Coronary artery disease is one of the most common cardiological diseases. The cause of coronary artery disease is changes in the coronary vessels that lead to hypoxia of the heart muscle. The most serious consequence of coronary artery disease is myocardial infarction. A he althy lifestyle helps to prevent the development and slow down the progression of coronary artery disease. What are the symptoms and how is coronary artery disease treated?

What is coronary artery disease?

Coronary artery disease is a condition that reduces blood flow to the coronary vessels. Coronary heart disease results in a decrease in the amount of blood, and with it the oxygen and nutrients supplied to the heart muscle cells. Coronary artery disease is the most common cause of ischemic heart disease.

Myocardial ischemia causes chest pain. The longer the oxygen supply to the heart muscle cells is interrupted, the greater the risk of their necrosis. Necrosis of a part of the heart wall caused by hypoxia is called myocardial infarction.

Common symptoms of coronary artery disease

Symptoms of coronary artery disease include:

  • pain located behind the sternum, caused by hypoxia of the heart muscle, pain symptoms resemble crushing and pressure in the chest
  • pain radiating to the lower jaw, left shoulder and even shoulder

Typical for coronary heart disease are the circumstances of the symptoms that increase with the increase in oxygen demand of the heart muscle and appear when the heart becomes overloaded with work - during physical exertion, climbing stairs or strong emotions that accelerate the beating hearts.

As coronary artery disease progresses, myocardial ischemia may appear irrespective of the activity undertaken, also during rest. In stable coronary artery disease, chest pain is relieved by rest or by taking the appropriate medication (nitroglycerin). If the pain continues and does not go away with medication, it may be a symptom of a heart attack.

The 4-grade scale of the Canadian Society of Cardiology (CCS) is used to describe the severity of pain in ischemic disease. Subsequent steps on this scale correspond to the increasing advancement of coronary artery disease. IncreasePain symptoms on the CCS scale indicate the need for more intensive treatment.

CCS is graded as follows:

  • CCS class I - ailments appear only during intense physical exertion.
  • CCS II class - pain occurs during exercise slightly greater than usual (climbing stairs, climbing hills or walking>200 m on flat ground),
  • CCS Class III - ailments during normal physical activity (after walking 100-200 m flat or while climbing the first floor by stairs),
  • CCS IV class - pain occurs regardless of physical activity, also at rest.

Although chest pain is the most common symptom of coronary artery disease, it may not necessarily be present in all patients. In some cases, coronary artery disease has an atypical course and manifests itself in the form of the so-called masks. Coronary heart disease masks are symptoms that suggest a different medical condition and do not indicate that the actual cause is heart disease.

Atypical symptoms of coronary artery disease

Atypical symptoms of coronary artery disease include :

  • epigastric pains
  • nausea and vomiting
  • shortness of breath
  • decreased exercise tolerance
  • weakness

The atypical picture of coronary artery disease is statistically more common in women and also in patients with diabetes. Coronary artery disease in the form of masks increases the risk of its being overlooked or ignored.

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What causes coronary artery disease?

The causes of coronary heart disease include:

  • atherosclerosis
  • stress
  • taking drugs and certain medications
  • drinking a lot of alcohol
  • smoking

The most common cause of coronary artery disease is atherosclerosis. Atherosclerosis causes changes in the structure of the vessels and their gradual narrowing. Blood clots can easily form in the vessels of a person suffering from atherosclerosis.

All these factors lead to "clogging" of the coronary vessels, which results in myocardial ischemia. Atherosclerosis is the cause of over 98% of cases of coronary heart disease.

In rare cases, coronary artery disease may occur unrelated to atherosclerosis. An example of this is when a coronary artery spasms, which obstructs blood flow. Coronary vasospasm can occur under the influence of severe stress, the use of drugs and certain medications, as well as under the influence ofdrinking a lot of alcohol.

Spasm of the coronary vessels is especially common in smoking patients. Regardless of the cause, coronary artery disease always leads to hypoxia of the heart muscle.

Breakdown of coronary artery disease

Coronary artery disease takes many years to develop. The onset of the disease is quite insidious - changes in the coronary vessels do not cause any symptoms. The chest pain typical of coronary artery disease develops over time.

As the disease progresses, episodes of pain become more frequent. Advanced coronary artery disease may completely obstruct the coronary artery. This can lead to a heart attack.

