Coronary Artery Diseases : Medicines to Surgical Treatment

Coronary artery disease widely known as CAD is an artery that supplies blood to your heart. CADs are grouped under cardiovascular disease which according to WHO accounts for more than 32% of deaths worldwide. In developed countries coronary artery diseases are a public health problem. Coronary artery disease (CAD) occurs when the inner lining of the arteries becomes damaged due to the buildup of plaque on the vessel walls. This plaque accumulation causes the arteries to harden and narrow, a condition known as atherosclerosis. As a result, blood flow is restricted, putting extra strain on the heart and potentially leading to a heart attack. High cholesterol levels, stress and a sedentary lifestyle are the main villains of the story!

The Role of Atherosclerosis in CAD

•  The major risk factors for atherosclerosis (high levels of plasma low-density lipoprotein [LDL], low plasma high-density protein (HDL) and diabetes. Diabetes mellitus  disturbs the normal functions of epithelium.
•  Functional changes in the vessels ultimately result in the collections of fat, smooth muscle cells, fibroblasts, and intercellular matrix that define the atherosclerotic plaque. The first site of collection of fat is the coronary artery leading to narrowing and thickening of vessels. 
• Rather than viewing atherosclerosis strictly as a vascular problem, it is useful to consider in in the context of alterations in the nature of the circulating blood hyperglycemia; increased concentrations of LDL cholesterol, tissue factor, fibrinogen, von Willebrand factor, coagulation factor VII, and platelet microparticles).
•  The combination of a “vulnerable vessel” in a patient with “vulnerable blood” promotes a state of hypercoagulability and hypofibrinolysis.

Recognizing the Symptoms of Coronary Artery Disease

Our heart is a magical organ, it keeps working tirelessly until the end stage! Early stage of CAD does not show any symptoms. In Indian practice due to lack of regular screening, it is often unnoticed. Due to continuous deposition of fat, slowly the functioning of the heart because of lack of oxygen supply. As the heart slows down, it slows your body too! Here is a list of cardinal symptoms of coronary artery diseases. 

Chest Pain 

Chest pain, also known as angina, is a common symptom of coronary artery disease (CAD). It occurs when the heart muscle doesn’t get enough oxygen-rich blood due to narrowed or blocked coronary arteries. The pain can feel like pressure, tightness, or squeezing in the chest and may also radiate to the shoulders, arms, neck, or back. Angina is often triggered by physical activity, stress, or heavy meals and usually subsides with rest. However, persistent or severe chest pain may indicate a heart attack and requires immediate medical attention.

Shortness of Breath

Shortness of breath is a common symptom in patients with coronary artery disease (CAD). It occurs when the heart is unable to pump enough blood to meet the body’s needs, particularly during physical activity. As the coronary arteries narrow due to plaque buildup, the heart receives less oxygen, which can lead to difficulty breathing. This symptom may be experienced alongside chest pain or independently. In some cases, shortness of breath may be an early warning sign of an impending heart attack, so it’s important to seek medical attention if this symptom occurs frequently or suddenly worsens.

Fatigue 

Fatigue is a frequent symptom in patients with coronary artery disease (CAD). It occurs because the heart’s reduced ability to pump blood effectively means that the body’s organs and tissues receive less oxygen and nutrients, leading to a general sense of tiredness and lack of energy. This chronic fatigue can be especially noticeable during physical activities that previously were easy to perform. In some cases, fatigue may be one of the earliest signs of CAD, even before more obvious symptoms like chest pain or shortness of breath appear. 

See your doctor if you persistently feel tired, breathless, or experience chest pain. Medanta – The Medicity in Gurugram has a team of cardiologists to reduce future complications. As a preventive measure, always monitor your lifestyle, especially as you enter your 30s.

Medications for Coronary Artery Disease

Here are few drugs used for patients with mild CAD or for prevention of future complications like stroke or heart attack. 

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs): According to many standard studies, high blood pressure should be investigated well. Patients with CAD tend to have hypertension due to blockage. These drugs are given to reduce blood pressure. 

Aspirin : It has a wide range of applications in medicine. In CAD patients it used to thin blood to prevent clots and heart attacks. Daily consumption of aspirin can lead to a bleeding stomach or intestine. 

Cholesterol medicine : Since LDL or bad cholesterol is the main villain of the story, your doctor advises you to take these drugs to improve the condition. 

Beta-Blockers : These medications work by blocking the effects of adrenaline on the heart, which slows down the heart rate and reduces the force of each heartbeat. By doing so, beta blockers decrease the heart’s demand for oxygen, making it easier for the heart to function even when the coronary arteries are narrowed or blocked. This helps to relieve symptoms like chest pain (angina). 

