Coronary artery disease

This is the occlusion of one or more arteries supplying blood to the heart, usually because of atherosclerosis. This causes a limit of blood supply to the heart muscles. Coronary artery disease is also known as coronary heart disease.

The etiology(cause) of the disease is commonly an accumulation of lipid and fibrous materials to form a hard substance in the walls of coronary arteries. This hard substance is known as plaque. As a result, the lumen of the arteries of the heart get narrowed and hence blood flow to the heart is limited or blocked.

Risk factors of coronary heart disease can be classified into modifiable and non-modifiable. The modifiable risk factors include:

  1. Stress
  2. Obesity
  3. Uncontrolled hypertension
  4. Sedentary life style
  5. Consuming diets with high levels of saturated fatty acids
  6. High serum lipids levels/cholesterol in blood
  7. Smoking of cigarettes. Second hand smoking is also a risk factor for coronary artery disease

The non-modifiable risk factors include:

  1. Age. Susceptibility increases with age.
  2. Sex. Men are more susceptible. Women have a decreased risk upto menopause.
  3. Race
  4. Positive family history
  5. Clients with Type 2 diabetes, i.e Diabetes mellitus.
  6. Geographic location

Most of the non-modifiable risk factors can be corrected by acting on the modifiable risk factors.

The pathogenesis of coronary heart disease follows that the build up of plaque in the walls of the coronary arteries causes progressive narrowing of the lumen of these arteries. This causes resistance to blood flow to the heart.

A person with this disease can have no symptoms or show the following:

  1. Chest pain. This is known as angina.
  2. Shortness of breadth
  3. Heart attack when blood supply to the heart has been completely occluded.

Complications of coronary artery disease include:

  1. Angina-chest pain
  2. Myocardial infarction-Heart attack
  3. Heart failure
  4. Cardiac arrhythmias

Coronary heart disease can be diagnosed with the following tests:

  1. Electrocardiogram
  2. Echocardiogram
  3. Exercise stress test
  4. Nuclear stress test
  5. Angiogram
  6. CT scan of the heart. This may show calcium deposits in the arteries of the heart.

The management of coronary heart disease involves treatment with:

  1. Medications which reduce cholesterol in blood.
  2. Aspirin. This decreases the tendency of the blood to clot hence preventing the obstruction of coronary arteries.
  3. Beta blockers
  4. Calcium channel blockers- alleviate chest pain
  5. Ranolazine
  6. Nitroglycerine
  7. ACEIs and ARBs. These drugs decrease blood pressure and thus help slow or prevent the progression of coronary artery disease.
  8. Station which decreases production of harmful cholesterol in the liver.
  9. Anticoagulant
  10. Antianginal-Reduce chest pain or pressure caused by blockages in the heart arteries.
  11. Calcium channel blockers-relaxes blood vessels

N/B: Before using any of these drugs, please consult your doctor.

A coronary artery bypass surgery to restore blood flow to the heart may also need to be performed

Prevention of the disease can be effected by lifestyle changes such as:

  1. Avoiding smoking
  2. Eating healthy foods
  3. Exercising regularly
  4. Losing excess weight and
  5. Reducing stress