In modern society, stress, irregular lifestyles, and unhealthy dietary habits form a triple threat that silently forges an invisible “killer” within us—coronary artery disease (CAD). This term might be familiar to you from visits to your doctor’s office or family gatherings, but how does it silently endanger our hearts?
What is Coronary Artery Disease?
Coronary Artery Disease (CAD), also known as coronary heart disease, occurs when the coronary arteries (vessels supplying blood to the heart muscles) become diseased, leading to reduced blood flow and consequently, insufficient oxygen and nutrients reaching the heart muscles. If this condition progresses severely, it can cause angina, myocardial infarction, or even sudden death.
Signs and Symptoms of CAD
Symptoms of CAD may include:
- Angina: A feeling of tightness or pressure in the chest that may radiate to the arms or neck.
- Shortness of Breath: Due to the heart’s inability to pump blood effectively, leading to fluid build-up in the lungs.
- Fatigue: Poor circulation causes oxygen deficiency in various parts of the body.
- Arrhythmia: The heart’s rhythm becomes irregular.
It’s noteworthy that symptoms in women may differ from men, with pain potentially occurring not only in the chest but also in the jaw, shoulders, upper back, and other areas. Additionally, patients may experience fainting, sweating, shortness of breath, anxiety, palpitations, nausea, or dizziness. It’s crucial to suspect unstable angina when chest pain changes in nature, such as becoming more intense, frequent, prolonged, and not relieved by nitroglycerin or removing the precipitating factors.
The Culprits Behind CAD
The primary culprit of CAD is atherosclerosis—the gradual narrowing or blockage of arteries due to the build-up of cholesterol, fat, and other substances on the artery walls. The following factors may exacerbate this process:
- Unhealthy Diet: Excessive intake of high-fat, high-salt, and high-sugar foods.
- Lack of Exercise: Sedentary lifestyle and lack of regular physical activity.
- Smoking and Alcohol Abuse: Nicotine and alcohol are harmful to blood vessels.
- Hypertension: Persistent high blood pressure exerts extra strain on the vessels.
- Diabetes: Improper blood sugar control can damage blood vessels.
- Obesity: Being overweight increases the heart’s workload and affects lipid levels.
- Stress: Long-term stress can promote atherosclerosis.
- Family History: Having a family history of CAD increases risk.
Therefore, actively avoiding these risk factors is essential to maintaining our vascular health and reducing the incidence of CAD.
Strategies to Combat CAD
Diagnosis
Diagnosis of CAD relies on several tests:
- Electrocardiogram (ECG): Measures the electrical activity of the heart.
- Stress Test: Observes the heart’s performance during physical activity.
- Coronary Angiography: Visualizes blood flow using a contrast agent.
Treatment
The goal of treating CAD is to improve blood supply and alleviate symptoms, which includes:
- Lifestyle Changes: Healthy diet, regular exercise, smoking cessation, and moderating alcohol consumption.
- Medication: Use of cholesterol-lowering drugs, antiplatelet agents, β-blockers, etc.
- Interventional Procedures: Such as Percutaneous Coronary Intervention (PCI).
- Coronary Artery Bypass Grafting (CABG): Reconstructing blood flow pathways.
Interventional treatments involve placing stents in the coronary arteries to open them up, providing quick recovery with good results. In contrast, CABG surgery involves taking a segment of blood vessel from another part of the patient’s body and connecting it to bypass the narrowed or blocked coronary arteries to alleviate symptoms of ischemia.
Factors to Consider When Deciding on Stent Placement
Several factors influence the decision to place a stent:
- Symptom Severity: Patients with stable CAD whose symptoms are controllable by medication may not need immediate stent placement. However, those with significant symptoms despite appropriate medication might require it.
- Degree and Location of Coronary Narrowing: Coronary angiography reveals specific narrowing details. High-grade stenosis (typically >70%) or critical narrowing in major coronary branches might necessitate stent placement.
- Left Ventricular Function: Reduced function indicates impaired heart pumping ability, potentially requiring more aggressive intervention, including stent implantation.
- Evidence of Ischemia: Non-invasive tests like nuclear myocardial perfusion imaging, stress echocardiography, or other forms of stress testing can show the extent and location of ischemic areas. Large areas of myocardial ischemia may require interventional treatment.
- Acute Coronary Syndrome: In cases of acute myocardial infarction or unstable angina, urgent stent placement is often necessary to restore blood flow quickly and limit cardiac damage.
- Overall Health Status: Age, presence of other significant illnesses (like diabetes or renal impairment), and bleeding risks should be considered.
- Anticipated Quality of Life Improvement: If stent implantation is expected to significantly enhance the patient’s quality of life, this treatment approach tends to be favored.
- Tolerance to Antiplatelet Therapy: After stent implantation, long-term use of antiplatelet drugs (like aspirin combined with clopidogrel or other newer P2Y12 inhibitors) is required. If the patient cannot tolerate these medications, reevaluation of stent placement may be necessary.
- Stent Type Choice: The decision between bare-metal stents and drug-eluting stents (DES) considers multiple factors, including the likelihood of needing a second procedure and the patient’s suitability for long-term antiplatelet medication use.
- Patient Preference: The patient’s own treatment preferences and wishes should be considered an important factor.
Doctors and patients usually make a joint decision on whether and when to place a stent based on a comprehensive assessment of results.
Prevention: Better Lifestyle Choices
Prevention is always better than cure. The following simple steps can help reduce the risk of developing CAD:
- Exercise: At least 150 minutes of moderate-intensity activity weekly.
- Balanced Diet: Eat more vegetables, fruits, and whole grains.
- Weight Control: Achieve and maintain a healthy weight.
- Quit Smoking: Stop smoking and avoid secondhand smoke.
- Regular Check-ups: Monitor blood pressure, blood sugar, and cholesterol levels.
For patients already suffering from hypertension, diabetes, and other conditions, it’s vital to cooperate with medical treatment and manage their condition. Secondary prevention involves preventing the worsening of the disease after its onset through medication and non-pharmacological measures, including adhering to medical advice and maintaining a healthy lifestyle.
Daily Care for CAD Patients
Beyond treatment and prevention, CAD patients must pay attention to certain daily details.
Firstly, they should maintain regular living patterns, avoid overexertion and emotional excitement. Secondly, they should follow a low-salt, low-calorie, low-fat diet principle, control weight, and keep blood pressure and lipid levels stable.
Additionally, patients need to learn to adjust their mindset, keep emotions stable, and avoid excessive anxiety or depression. Lastly, appropriate exercise is also an important part of recovery for CAD patients, but they should choose suitable activities based on their condition to avoid overdoing it.
In conclusion, although CAD is frightening, we can effectively protect our heart health by actively understanding, preventing, and treating it.