Coronary Artery Disease: Causes, Symptoms, and Treatment

Coronary artery disease (CAD) is the most common cardiovascular problem that increases heart attack risk. This condition occurs due to plaque buildup in vessel walls caused by atherosclerosis, also known as hardening of the arteries. Plaques narrow the inside of vessels, preventing sufficient oxygenated blood from reaching your heart. As a result, symptoms such as chest pain (angina) and shortness of breath occur, and most importantly, this condition significantly increases heart attack risk.

What Is Coronary Artery Disease?

Coronary artery disease (CAD) is the narrowing or blockage of the coronary arteries that supply the muscle tissue of your heart. Through a process called atherosclerosis, plaques composed of fat, cholesterol, and calcium accumulate on the inner surface of these vessels. These plaques gradually narrow the vessel diameter and restrict blood flow. Sometimes plaques can rupture and a blood clot can form on them. This clot can completely block the vessel, causing a heart attack.

What Are the Types of Coronary Artery Disease?

Although coronary artery disease is basically viewed as a single disease, it can manifest itself in different ways depending on the clinical situation. This condition is related to whether the narrowing in the vessels occurs suddenly or progresses over time. These different manifestations of the disease play an important role in determining the treatment approach.

The basic clinical conditions of coronary artery disease are:

Chronic Stable Angina: This is the most common condition. The narrowing in your heart vessels is stable and chest pain (angina) usually occurs during exertion when your heart’s oxygen need increases. The pain subsides with rest.

Acute Coronary Syndrome: This is an emergency condition where blood flow to your heart suddenly and severely decreases. This category includes the following conditions:

• Unstable Angina: Chest pain that occurs even at rest or becomes progressively severe. The risk of turning into a heart attack is high.
• Heart Attack (Myocardial Infarction): Permanent damage to part of the heart muscle due to a clot blocking the vessel. Requires emergency intervention.

What Causes Coronary Artery Disease?

Coronary artery disease occurs when multiple risk factors come together. While some of these factors cannot be changed, such as genetic predisposition, a large portion is related to your lifestyle habits. The most important factors include smoking, high cholesterol, hypertension, and diabetes. Lifestyle, genetic structure, and environmental factors together accelerate the development of the disease.

The main causes and risk factors of coronary artery disease are:

• High Blood Pressure (Hypertension): High blood pressure damages vessel walls and accelerates plaque formation.
• High Cholesterol (Dyslipidemia): Particularly high levels of bad cholesterol (LDL) increase plaque accumulation in vessels.
• Diabetes: Uncontrolled blood sugar causes inflammation and damage to vessel walls.
• Smoking: Smoking narrows blood vessels, increases blood’s tendency to clot, and damages vessel walls.
• Obesity: Excess weight triggers other risk factors such as high blood pressure and diabetes.
• Sedentary Lifestyle: Lack of physical activity increases bad cholesterol while decreasing good cholesterol.
• Age and Gender: Risk increases after age 45 in men and after age 55 in women. In post-menopausal women, risk equals that of men.
• Family History: If there is a history of early heart disease in your family, your risk also increases.
• Stress: Chronic stress can raise blood pressure and damage vessels.

What Are the Symptoms of Coronary Artery Disease?

Coronary artery disease does not always cause symptoms, but as vessel blockage progresses, various warning signals emerge. These symptoms usually manifest when the heart’s oxygen need increases. The most common complaint is chest pain, but it can also progress with more vague symptoms such as weakness, shortness of breath, or palpitations. Complaints sometimes last briefly and pass with rest, so they should not be overlooked.

The most common symptoms of coronary artery disease are:

• Chest Pain (Angina): You may feel pressure, tightness, burning, or heaviness in your chest. This pain usually occurs with physical activity or emotional stress and passes with rest. The pain may radiate to your left arm, neck, jaw, or back.
• Shortness of Breath: Because your heart cannot pump sufficient blood, you experience shortness of breath, especially during exertion.
• Fatigue and Weakness: Because your heart’s workload increases, you feel tired quickly, especially during physical activities.
• Nausea and Cold Sweating: Especially in women and elderly people, heart attack symptoms may include nausea, cold sweating, and digestive problems.
• Palpitations: You may experience the feeling that your heart is beating irregularly or rapidly.

Who Gets Coronary Artery Disease?

Coronary artery disease can be seen at any age. Frequency particularly increases in men over 45 and women over 55. Having a family history of early heart disease also significantly increases risk. Smokers, hypertension patients, diabetics, and individuals with high cholesterol are in the highest risk group. Obesity, chronic stress, inactivity, and unhealthy nutrition also increase risk. In post-menopausal women, the disease becomes more common as the protective effect of estrogen decreases.

The main groups at risk for coronary artery disease are:

• Those with Risk Factors: Individuals with risk factors such as high blood pressure, high cholesterol, diabetes, smoking, or obesity are in the highest risk group.
• Elderly Individuals: As age progresses, the atherosclerosis process accelerates, so risk increases in men over 45 and women over 55.
• Those with Family History: If there are individuals in the family who have had heart disease or heart attacks at an early age, your risk increases due to genetic predisposition.
• Those with Sedentary Lifestyle: Individuals who do not engage in regular physical activity more frequently experience risk factors such as obesity and high cholesterol.
• Those Living Stressful Lives: Chronic stress has negative effects on blood pressure and cholesterol levels.

How Is Coronary Artery Disease Diagnosed?

The diagnosis of coronary artery disease is made through a detailed evaluation by your doctor and various tests. Your medical history and risk factors are carefully examined. The main methods used for diagnosis are tests that measure your heart’s electrical activity and methods that enable imaging of your vessels.

