Coronary Artery Disease: A Serious Risk Smokers Should Not Ignore

What Is Coronary Artery Disease?

Coronary artery disease is one of the most common forms of heart disease. It occurs when the arteries that supply blood to the heart become narrowed or blocked.

When the heart muscle does not receive enough oxygen-rich blood, myocardial ischaemia may develop. If blood flow is severely or completely blocked, part of the heart muscle may become damaged, leading to a heart attack.

Why Do the Coronary Arteries Become Narrowed?

Coronary artery narrowing usually develops from atherosclerosis, a condition in which the artery walls become thickened and hardened.

Fatty deposits, cholesterol, calcium, and other substances gradually accumulate inside the coronary arteries and form plaques. As these plaques grow, the space inside the arteries becomes narrower, reducing blood flow to the heart.

A plaque may also rupture suddenly and trigger the formation of a blood clot, which can partially or completely block the artery and cause an acute heart attack.

Who Is at Risk?

Risk factors can be divided into two main groups.

Risk Factors That Cannot Be Controlled

๐ Increasing age

๐ Family history and genetics

๐ Biological sex

Men generally have a higher risk than premenopausal women. After menopause, the level of risk between men and women becomes more similar.

Risk Factors That Can Be Controlled

๐ Smoking

๐ Diabetes

๐ High blood pressure

๐ High blood cholesterol

๐ Being overweight or having obesity

๐ Physical inactivity

๐ An unhealthy diet

Smoking is particularly harmful because it damages the artery walls, promotes blood clot formation, reduces oxygen levels in the blood, and causes the heart to work harder.

Warning Signs of Coronary Artery Disease

Symptoms vary depending on the location and severity of the blockage. Some people may not experience any obvious symptoms until the condition becomes severe.

Acute Symptoms

Acute coronary artery blockage may develop quickly and cause severe symptoms, including:

๐ Severe chest tightness or pressure

๐ Sudden shortness of breath

๐ Fainting or loss of consciousness

๐ Cold sweating

๐ Nausea or vomiting

๐ Irregular heartbeat

๐ Cardiac arrest in severe cases

These symptoms require immediate emergency medical attention.

Chronic Symptoms

In chronic coronary artery disease, the artery may be narrowed but not completely blocked. Some blood can still pass through, although the amount may be insufficient during physical exertion.

Possible symptoms include:

๐ No noticeable symptoms in some patients

๐ Chest discomfort during exercise or strenuous activity

๐ Shortness of breath

๐ Becoming tired more easily than usual

๐ Difficulty taking a full breath

The most common symptom is pressure, squeezing, or tightness in the centre or left side of the chest. The discomfort may spread to:

๐ The left arm

๐ Both arms

๐ The shoulder

๐ The neck

๐ The jaw

๐ The back

Some people may also experience sweating, palpitations, dizziness, or unusual fatigue.

How Is Coronary Artery Disease Diagnosed?

Doctors may use several examinations depending on the patient’s symptoms and level of risk.

Electrocardiogram

An electrocardiogram, or ECG/EKG, is a quick initial test that records the electrical activity of the heart.

It may help identify abnormal heart rhythms and signs of reduced blood flow, particularly during an acute heart attack.

However, a normal ECG does not always rule out coronary artery disease.

Cardiac Enzyme Blood Test

When the heart muscle is damaged due to insufficient blood flow, substances such as cardiac troponin are released into the bloodstream.

A cardiac enzyme test can therefore help diagnose an acute heart attack and assess the degree of heart-muscle injury.

Echocardiogram

An echocardiogram uses sound waves to create images of the heart.

It allows doctors to assess:

๐ The heart’s structure and size

๐ The strength of heart-muscle contraction

๐ The movement of the heart walls

๐ The opening and closing of the heart valves

๐ The heart’s overall pumping function

Exercise Stress Test

An exercise stress test assesses how the heart responds when it is required to work harder.

The patient may walk or run on a treadmill or ride a stationary bicycle while the heart rhythm, blood pressure, and symptoms are monitored.

Doctors look for warning signs such as:

๐ Chest tightness

๐ Palpitations

๐ Dizziness or faintness

๐ Unusual shortness of breath

๐ Changes in the electrocardiogram

Another option is a stress echocardiogram, which uses ultrasound images to assess whether the heart muscle contracts abnormally during exercise. It may also help evaluate heart-valve function while the heart is working harder.