It is always crucial to decide treatment plans, you can visit Artemis Hospital in Gurugram to build an integrated treatment plan. A good team of doctors can make your journey easy. 

Surgical Treatment of CAD

Coronary Artery Bypass Grafting (CABG) is a surgery where a blocked coronary artery is bypassed using a healthy artery or vein. If there are additional blockages that cannot be bypassed with an artery, a vein (often the saphenous vein from the leg) is used to create a new route from the aorta to the coronary artery, bypassing the blockage. Comprehensive management plays a crucial role, Fortis Cardiac Care in Gurugram believes in wellness and works with patients closely in an integrated manner. 

There is some debate about when CABG should be done, but doctors agree on a few points:

1. The surgery is generally safe, with a very low risk of death (less than 1%) in patients who are otherwise healthy, have a well-functioning heart, and are operated on by an experienced surgical team. Marengo Hospital in Gurugram has highly experienced doctors, successfully performing 400+ surgeries.
2. The risk of death during or after surgery increases if the patient has severe heart problems, other health issues, is older than 80, or if the surgical team is less experienced. The success and risk of the surgery greatly depend on choosing the right cases and the skill of the surgeons.

Advantages of CABG

• Angina is abolished or greatly reduced in -90% of patients after complete revascularization. 
• Survival may be improved by operation in patients with stenosis of the left main coronary artery as well as in patients with significant obstruction of the proximal left anterior descending coronary artery. 
• Survival may also be improved in the following patients: (a)patients with obstructive CAD who have survived sudden cardiac death; (b) patients who have undergone previous CABG, especially of a graft supplying the left anterior descending coronary artery, and (c) patients with recurrent stenosis. 
• Among patients with type 2 diabetes mellitus and multivessel coro- nary disease, CABG surgery plus optimal medical therapy is superior to optimal medical therapy alone in preventing major cardiovascular events. 

Opting for a surgical treatment can be challenging. Talk to your healthcare provider about the severity of coronary heart disease. Multiple blockage needs surgical intervention if medicines have failed to show improvement. 

CABG can also lower the risk of future heart attacks, improve heart function, and enhance your overall quality of life. For some patients, especially those with complex blockages or diabetes, CABG has been shown to provide better long-term outcomes compared to other treatments. Ultimately, CABG may offer a better chance of a longer, healthier life by restoring adequate blood flow to your heart. All you need is well experienced doctors, sometimes multiple opinions. Visit Max Hospital in Gurugram and get treated by the best! 

Faq 

Why do young people experience heart attacks? 

Young people can experience heart attacks due to a combination of lifestyle factors, including poor diet, physical inactivity, smoking, and stress, which contribute to obesity, hypertension, and other cardiovascular risks. Additionally, rising rates of obesity and metabolic syndrome in younger populations, along with genetic predispositions or family history of heart disease, further increase their vulnerability. These factors can lead to early onset of conditions traditionally associated with older age, such as atherosclerosis and high cholesterol, ultimately raising the risk of heart attacks in young individuals.

What are the risk factors of coronary artery diseases? 

Coronary artery disease (CAD) is influenced by several risk factors, including unhealthy lifestyle choices such as poor diet, physical inactivity, smoking, and excessive alcohol consumption, all of which contribute to obesity, high blood pressure, and unhealthy cholesterol levels. Medical conditions like hypertension, high cholesterol, diabetes, and obesity further increase the risk of CAD by promoting plaque buildup in the arteries. Family history and genetics also play a significant role, particularly if close relatives developed CAD at an early age.

Can you live a long life with coronary artery diseases? 

Yes, it is possible to live a long life with coronary artery disease (CAD) if it is properly managed. While CAD is a serious condition, advancements in medical treatment, lifestyle modifications, and early detection can significantly improve outcomes. Patients with CAD can manage their condition through medications, regular physical activity, a heart-healthy diet, and by avoiding smoking and excessive alcohol consumption.

How much blockage is normal? 

In healthy individuals, the coronary arteries should have minimal to no blockage, as even small amounts of narrowing can impact blood flow to the heart. Generally, a blockage of less than 20% is considered normal and not significant enough to cause symptoms or require intervention. However, when blockages exceed 50%, they can begin to impair blood flow and increase the risk of heart-related symptoms or events.

What is the best treatment for coronary artery diseases? 

The best treatment for coronary artery disease (CAD) involves a combination of lifestyle modifications, medications, and, in some cases, interventional procedures. Lifestyle changes are foundational and include adopting a heart-healthy diet, engaging in regular physical activity, quitting smoking, and managing stress. Medications, such as statins to lower cholesterol, aspirin to prevent blood clots, and beta-blockers to reduce heart workload, are commonly prescribed to manage symptoms and prevent progression.