Based on the clinical picture, we distinguish two variants of coronary artery disease:

  • chronic coronary artery disease - also called angina. The heart muscle is periodically ischemic, but the disease is stable. Symptoms appear in certain situations (e.g. increased physical exertion). Pain is relieved by rest or taking appropriate medications;
  • acute coronary syndromes - these are sudden exacerbations of coronary artery disease, most often caused by a blood clot in a coronary vessel. An example of an acute coronary syndrome is myocardial infarction. Contrary to stable coronary artery disease, pain in acute coronary syndrome is long-lasting and is not relieved by treatment. Acute coronary syndromes can be a life-threatening condition, therefore they absolutely require reporting to the hospital.

Diagnosis of coronary heart disease

The diagnosis of coronary heart disease consists of several stages. There are many studies available to help confirm the diagnosis of coronary heart disease. Their selection depends on the current condition of the patient and the severity of symptoms.

Some diagnostic tests are useful in the diagnosis of a heart attack, others are used to diagnose chronic coronary artery disease.

The main symptom of coronary artery disease, chest pain, can accompany many other conditions. If coronary artery disease is suspected, among others, pulmonary embolism, gastroesophageal reflux, pneumothorax or aortic aneurysm should be excluded.

All these diseases can cause chest pain, hence it is easy to mistake them for coronary artery disease.

The tests performed during the diagnosis of coronary artery disease are:

  • electrocardiography (EKG)
  • stress test
  • laboratory tests
  • echocardiography
  • coronary angiography

Electrocardiography (EKG)

One of the simplest tools used in the diagnosis of coronary heart disease is electrocardiography(EKG). An EKG is a record of the electrical activity of the heart. In coronary artery disease, myocardial hypoxia occurs, which may cause characteristic changes in the ECG recording.

Abnormalities in the ECG are most often seen during the symptoms (chest pain). The ECG may be normal between bouts of pain. The EKG is also used to diagnose a heart attack.

It is worth knowing, however, that some heart attacks may be unchanged in the EKG. If a heart attack is suspected and the ECG is normal, further diagnostic testing should be performed.

Stress test

In patients with chronic coronary artery disease, symptoms may appear only during increased physical activity. There is no pain during rest and the ECG is normal. To determine if you are suffering from coronary artery disease, you need to increase the workload on your heart.

For this purpose, the so-called exercise test. The stress test consists in making an intense effort by the patient (brisk walking on a treadmill or riding a stationary bike). The load during the test gradually increases until you reach your maximum heart rate.

The patient is constantly monitored (regular blood pressure measurements, constant ECG recording). If you develop chest pain, heart problems, or large fluctuations in blood pressure, the stress test is stopped. If during the examination there are changes in the ECG indicative of ischaemia, the test is considered positive.

Laboratory tests

Laboratory tests in the diagnosis of coronary artery disease are performed primarily in the event of a suspected heart attack. A heart attack causes necrosis in part of the heart muscle. Disintegrating cells release various molecules into the bloodstream and use them as markers.

Troponins are the most frequently reported marker of myocardial necrosis. If a heart attack is suspected, the level of troponins should be checked at least three times at intervals of several hours. Rising troponin levels are evidence of myocardial necrosis.

In most cases it indicates a heart attack. However, it is worth remembering that the level of troponins may also increase in other heart diseases (e.g. myocarditis). For this reason, the results of the troponin test are always interpreted in relation to the clinical symptoms and the EKG recording.

Echocardiography

Echocardiography (the so-called echo of the heart) is an examination of the heart using an ultrasound machine. The echo of the heart allows you to accurately assess the anatomy of the heart - its wall contractility, valve function and blood flow in the heart cavities. Echocardiography canbe used to diagnose coronary artery disease and diagnose its complications.

One of the variants of echocardiography is the so-called stress echo, somewhat reminiscent of an exercise test. Contrary to a standard exercise test, the patient does not need to be active during the test. Instead, he is given drugs to increase the work of his heart.

If, after taking the drugs, the heart starts to contract worse in the echo test, the test result is positive. Echocardiography is also useful for examining patients who have had a heart attack. Thanks to it, it is possible to assess the degree of heart damage, detect contractility disorders, and also diagnose post-infarction heart failure.

Coronary angiography

The above-mentioned methods of diagnosing coronary artery disease are non-invasive tests. The final and most accurate confirmation of coronary artery disease is obtained in an invasive examination - coronary angiography. Coronary angiography is a test that allows the imaging of the coronary arteries.

