Coronary artery disease refers to diseased coronary arteries that are obstructed or have reduced blood flow due to atherosclerotic plaque which results in decreased blood flow to the heart.
Subsequent reduced blood flow may result in damage to the heart muscle, or referred to as myocardium, commonly referred to as a “heart attack”. This damage is usually irreversible and can affect the normal pumping capacity of the heart, resulting in decreased cardiac output.
The most common sign of coronary artery disease is “chest pain” that can occur either at rest or when exercising / moving. Chest pain that occurs whilst exercising, but is relieved when exercise stops may be referred to as “angina.” This is usually a temporary feeling that is caused when the oxygen requirement of the heart is exceeded by the supply which is often due to the presence of coronary artery disease.
Chest pain may also be caused by a reduction in blood flow due to the presence of atherosclerosis or plaque build-up. Cessation of activity or exercise reduces the oxygen requirement of the heart and the myocardial muscle requirement for oxygen, ultimately relieving the pain when resting, typically occurring within a few minutes.
If chest pain is not relieved by rest it may be a sign of ongoing damage to the heart caused by a decreased flow of blood rich oxygen to the heart muscle. This could also be a myocardial infarction or “heart attack.” This may result in a reduction in cardiac output or pumping function and can have long term implications to the patient such as heart failure.
Other signs of coronary artery disease include shortness of breath, palpitations or heart irregularity, sweating, and pain in the patients throat, arms, shoulder, jaw or back.1
Patients may often present after to their local Doctor or an Emergency Department after they have experienced a period of chest pain.
The diagnosis of coronary artery disease may be relatively simple or complicated depending on the individual presentation. Diagnostic tests can include:
It is important for patients with chest pain or concerns regarding their health to see their General Practitioner or an Emergency Department as soon as possible for assessment. Early intervention can improve patient outcomes.
Treatment for coronary artery disease may depend upon the level of the coronary artery disease the patient has and the urgency of the treatment. This may be defined as managing “Stable” or “Unstable” coronary artery disease.
Treatment for coronary artery disease can vary for each individual and depend on the individual level of risk for coronary artery disease, the presence of coronary artery disease, frequency of symptoms and severity of the disease. A simple method used to treat coronary artery disease may be to reduce the risk of developing coronary artery disease by:
Medications may be used to assist in the ongoing management of:
An Interventional Cardiologist may perform a Coronary Angiogram which is when the coronary arteries are assessed for the presence of obstruction, usually atherosclerotic plaque. Once identified the Cardiologist may decide to insert a type of coronary stent that will maintain adequate flow through the affected coronary artery. There are two main types of coronary stents available currently:
Bare Metal Stent
In some cases, the obstruction can be so severe in the coronary artery that open-heart surgery may be considered the most suitable treatment option. In this case, there may be multiple coronary arteries affected by atherosclerotic plaque, causing reduced blood flow to the heart, leading to symptoms. However, the use of multiple coronary stents may not be suitable for all patients.
This procedure is referred to as a Coronary Artery Bypass Graft (CABG) and is performed by a Cardiac Surgeon. Cardiac Surgeons may use blood vessels from various parts of the body to connect these vessels above and below the obstruction, and reinstating a more acceptable arterial blood flow to the heart.