3.
1 CORONARY ATHEROSCLEROSIS:
Atherosclerosis is the gradual build-up of plaque in the walls of
our arteries. Arteries are blood vessels that carry oxygen-rich blood to organs
and tissues throughout our body. Plaque (atheroma) is a sticky substance made
of fat, cholesterol, calcium and other substances.
SYMPTOMS AND CAUSES:
Atherosclerosis symptoms often don’t start until an artery is very narrow
or blocked. Many people don’t know they have plaque build-up until they have a
medical emergency like a heart attack or stroke.
Affected locations may include:
Heart : We may experience:
Shortness of breath (dyspnea) during
light physical activity.
Chest pain or discomfort (angina).
Pain in your back, shoulders, neck,
arms or belly.
Feeling dizzy or lightheaded.
Heart palpitations.
Fatigue.
Nausea or vomiting that may feel
like indigestion.
Digestive system Pain or cramping in your belly
(abdomen) after eating.
Bloating, nausea and vomiting.
Diarrhea.
Unintentional weight loss due to
“food fear” (fear of pain after
eating).
Legs and feet Muscle pain (intermittent
claudication).
Burning or aching pain in your
feet and toes when you rest,
especially when lying flat.
Changes in skin color (like
redness).
Cool skin on your feet.
Frequent skin and soft tissue
infections, often in your legs or
feet.
Sores on your feet or toes that
don’t heal.
Kidneys Markedly elevated blood
pressure that doesn’t respond to
multiple medications.
Changes in how often you pee.
Swelling (edema).
Feeling drowsy or tired.
Skin that feels dry, itchy or numb.
Headaches.
Unexplained weight loss.
Nausea, vomiting or loss of
appetite.
Brain Dizziness.
Drooping on one side of your
face.
Loss of feeling, loss of muscle
strength or weakness on one
side of your body.
Severe headache.
Slurred speech or difficulty
forming words.
Vision loss in one eye. You may
notice a dark shade coming
down over your field of sight.
CAUSES:
High LDL cholesterol and triglyceride levels.
Tobacco products.
High blood pressure.
Diabetes.
These factors can damage your artery’s inner lining (endothelium). This causes
atherosclerosis to begin. The damage usually occurs slowly and over time.
RISK FACTORS:
Being older than age 45 (for people assigned male at birth or AMAB).
Being older than age 55 (for people assigned female at birth or AFAB).
Family history of premature cardiovascular disease. This means a close
biological family member who’s AMAB received a cardiovascular disease
diagnosis before age 45. Or, one who’s AFAB got a diagnosis before age 55.
Diabetes.
High blood pressure (hypertension).
High cholesterol (hyperlipidemia), especially high LDL cholesterol or high
levels of a specific lipoprotein called lipoprotein (a).
Metabolic syndrome.
Smoking or tobacco use.
Lack of physical activity.
Eating foods high in saturated fat, trans fat, sodium and sugar.
Diagnosis and Tests
Perform a thorough physical exam. This includes using a stethoscope to
listen to your heart and blood flow through your arteries. For example, your
provider will check your carotid arteries (in your neck) for a whooshing sound
called a “bruit.” This sound may indicate the presence of plaque.
Ask about your medical history and family history. These details can help
show your risk for atherosclerosis and its complications.
Ask about your lifestyle. Your provider may ask about habits like past or
present use of tobacco products.
Order blood tests. Cardiac blood tests show your cholesterol levels and
many details about your heart function.
Management and Treatment
Lowering your risk of blood clots.
Preventing complications like a heart attack or stroke.
Easing symptoms.
Helping you develop patterns of eating that support your heart and blood
vessels.
Slowing or stopping plaque buildup in your arteries.
Improving blood flow by widening your arteries or bypassing (avoiding)
blockages.
3.2 Coronary artery disease
Coronary artery disease (CAD) is a condition where the major blood vessels
supplying the heart become narrowed or blocked. Here’s a detailed overview:
Causes
• The primary cause of CAD is the buildup of cholesterol and other
substances on the artery walls, known as atherosclerosis.
Risk factors include:
• High blood pressure
• High cholesterol levels
• Smoking
• Diabetes
• Obesity
• Sedentary lifestyle
• Family history of heart disease
• Age (older age increases risk)
• Gender (men are at higher risk)
• Stress
Symptoms:
Symptoms often don’t appear until the arteries are significantly narrowed.
Common symptoms include:
• Chest pain (angina): A feeling of pressure or tightness in the chest
• Shortness of breath
• Heart attack: Occurs if a coronary artery is completely blocked
• Other symptoms: Nausea, sweating, fatigue, faster heartbeat, dizziness
Diagnostic Methods
Diagnosis typically involves a combination of medical history review, physical
examination, and various tests:
• Electrocardiogram (ECG or EKG): Measures the electrical activity
of the heart
• Echocardiogram: Uses sound waves to create images of the heart
• Stress tests: Assess how the heart works during physical activity
• Nuclear stress test: Uses a radioactive tracer to visualize blood flow to
the heart
• Cardiac catheterization: Involves inserting a catheter to check for
blockages
• CT scan: Detects calcium deposits and blockages in the arteries
Treatment
Treatment aims to manage symptoms and reduce the risk of complications. It
includes lifestyle changes, medications, and sometimes procedures:
• Lifestyle changes: Healthy diet, regular exercise, quitting smoking,
managing stress
• Medications:
• Cholesterol-lowering drugs (e.g., statins)
• Anticoagulants (e.g., aspirin)
• Beta blockers (reduce blood pressure and heart rate)
• Nitrates (relieve chest pain)
• ACE inhibitors (reduce blood pressure) – Angiotensin
converting enzyme
• ARBs (reduce blood pressure) - Angiotensin II receptor
blockers
• Procedures:
• Angioplasty and stent placement: Opens narrowed
arteries
• Coronary artery bypass graft (CABG): Uses a vessel
from another part of the body to bypass a blocked artery