Apart from the ability to accurately show the stenosis in the coronary arteries, coronary angiography has one more important advantage - it serves not only the diagnosis, but also the treatment of coronary artery disease. Coronary angiography involves the insertion of a special catheter near the coronary arteries.

Initially, the catheter is inserted into the radial or femoral artery and then advances along the vessel towards the heart. After reaching the target location, contrast is administered to the coronary arteries. Then the image of the contrast flowing through the vessels is recorded.

In a he althy person, all the coronary vessels quickly fill with contrast. In a patient with coronary artery disease, the narrowing of the arteries slows the movement of contrast. In case of extreme narrowing of the coronary vessels, the flow of contrast may be completely blocked.

In addition to a thorough analysis of the location and severity of the stenosis, it is possible to dilate the coronary arteries with stents during coronary angiography.

Treatment of coronary artery disease

The treatment of coronary artery disease consists of 3 main methods:

  • lifestyle modification
  • pharmacotherapy
  • invasive treatment (treatments)

In the early stages of the disease, the first two interventions are mainly used. Invasive treatment is reserved for patients with advanced coronary artery disease and acute coronary syndromes (myocardial infarction).

Lifestyle modification

The right lifestyle plays a huge role in every phase of coronary artery disease. Regular, patient-adapted physical activity, quitting smoking and a proper diet allow you to significantly slow downthe progression of the disease.

Basic nutrition rules for patients with coronary artery disease include avoiding excess caloric intake, reducing processed food consumption, consuming vegetables and fruits with every meal, and significantly reducing the diet of fatty foods, sweets and alcohol.

Pharmacotherapy

Drugs used in the treatment of coronary heart disease can be divided into two groups. The first of these are causal drugs - reducing the risk of a heart attack and inhibiting the progression of atherosclerosis. These include statins, which lower blood cholesterol, and acetylsalicylic acid (75 mg aspirin), which reduces the risk of blood clots in the vessels.

Statin and acetylsalicylic acid are the basic drugs that should be taken by every patient with coronary artery disease. Additional medications may be needed if you have other medical conditions, such as diabetes or high blood pressure.

The second group of drugs used in the treatment of coronary artery disease are symptomatic preparations. Their action enables the reduction of pain caused by heart ischemia. This group includes vasodilators, including nitrates, beta-blockers and calcium channel blockers.

The most commonly used symptomatic drug is nitroglycerin. Nitroglycerin is available as fast-absorbing sublingual formulations to help reduce chest pain in minutes.

It is worth remembering that the chest pain should subside within 5 minutes after the administration of nitroglycerin. If the pain persists after this time, it may be a sign of a developing heart attack. In such a situation, you should immediately call an ambulance.

Treatment treatment

If, despite proper pharmacological treatment, the progression of the coronary heart disease cannot be slowed down, surgical treatment may be necessary. It is reserved for patients with significant narrowing of the coronary arteries who may experience a heart attack at any time.

Surgical treatment is also the basic and most effective method of treatment of acute coronary syndromes.

The two types of treatments used in coronary artery disease are:

  • Percutaneous Coronary Interventions (PCI)- a procedure involving the widening of narrowed coronary vessels. It is usually performed together with coronary angiography, i.e. an imaging examination of the coronary arteries. After the contrast is administered to the coronary vessels, their narrowing becomes visible. Then, the therapeutic part of the procedure begins. Depending on the needs, blood clots and plaques are removedatherosclerotic lesions of the coronary vessels, and sometimes stents are inserted. Stents are special, thin tubes that widen the vessels and restore blood flow. Percutaneous coronary interventions are invasive but do not require opening the chest or open-heart manipulation. All tools enter the body through the radial or femoral arteries. The dilatation of the coronary vessels is performed urgently - to unblock the vessels in a heart attack or elective - to improve the blood supply to the heart in advanced coronary artery disease. In recent years, the techniques of procedures on coronary vessels have been significantly improved, and the increasing experience of cardiologists translates into a significant improvement in the safety of procedures.
  • Coronary Aortic Bypassing (CABG)- Compared to stenting, coronary aortic bypass is more invasive, requiring the opening of the thorax and the use of extracorporeal circulation. In some patients, it is the only possible treatment method. If coronary artery disease affects many vessels at the same time or the placement of stents is technically impossible, it is necessary to perform a so-called by-passes. The essence of the procedure is to create new coronary vessels that supply blood to the heart. Vascular bypass grafts are performed with the use of other vessels taken from the patient (most often the saphenous vein). Coronary bypass surgery is associated with a hospital stay of several days, followed by rehabilitation for several weeks. For patients who cannot undergo less invasive percutaneous (stenting) surgery, by-passes are the only treatment option for advanced coronary artery disease.

