Coronary Artery Disease: Diagnosis and Treatment

Introduction

Cardiovascular diseases are known as one of the leading causes of death all over the world. In particular, coronary artery disease (CAD) is a serious condition caused by atherosclerosis or plaque buildup in coronary arteries. Alternatively, it is called ischemic heart disease or coronary heart disease. Arteries’ thickening is dangerous because it prevents the normal flow of oxygen, blood, and nutrients to the heart, resulting in major health issues. Sometimes, people do not have symptoms of the disease development, and heart attack becomes the first sign of coronary artery disease (Papageorgiou, 2016). The main symptoms of CAD are chest discomfort (angina) and shortness of breath. This topic is significant to study because some risk factors can be changed, helping people lower their chance of developing CAD. Therefore, raising awareness of the population about this disease is essential. The purpose of this research paper is to explore the cause, symptoms, and treatment of coronary artery disease, as well as discuss the importance and available services of cardiac rehabilitation.

Pathophysiology of Coronary Artery Disease

Scientific research has answered many questions about cardiovascular diseases, and people’s knowledge about the pathophysiology of coronary artery disease has improved over the past years. Pathophysiology means the functional changes that develop along with a disease or syndrome. It is known that CAD occurs when a condition called atherosclerosis develops. As Papageorgiou (2016) reports, atherosclerosis was earlier considered a cholesterol storage disease. However, scientific research discovered that an inflammatory process is involved, and it is now regarded as an inflammatory disorder (Papageorgiou, 2016). Therefore, clinical approaches to the treatment of CAD have evolved as well, both for acute and chronic phases of this condition.

Causes

Atherosclerosis in other words means the accumulation of cholesterol plaque in arteries. It is caused by the hardening and stiffening of the artery’s lining, which happens when calcium and fatty deposits, and inflammatory cells, build up (Papageorgiou, 2016). Generally speaking, atherosclerosis is the underlying cause of such diseases as cerebrovascular or peripheral disease and CAD, based on the artery affected (Papageorgiou, 2016). With coronary artery disease, limited blood flow to the heart can cause ischemia of myocardial cells because of the lack of oxygen (Papageorgiou, 2016). As a result, a person can have a heart attack that leads to the damage and death of heart muscle. Furthermore, it is known that it can lead to other dangerous conditions, like stroke, heart attack, or death.

Signs and Symptoms

Angina and shortness of breath are the main symptoms of coronary artery disease. In other words, angina refers to chest discomfort and pain. It occurs when the arteries narrow down as a result of plaque accumulation and cause pain in the chest by blocking the blood flow to the body and the heart muscle (Papageorgiou, 2016). Shortness of breath is another symptom which nevertheless can be associated with other conditions. Generally, signs of coronary heart disease can take years to develop before the person notices them and gets checked by a doctor. Usually, the course of the disease is wave-like and involves periods of relatively good health and angina episodes (Papageorgiou, 2016). Other common signs of CAD include pain in the jaw, back, neck, or arm, unstable or rapid heart rate, general weakness, and swelling of the legs in the later stages (Papageorgiou, 2016). For some people, heart attack becomes the first sign of the problem and includes such symptoms as chest pain, lightheadedness, dizziness, weakness, nausea, and shortness of breath.

Risk Factors

In addition to common signs and symptoms, it is essential to discuss risk factors for coronary artery disease. Some groups of people have an increased possibility of developing CAD. For example, individuals with a high cholesterol level or blood pressure (hypertension), diabetes, and obesity are more vulnerable when it comes to coronary artery disease (Papageorgiou, 2016). Besides, men older than 45 and post-menopausal women, as well as smokers and alcohol consumers, can be at higher risk of CAD (Papageorgiou, 2016). Heredity, family history of heart disease, and insufficient or excessive physical activity are other factors that add to the threat of having coronary artery disease.

Diagnosis

When symptoms of coronary heart disease appear, the right and timely diagnosis becomes vital because it can affect a patient’s life. Unless a person is having a stroke or a heart attack, the doctor will ask them about the symptoms and consider risk factors and medical history. Then, a physical exam will be used to evaluate the patient’s condition. CAD is diagnosed by several methods, including electrocardiograph tests (EKG), exercise and pharmacologic stress tests, coronary calcium scan, echocardiogram, blood tests, or cardiac catheterization (Papageorgiou, 2016). EKG records the heart’s electrical activity and detects heart rhythm problems. Exercise and pharmacologic stress tests are used to make the heart work hard and know if the patient has coronary blockages and angina. A coronary calcium scan detects if there is calcium in the coronary arteries walls to detect signs of atherosclerosis. An echocardiogram evaluates the heart’s structure and function by using sound waves. Blood tests are made to measure factors that have a negative impact on arteries. Cardiac catheterization detects CAD and is done by inserting catheters into blood vessels.

