Coronary heart disease, also known as coronary artery disease, is a condition in which plaque is deposited within the coronary arteries. These arteries supply oxygen-rich blood to the cardiac muscle, which is the heart muscle.
Causes of coronary heart disease
The most common cause of coronary heart disease is atherosclerosis, which is when plaques occur within the coronary arteries. These plaques are made up of cholesterol, various fatty substances, calcium and fibrin, which is procoagulant. There are two types of plaques: hard plaque and soft plaque.
– Hard plaque tends to grow progressively and at some point causes an imbalance and/or interruption between the blood that reaches the heart muscle and the blood it needs, causing what is known as angina pectoris and/or myocardial infarction.
– Soft plaque tends to evolve differently and its mediation is conditioned by the existence of an inflammatory process that activates the coagulation process and can suddenly obstruct the lumen of the coronary artery completely, causing an acute myocardial infarction.
Some of the factors that increase the probabilities of having heart disease are:
– high cholesterol levels
– high blood pressure
– diabetes
– a diet very high in saturated fat
– overweight
– sedentary lifestyle
– too much stress
– smoking
– having close relatives with heart disease at an early age
Symptoms of coronary heart disease
You may not know you have coronary artery disease until you begin to have symptoms of clogged arteries. Chest pain (angina) and shortness of breath are often the first signs of coronary artery disease. Some people don’t know they have coronary artery disease until they have a heart attack.
If you have several of the risk factors you should talk to your doctor even if you have no symptoms. There are some steps you can take to lower your risks and improve the health of your heart and blood vessels.
A person can have coronary artery disease for many years without symptoms. This slow disease process may begin in childhood. In some people, the disease may cause symptoms in their 30s and 40s, while others do not have symptoms until after age 50 or 60. But as the degree of blockage increases, the reduced blood flow to the heart may begin to cause what is called angina pectoris.
Some patients with coronary artery disease may not have symptoms of angina pectoris. Sometimes the poor oxygen supply to the heart (called ischemia) does not cause any pain. This is called silent ischemia.
Another form of coronary artery disease is myocardial infarction, which is caused by a total blockage of the coronary artery. The blockage of the coronary artery prevents oxygen- and nutrient-rich blood from reaching a section of the heart. If blood cannot reach the heart muscle, the heart muscle will die. If treatment is obtained immediately, the damage can be reduced, but if a section of heart muscle dies, the damage is irreversible.
Treatments for coronary heart disease
1. Medications: Several medications help relieve the pain of angina caused by coronary artery disease. People suffering from severe angina are often given several different medications. Antiplatelet medications such as aspirin may also be given to patients with angina because these medications decrease the likelihood of blood clots forming at the sites of blockages.
– A drug called nitroglycerin can widen or dilate arteries and thus improve blood flow to the heart.
– Beta-blockers “block” chemical messages the heart receives that might make it work harder than it needs to.
– Calcium channel blockers help keep arteries open and lower blood pressure by relaxing the smooth muscle that surrounds the arteries in the body.
2. Percutaneous interventions: Angioplasty opens narrowed arteries, a procedure performed by interventional cardiologists, using a long, thin tube called a “catheter” that has a small balloon (or balloon) at the tip, which they inflate at the site of the artery blockage to compress the plaque against the artery wall. Angioplasty is also called percutaneous transluminal coronary angioplasty (PTCA).
Balloon angioplasty is complemented by the placement of a stent. The stent is a tubular metal mesh that is implanted in the area of the artery obstructed by the plaque. Current stents are coated with drugs that reduce the possibility of the artery closing again. These are called drug-eluting stents.
Rotational atherectomy may be another option for those patients for whom balloon angioplasty is not effective due to the hardness of the plaque. This device presents a small olive surrounded by diamond crystals in the distal part of the catheter that rotates at high revolutions (between 160,000 and 190,000) per minute and cuts the hard plaque to subsequently continue with stent implantation.