Coronary Artery Disease

Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease. Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis. For some people, the first sign of CAD is a heart attack.

Common risk factors for coronary artery disease include high blood pressure, high cholesterol levels, smoking, obesity, diabetes, lack of physical activity, unhealthy diet, excessive alcohol consumption, stress, and age. Genetics and family history also play a significant role in determining an individual’s risk.

The symptoms of coronary artery disease can vary depending on the specific condition but may include chest pain or discomfort (angina), shortness of breath, fatigue, dizziness, palpitations (irregular heartbeats), swelling in the legs, ankles, or abdomen, and fainting spells. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. However, it’s important to note that some people with coronary artery disease may not experience any symptoms, especially in the early stages.

Diagnosis of coronary artery disease typically involves a combination of medical history assessment, physical examination, and diagnostic tests. These tests may include blood tests to check cholesterol levels and other markers of heart health, electrocardiogram (ECG or EKG) to measure the heart’s electrical activity, echocardiogram to visualize the heart’s structure and function, stress tests, coronary angiography, cardiac CT scan, and others as determined by your healthcare provider.

Treatment for coronary artery disease may include lifestyle changes such as dietary modifications, exercise programs, and smoking cessation, medications to control blood pressure, cholesterol levels, and other risk factors, procedures such as angioplasty and stent placement to open blocked arteries, coronary artery bypass grafting (CABG) surgery, and cardiac rehabilitation programs to support recovery and improve heart health.

You can reduce your risk of coronary artery disease by adopting a healthy lifestyle. This includes maintaining a balanced diet low in saturated fats, cholesterol, and sodium, exercising regularly, maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, managing stress effectively, and getting regular check-ups with your healthcare provider to monitor and manage any risk factors.

Acute coronary syndrome (ACS) is a broad term for three types of coronary artery disease that affect millions of people each year. Types of ACS includes:

• Unstable angina which involves sudden, unexpected chest pain or pressure
• Non-ST-elevation myocardial infraction(NSTEMI), which is a heart attack meaning the coronary arteries aren’t fully blocked or were blocked for a short amount of time
• ST-elevation myocardial infraction(STEMI), which is a much more severe heart attack that occurs when blood flow to your heart is fully blocked

These potentially life-threatening conditions occur when a blockage causes blood flow to your heart to suddenly slow or stop.

Acute coronary syndrome is a medical emergency that requires immediate attention.

For more details: Acute Coronary Syndrome (ACS): Causes, Symptoms & Treatment (clevelandclinic.org)

A gradual buildup of fat and cholesterol (plaque) hardens and narrows your arteries (atherosclerosis). Acute coronary syndrome can occur suddenly when this plaque tears or splits open.

A blood clot forms over the opening, narrowing or blocking blood flow to a part of your heart called the myocardium. The heart can’t get enough oxygen. Lack of oxygen (ischemia) damages the heart muscle, leading to unstable angina or heart attack.

Coronary artery spasm and Spontaneous coronary artery dissection (SCAD) can also cause ACS.

Inflammation contributes to many of the characteristics of plaques implicated in the pathogenesis of acute coronary syndrome. Moveover, inflammatory pathways not only regulate the properties of plaques that precipitate acute coronary syndromes but also modulate the clinical consequences of the thrombotic complications of atherosclerosis.

Vascular inflammation has been recognized as one of the key factors in the pathogenesis of acute coronary syndromes (ACS). It is known that elevated plasma inflammatory biomarkers such as high sensitivity C-reactive protein and Interleukin-6 are associated with cardiovascular events. Recently peri-coronary adipose tissue (PCAT) attenuation by computed tomography angiography has emerged as a marker specific for coronary artery inflammation. Recent studies demonstrated that high PCAT attenuation was associated with increased cardiac mortality6 and progression of no culprit plaque. Current results strongly suggest that not only plaque morphology but also inflammation plays an important role in the development of ACS. Anti-inflammatory therapy may have additional value in those subjects with high PCAT attenuation for the prevention of ACS and cardiac death.