Besides, additional diagnostic imaging tests can be carried out to diagnose CAD. They include nuclear imaging that provides images and computed tomography angiogram that produces 3D pictures of the heart (Papageorgiou, 2016). If the patient turns for medical help in time and follows the doctor’s prescriptions, the quality of life can be improved, and the symptoms of CAD can be reduced. Coronary artery disease treatment includes medical procedures and medication, invasive or non-invasive surgery, and prophylaxis. Lifestyle changes are often recommended, for example quitting smoking, regular exercise, and a healthy diet.

Medical Procedures

Several medical procedures can be used to treat coronary artery disease in patients. For example, interventional procedures remove the buildup of plaque and prevent blockages (Papageorgiou, 2016). They are non-surgical and include balloon angioplasty when a catheter is inserted in the artery and stenting when a metal tube is installed to keep the artery open (Papageorgiou, 2016). Surgery can be used, such as coronary artery bypass graft (CABG), to create new paths for blood flow around the blocked areas (Papageorgiou, 2016). In addition, enhanced external counterpulsation (EECP) is another medical procedure used to treat CAD. It creates natural paths for blood flow around the clogged arteries and improves the overall circulation (Papageorgiou, 2016). EECP can be used for chronic patients when medication does not bring relief, and other medical procedures cannot be done.

Medication

Medication is another way to manage the patient’s risk factors for CAD, relieve symptoms, and treat the disease. Different types of medications for the heart can be prescribed, for example, drugs lowering cholesterol levels (statins, fibrates, bile acid sequestrants, niacin) (Papageorgiou, 2016). The doctor can also recommend medication that lowers blood pressure, such as beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) (Papageorgiou, 2016). Calcium channel blockers, ranolazine, and nitrates, or nitroglycerin are used to reduce the symptoms of angina, while anticoagulants and antiplatelets are prescribed to make blood thinner and prevent clots (Papageorgiou, 2016). Patients with diabetes also take medication that lowers their blood sugar levels. The doctor’s recommendations and prescription must be followed to treat the disease.

Cardiac Rehabilitation

A cardiac rehabilitation program (CRP) helps people recovering from heart problems that required medical care or surgery, such as coronary artery disease. The purpose of CRP is to help the patient recover, improve health and quality of life, and prevent future heart problems. For example, the program can reduce one’s cholesterol level, heart rate, blood pressure, and plaque buildup, as well as improve bone density, mood, and overall health (Papageorgiou, 2016). Patients usually follow their medication prescriptions better during CRP and experience fewer heart disease symptoms, such as weakness, fatigue, or angina. Most importantly, the program educates people and helps them better understand and manage their disease.

The program generally includes such services as physical activity and exercise plan, mental health support to relieve stress, and educating the participants about making their lifestyle healthier. There are several phases, and they begin when the patient arrives at the hospital. Exercise physiologists provide recommendations on lifestyle and habits and educate the patient about a home exercise plan (Niebauer, 2017). Family and friends’ support is particularly important for everyone doing rehabilitation after heart disease. As patients complete the main phase, there is more independence about the exercise plan; however, the staff still monitors their progress. A cardiac rehabilitation program can be effective as a result of cooperation between the patient and medical specialists.

Overall, CRP effectively improves patients’ health and reduces their risk of dying from heart disease. According to Niebauer (2017), patients go to cardiac rehabilitation to avoid another cardiac problem, recover, and manage their condition. Besides, they receive emotional support after the medical procedures and learn how to improve their health, for example, by eating healthy, avoiding smoking or drinking, and taking medications as prescribed by the doctor. Cardiac rehabilitation is a program that involves a team of people, such as health care, nutrition, and exercise specialists, physical therapists, and counselors. Patients usually have to do rehabilitation several hours a day, three days per week for three months, to complete the main phase (Niebauer, 2017). At the same time, it depends on the individual’s needs, and some people continue their program to improve their health and receive support. Therapy sessions typically last for two hours; however, they can vary based on the patient’s condition. The outcome after cardiac rehabilitation is improved quality of life and reduced risk of health complications and death in patients.

Conclusion

To conclude, coronary artery disease is a serious problem that involves coronary artery blockage because of plaque accumulation. The main symptoms are angina, shortness of breath, or heart attack signs, such as chest pain, weakness, lightheadedness, shortness of breath, and nausea. CAD can develop without obvious signs before a person is diagnosed. Therefore, it is important to raise awareness about this disease and its treatment to help people with risk factors prevent it.

References

Niebauer, J. (2017). Cardiac rehabilitation manual (2nd ed.). Springer.

Papageorgiou, N. (2016). Cardiovascular diseases: Genetic susceptibility, environmental factors and their interaction. Elsevier Science.

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