health. The following guidelines will help you in your exercising journey:

• Doctor’s Consent: Always consult your doctor about which exercises are beneficial for you according to your health. Exercise programs, especially for patients with heart conditions, have to be tailored according to the individual’s exercise capacity and risk profile.
• Aerobic Exercises: Aerobic exercises are usually advised for individuals with CAD, as they help the heart utilize oxygen better and improve blood circulation. You can choose an aerobic activity such as brisk walking, stretching, swimming, or light jogging. Aim for 15-20 minutes, 3-4 times a week. Always start slowly and gradually increase the pace.
• Resistance Training: Lifting weights increases muscle strength by making the muscles work against a weight or force. This training can be performed 2-3 days per week and includes one set of 8-10 exercises targeting all major muscle groups. Ensure you work out under the supervision of a professional trainer.
• Warm Up & Cool Down: Always perform a short warm-up session before starting the main exercise. After exercising, it is equally important to cool down.
• Take a Break When Tired: Take a break of a few minutes in between sessions if you get too tired. Sip some water. If you continue to feel exhausted, stop exercising. Also, don’t overexert yourself if you are unwell or have a fever.
• Wear the Right Clothing: Wear comfortable and breathable clothes that enable you to stretch easily while exercising.

Are you still apprehensive about starting to exercise after stent surgery? Read some tips that will help you navigate your exercising journey post-surgery.

II. Making Dietary Changes Amicable to Heart Health

After the diagnosis of CAD, making dietary changes can improve the condition of your heart and also reduce the risk of having further episodes. Quitting smoking and alcohol intake goes without saying. Watch this informative video to learn about dietary modifications for improving your heart’s health.

A Special Mention to These ‘Star Nutrients’

• Omega-3 Fatty Acids: Omega-3 fatty acids are “healthy fats” that support heart health. They help reduce inflammation and triglycerides, mildly lower blood pressure, and boost immune functioning. Rich sources of Omega-3 fatty acids include:
  • Nuts and seeds like flax seeds, chia seeds, and walnuts
  • Plant oils such as flaxseed oil, soybean oil, and canola oil
  • Fish, especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines, and other seafood
  Supplements can be considered under the guidance of a healthcare provider.
• Vitamin D: Vitamin D is beneficial for reducing the risk of heart disease. Bask in the morning sunshine for optimum levels of this vitamin. You can also load your plate with foods rich in vitamin D like milk, eggs, fortified orange juice, tuna, and soya milk. Fill any gaps in your Vitamin D levels with dietary supplements.

• Chest pain (angina): In cases of narrowed coronary arteries, the blood supply to the heart is insufficient, which can lead to chest pain (angina) or shortness of breath.
• Irregular heart rhythms (arrhythmias): When the heart does not receive adequate blood and oxygen due to CAD, the normal heart signaling can be disrupted, leading to irregular heartbeats.
• Heart failure: The narrowing of arteries due to CAD weakens the heart, making it difficult for the heart to perform its functions. Heart failure occurs when the heart cannot pump blood effectively to meet the body's requirements.
• Heart attack: The rupture of plaque in one of the coronary arteries can result in the formation of blood clots. This blood clot can obstruct the supply of blood and oxygen to the heart, leading to a heart attack.

• Yoga: Yoga plays a crucial role in enhancing the overall health of individuals with coronary artery disease (CAD). It significantly improves obesity, lipid profile, blood pressure, and diabetes mellitus. Practicing yoga can help maintain heart health.
• Acupuncture: Research indicates that acupuncture can be an effective complementary therapy for CAD, as it enhances blood circulation throughout the body and within the heart.

It's possible to lead a normal life after having heart surgery or experiencing a heart attack. Here are a few tips that will help you in your journey of recovery from CAD:

1. Cardiac Rehabilitation Program: This is a major step for anyone recovering from a heart attack, heart failure, or other heart problems that require surgery or medical care. This rehab program aims to improve the quality of life and prevent another cardiac event. A supervisor will guide you regarding:
   • Physical activity
   • Healthy eating
   • Ways to relieve stress and improve mental health
2. Coordinate with Your Doctor: Keep in regular touch with your doctor. Make sure to consult your doctor in case of any health issues.
3. Follow a Proper Medication Regimen: Take the medications prescribed by your doctor regularly without fail. It is also advisable to consult your doctor when starting any medication for other medical conditions to avoid interactions between different drugs.
4. Join Support Groups: If you have a heart condition, you might find it useful to meet other people who are facing a similar situation. This can provide motivation to live with your condition.