Risk factors for coronary heart disease

Coronary artery disease is an example of a disease whose development largely depends on the patient's lifestyle. By appropriate pro-he alth measures, you can significantly reduce the risk of coronary heart disease and slow its progression. Knowing the risk factors for coronary artery disease is a very important element of its prevention.

Factors increasing the risk of coronary artery disease are divided into: modifiable (depending on the patient's actions) and non-modifiable (those that are beyond the patient's control).

Modifiable risk factors for coronary heart disease are:

  • high cholesterol
  • obesity
  • hypertension
  • blood glucose increased

Modifiable risk factors for coronary artery disease depend on our lifestyle. Incorrect diet and insufficient physical activity have numerous consequences. All of these factorsaffect the progression of atherosclerosis, which results in coronary artery disease.

All arterial vessels, including the coronary vessels, are adversely affected by cigarette smoking. Both active and passive smoking are a significant risk factor for coronary artery disease. Coronary artery disease is also related to the daily level of stress - chronic emotional tension can aggravate its symptoms.

The risk factors for coronary artery disease independent of the patient's lifestyle are:

  • age - the risk of coronary heart disease increases with age;
  • gender - coronary heart disease in middle-aged people more often affects men. Female sex hormones - estrogens - partially protect the blood vessels from the progression of atherosclerosis. After the menopause, when the level of female sex hormones decreases, coronary artery disease affects both sexes with equal frequency;
  • genetic burden - a family history of atherosclerosis and other cardiovascular diseases also increases the risk of developing coronary heart disease.
Worth knowing

Structure of the heart and its physiology

The heart is the central organ of our circulatory system. Its function can be compared to a pump that pumps blood into the blood vessels. The heart contracts an average of 70 times a minute, which is over 100,000 beats a day.

During the day, the heart pumps up to 7,000 liters of blood. The effort of the heart muscle is continuous, both during the day and at night. The workload of the heart is incomparably greater in relation to other muscles of our body.

In order for the heart muscle to contract continuously, it requires a constant supply of nutrients. The most important of these is oxygen - the basic ingredient that maintains the vitality of the heart muscle cells. In addition to oxygen, proper concentrations of electrolytes are necessary for the proper functioning of the heart - incl. calcium, sodium and potassium.

How is the heart muscle supplied with oxygen and nutrients? A special part of the circulatory system is responsible for this function - the so-called coronary vessels. Two coronary arteries - right and left - wrap around the entire heart muscle.

The name of the coronary arteries comes from the shape of the crown around the heart. The coronary arteries begin at the beginning of the aorta. In their course, they create smaller and smaller branches that gradually penetrate deeper and deeper layers of the heart muscle.

Thanks to the coronary vessels, blood, and with it oxygen and nutrients, can reach every cell that builds the heart.

Find out which diseases weaken the heart

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The effects of the diseasecoronary

Coronary artery disease is an insidious disease. Appropriate treatment and lifestyle changes can significantly slow down its progress. However, if the right steps are not taken, coronary artery disease will continue to develop.

Progressive atherosclerosis can completely obstruct the coronary vessels. Then the risk of a heart attack increases significantly.

A heart attack is the death of some cells in the heart muscle, caused by a lack of oxygen and nutrients. A heart attack is the most dangerous form of coronary artery disease. A heart attack requires prompt diagnosis and treatment.

Unfortunately, some heart attack patients die even before they come to the hospital. We are talking then about sudden cardiac death - the most dramatic effect of coronary heart disease.

When part of the heart wall dies, a wound forms at the site of the necrosis. Heart cells cannot regenerate. The wound may heal over time, but the heart remains permanently damaged.

A heart attack carries the risk of further complications, as the heart muscle will never work the same again. In the early post-infarction period, there is a risk of rupture of the heart wall and sudden damage to the heart valves. The way in which electrical impulses are conducted in the heart is also changing.

For this reason, any heart attack carries the risk of serious arrhythmias that can be life-threatening. The infarcted region is devoid of contractility. A heart that is contracting abnormally may not be able to pump enough blood.

This condition is called heart failure. The larger the area of ​​the heart affected, the greater the risk of developing heart failure.

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Cardiology