The main methods used in diagnosis are:

• Electrocardiogram (ECG): Measures your heart’s electrical activity and can show signs of conditions such as heart attack.
• Stress Test: ECG and blood pressure measurements are taken while you exercise on a treadmill or bicycle. This test shows how your heart responds when its oxygen need increases.
• Coronary Angiography: A special dye (contrast) is given to your heart vessels by entering through a vessel in your groin or wrist. With X-ray images, your narrowed or blocked vessels are clearly visualized. This is the most definitive method for diagnosing coronary artery disease.
• Heart Tomography (Coronary CT Angiography): A less invasive method used to image plaques and narrowing in your vessels.
• Heart Ultrasound (Echocardiography): Used to evaluate your heart’s structure, pumping power, and valve function.

How Is Coronary Artery Disease Treated?

Treatment of coronary artery disease is planned individually according to the severity of the disease, location of narrowing, and level of your symptoms. The aim in treatment is to reduce your symptoms, stop the progression of the disease, and prevent serious complications such as heart attack. Treatment options include lifestyle changes, medications, interventional procedures, and surgical methods.

The methods applied in the treatment of coronary artery disease are:

Lifestyle Changes

This is one of the most important steps that directly affects the course of the disease. Healthy nutrition, regular exercise, quitting smoking, and maintaining ideal weight form the basis of treatment.

• Healthy Nutrition: You should adopt a nutrition plan specifically designed for heart health. You should stay away from foods containing saturated fat and trans fat (red meat, processed foods, fried foods) and limit salt consumption to 5 grams (one teaspoon) daily. Instead, you should prefer foods such as plenty of vegetables, fruits, whole grain products, and fish rich in omega-3 fatty acids.
• Regular Exercise: Exercise not only helps with weight control but also lowers your blood pressure, regulates your cholesterol levels, and enables your heart to work stronger. With your doctor’s approval, you should aim to exercise at least 150 minutes of moderate intensity (brisk walking, swimming, cycling) or 75 minutes of high intensity per week.
• Quitting Smoking: Smoking is the factor that causes the greatest harm to your heart and vascular health. Quitting smoking stops damage to vessel walls and reduces blood’s tendency to clot. This is the most important step to take to reduce your heart attack risk.
• Weight Control: Maintaining your ideal weight is vital for your heart health. Excess weight triggers other risk factors such as high blood pressure and diabetes. You can create a plan with your doctor to reach and maintain your ideal weight.
• Stress Management: Chronic stress can raise blood pressure and negatively affect heart health. Trying to manage stress with meditation, yoga, deep breathing exercises, or hobbies is also an important part of lifestyle changes.

Medication Treatment

Medications such as blood thinners (aspirin, clopidogrel), cholesterol-lowering drugs (statins), blood pressure medications, and beta blockers are used.

Interventional Treatment (Balloon Angioplasty and Stent)

The narrowing in the heart vessel is intervened with a balloon to widen the vessel, and then a stent is placed to ensure the vessel stays open.

Surgical Treatment (Coronary Bypass Surgery)

A new path is created around the blocked vessel with a healthy vessel taken from another part of your body.

What Should People with Coronary Artery Disease Pay Attention To?

There are important points that individuals diagnosed with coronary artery disease should pay attention to in order to improve their quality of life and prevent the progression of the disease. These precautions include both following your doctor’s recommendations and adopting a healthy lifestyle.

Those with coronary artery disease should pay attention to the following:

• Take Your Medications Regularly: You should use the medications prescribed by your doctor regularly without missing the dose and timing.
• Eat Healthily: You should create a nutrition plan low in salt and saturated fat, rich in vegetables, fruits, and fiber.
• Quit Smoking: Smoking is the factor that causes the greatest harm to your heart and vascular health. You must definitely quit.
• Exercise Regularly: You should stick to the exercise program recommended by your doctor. At least 150 minutes of moderate-intensity exercise per week is targeted.
• Manage Stress: Stress can negatively affect your heart health. Try to reduce your stress with meditation, yoga, or hobbies.
• Control Your Blood Pressure and Cholesterol Levels: You should monitor your blood pressure and cholesterol levels with regular doctor check-ups.

What Can Coronary Artery Disease Lead To?

If coronary artery disease is not treated, it can lead to serious and permanent problems over time. The heart not receiving sufficient blood can cause weakening in the heart muscle and even heart failure. As vessel blockage progresses, the risk of arrhythmias and sudden cardiac arrest also increases.

One of the most serious consequences is heart attack. In this condition, heart tissue is deprived of oxygen and part of it may be irreversibly damaged. When the disease progresses, continuing daily activities becomes difficult and quality of life significantly decreases. Most of these risks can be prevented with treatment.

How Should Nutrition and Exercise Be?

Proper nutrition and regular exercise are two fundamental factors in controlling coronary artery disease. Mediterranean-type nutrition is rich in heart-friendly fats and antioxidants. Daily moderate-tempo exercise such as walking strengthens the heart muscle and increases vessel flexibility.

Fried foods, processed meats, excessive salt, and sugar should be avoided. Trans fats, margarine, and excessive red meat consumption should be limited. At least 150 minutes of brisk walking or cycling per week is recommended. The exercise program must be planned with doctor approval and personalized.

When Should You Consult a Doctor?

If you are experiencing symptoms such as pressure, tightness, pain in your chest, or shortness of breath, especially if these symptoms occur with exertion, you should consult a cardiology specialist without delay. If your chest pain starts suddenly, is very severe, does not pass with rest, and is accompanied by symptoms such as cold sweating and nausea, you should immediately go to the nearest emergency room.

Reference: Coronary artery disease