Coronary artery disease: what are the causes, and how is it treated?

Written by: Dr David Brull
Published:
Edited by: Top Doctors®

 

Coronary artery disease, also known as coronary heart disease, is when your coronary arteries (arteries supplying blood to the heart) narrow due to a gradual build-up of fatty material within their walls. This affects the blood supply over time, and while the supply may be sufficient at rest, it can become more restricted when the heart works harder, such as during exercise.

 

When the heart cannot get the blood it needs from these arteries, the patient experiences angina, which feels like a dull, heavy or tight pain in the chest, which can also spread to the left arm, neck, jaw, or back. This typically only lasts about a few minutes. A sudden blockage, however, may result in heart attack.

 

Causes of coronary artery disease

 

There are many factors that increase the chance of developing CAD. Some are modifiable, but some are factors that we have no control over, such as genetics, gender (women typically develop the disease later than men), and age. However, changes to the following factors can be helpful at any age:
 

  • Smoking
  • High blood pressure
  • Elevated cholesterol
  • Diabetes
  • Stress and behaviour
  • Physical inactivity and obesity


While some of these factors are existing conditions, they can be improved by lifestyle changes.

 

Treatment of coronary heart disease

 

Firstly, the important thing is to change the modifiable factors mentioned above. Every patient will be given advice with respect to healthy living. Adopt the policy of ‘you are what you eat’, and make sure to follow a healthy diet, especially if advised to lose weight. Alcohol and caffeine consumption should be reduced.
 

Regular exercise is encouraged, but with realistic expectations. 20-30 minutes a day, 5 times a week, is what the patient should be aiming for.
 

Smoking is one of the most important modifiable risk factors, and smokers are advised to stop. Help and support aids will be provided, as quitting is not an easy task.
 

Certain medications can also be prescribed, to improve the symptoms of angina, and to prevent platelets (small components in the blood stream) from becoming ‘sticky’, leading to blood clots. Other drugs may also slow the rate that fatty deposits build up in the arteries.

 

Interventional treatment for coronary artery disease

 

If patients still experience significant angina despite medical therapy, then interventional procedures may be helpful, such as PCI – percutaneous coronary intervention, formerly known as angioplasty or stenting. PCI is a day case procedure, so no overnight stay in hospital is needed. A fine wire is passed through the skin under local anaesthetic via an artery in the wrist or groin, and then fed across the narrowed section of coronary artery. A tiny balloon is then inflated inside the artery, opening it up and allowing a small wire mesh, called a stent, to be inserted. This keeps the artery open and coronary blood flow can be restored.


In some cases, when coronary artery disease becomes more widespread or is more severe, coronary bypass surgery may be appropriate. In this procedure, healthy blood vessel segments from other parts of the body are used to bypass the narrowed sections of the arteries.


In order to help the prevention of CAD, it is best that the patient attends routine health screenings, and tries to be as healthy as they possibly can. It is better to take action to prevent coronary heart disease by maintaining your own health, rather than treat the symptoms later on.

By Dr David Brull
Cardiology

Dr David Brull is a London heart specialist and leading Consultant Cardiologist with wide experience in treating all aspects of adult heart disease. His specialist interest is in the treatment of coronary artery disease through percutaneous coronary intervention (angioplasty and stenting).

Dr Brull was appointed Consultant Cardiologist and Honorary Senior Lecturer to the Whittington Hospital and Heart Hospital, University College Hospitals in October 2003 and became Cardiology Clinical Lead at The Whittington in 2011. Following his appointment in 2003, Dr Brull played an integral part in setting up the Primary PCI (heart attack) Service based at Heart Hospital UCLH, providing immediate access and round the clock treatment for heart attack patients throughout North and Central London. In April 2015 The Heart Hospital services moved to The Bart’s Heart Centre, forming the UK’s largest Cardiothoracic centre.

Dr Brull routinely sees patients with all common cardiac conditions including: angina (chest pain), hypertension (high blood pressure), heart failure, referrals for investigation of palpitations and collapse, cardiovascular risk assessment, perioperative cardiac assessment and treatment of elevated cholesterol levels. In addition to his work in the field of coronary artery disease, Dr Brull runs a specialist perioperative risk assessment clinic for patients prior to elective general surgery, working with a large multi-disciplinary team in order to reduce perioperative risk.

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