CT Scan

Coronary Calcium Score

A cardiac CT scan can measure calcium deposits in the coronary arteries and calculate a coronary calcium score.

Advantages include:

๐ No contrast injection is generally required.

๐ The examination usually takes less than 15 minutes.

๐ It provides a numerical estimate of the calcium burden in the arteries.

A higher calcium score generally indicates a greater amount of coronary plaque and a higher risk of coronary artery disease. Doctors can use the result alongside other risk factors to plan further care.

Coronary CT Angiography

Coronary CT angiography provides detailed images of the coronary arteries after contrast material is injected into the bloodstream.

It can help doctors assess:

๐ The location of narrowed arteries

๐ The severity of each blockage

๐ Abnormalities in the structure of the coronary arteries

๐ The condition of the arteries after certain heart procedures

Cardiac MRI

Cardiac magnetic resonance imaging provides detailed information about:

๐ The size and thickness of the heart muscle

๐ Heart contraction and pumping function

๐ Heart-valve narrowing or leakage

๐ Areas of scar tissue within the heart

๐ The severity of reduced blood flow to the heart muscle

The examination may take longer than other tests. Patients need to remain still and may be asked to hold their breath for short periods during image collection.

Coronary Angiography and Cardiac Catheterisation

Coronary angiography is an invasive procedure that can be used for both diagnosis and treatment.

A small catheter, usually around 1-2 millimetres in diameter, is inserted through an artery in the wrist or groin and guided towards the heart. Contrast material is then injected to show whether the coronary arteries are narrowed or blocked.

When a severe blockage is found, doctors may be able to perform balloon angioplasty and insert a stent during the same procedure.

The procedure is generally performed under local anaesthesia and usually does not require general anaesthesia.

Treatment of Coronary Artery Disease

Treatment depends on the severity and location of the blockage, the patient’s symptoms, test results, and general health.

In addition to medication and risk-factor control, two major procedures may be considered.

Balloon Angioplasty and Stent Placement

A small catheter with a balloon at its tip is inserted through an artery and guided to the narrowed area.

The balloon is inflated to widen the artery, after which a small mesh tube called a stent is usually placed inside the artery to keep it open.

This procedure helps improve blood flow to the heart muscle and reduce symptoms caused by severe narrowing.

Coronary Artery Bypass Surgery

Coronary artery bypass grafting, or CABG, is commonly considered when:

๐ Several coronary arteries are severely narrowed.

๐ The blockage is located in an important part of the coronary circulation.

๐ The artery is unsuitable for balloon angioplasty.

๐ Previous procedures have not provided adequate results.

During surgery, a healthy blood vessel from the chest, arm, or leg is connected to the coronary artery to create a new route around the blockage. This allows blood to reach the heart muscle more effectively.

Care After Treatment

After coronary artery treatment, patients may need long-term medication, including antiplatelet drugs, according to the cardiologist’s instructions. These medicines help reduce the risk of blood clots and recurrent artery blockage.

Patients should not stop antiplatelet medication without consulting their doctor, particularly after stent placement.

Coronary artery disease cannot always be permanently cured because atherosclerosis may continue to develop. Long-term care is therefore essential.

Recommended measures include:

๐ Stop smoking completely.

๐ Control blood pressure, cholesterol, and blood sugar.

๐ Maintain a healthy body weight.

๐ Exercise regularly as advised by the doctor.

๐ Choose foods low in saturated fat, trans fat, sugar, and sodium.

๐ Take prescribed medication consistently.

๐ Attend regular follow-up appointments.

Summary

Coronary artery disease occurs when the blood vessels supplying the heart become narrowed or blocked by atherosclerosis and plaque accumulation. Smoking is one of its most important preventable risk factors.

Symptoms may range from no noticeable problems to chest tightness, shortness of breath, pain spreading to the arm or jaw, fainting, or cardiac arrest.

Early assessment and treatment can help reduce heart-muscle damage and prevent serious complications. Smokers should therefore consider quitting as soon as possible and undergo appropriate cardiovascular risk assessment, particularly when other risk factors such as diabetes, high blood pressure, high cholesterol, or obesity are also present.

 

Reference :

Phyathai 3 Hospital Coronary Artery Disease

ArokaGO Providers Phyathai 3 Hospital