Coronary arteries are the arteries that supply blood flow to your heart muscle. Coronary artery disease occurs when cholesterol-containing plaque builds up on the inside and blocks the flow of blood in the coronary arteries. Decreased blood flow to the heart muscle most commonly causes chest pain (angina), shortness of breath, dizziness or decreasing exercise tolerance.
A coronary plaque contains a build-up of a type of cholesterol, low density lipoprotein (LDL), that has accumulated in the arterial wall over many years. This build up of low density lipoprotein (LDL) and other cellular components, are caused by and accelerated due to many factors.
Coronary artery disease starts with changes to the inner layer of a coronary artery, sometimes as early as childhood. At first, small plaques form on the inside of the coronary arteries. These early plaques do not restrict the coronary artery flow and are unlikely to cause symptoms.
As the plaque builds up, your coronary arteries narrow and the blood flow to the heart becomes restricted and stable symptoms may start to appear.
The most common stable symptoms and clues to progression of coronary artery disease are:
Chest pain or chest pressure that usually occurs with exercise and is relieved with rest. Often pain which often moves to, or starts in the jaw, neck, back or arms.
Unstable symptoms occurs when the surface of the plaque develops a crack and blood cells called platelets go at the site to try to repair the artery and form a clot. Previous symptoms of chest pain and shortness of breath may now occur at rest.
These unstable symptoms can occur just prior to the coronary artery completely blocking.
A completely blocked coronary artery will cause a heart attack or myocardial infarction. The signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath, nausea and sweating.
Women are less likely to experience typical signs and symptoms of a heart attack, such as neck or jaw pain. Women may present with heart attack after only having fatigue, breathlessness and minor sharp pain. Sometimes a heart attack occurs without any apparent signs or symptoms especially in people with diabetes.
If you suspect you are having a heart attack, call an ambulance, or if there is no ambulance, have someone drive you to the nearest hospital.
Risk factors for coronary artery disease include:
Coronary artery disease can lead to:
Prevention of coronary disease before it causes cardiac events and complications, is the best possible approach everyone can take. Prevention is an important part of Nightingale Cardiology’s comprehensive approach to coronary artery disease.
Healthy eating – follow the Nightingale Healthy Eating guide.
Exercise – exercise every day for at least 30 minutes with minimum brisk walking or equivalent. Your cardiologist may recommend alternatives depending on your circumstances and underlying fitness.
Blood pressure – get your blood pressure checked regularly either at home or with your doctor. For most people, the guidelines recommend an office blood pressure less than 135/85mmHg is desirable. Your doctor or cardiologist may recommend alternatives values depending on your circumstances and age.
Cholesterol target – if you have coronary artery disease, the European Society of Cardiology guidelines recommend a lowering of your low density lipoprotein (LDL) by at least 50% of the baseline level to less than 1.5 mmol/L, and less than 1.0 mmol/L if you have had two events. Your cardiologist may recommend medications to achieve this.