Blocked Heart Arteries:
Symptoms, Prevention, Diagnosis and Treatment

3.Possible causes and risk factors that lead to Blocked arteries

Causes

The most common cause of coronary artery disease is vascular injury to the inner layer of coronary artery with the buildup of plaque. The injury may be caused by various factors including:

• Sedentary lifestyle
• Diabetes or insulin resistance
• High blood pressure
• High cholesterol
• Smoking

Over the years, plaque made of cholesterol and other cellular waste products tend to accumulate at the site of injury through a process called as atherosclerosis. In some instances, the surface of the plaque ruptures and as a defense mechanism, blood cells clump at the site to repair the artery. The clump gets dislodged in some instances and can clog narrow arteries leading to a heart attack.

Risk factors

Some of the risk factors for blocked arteries are as follows:

• Family history: The risk of coronary artery disease is higher in members with a family history of the condition. The risk is higher in individuals with father or brother diagnosed with heart disease before 55 years or if the mother or sister developed the condition before 65 years of age.
• Age: The risk of damaged or narrowed arteries increases with age.
• Sex: Compared to women, men are generally at increased risk of the condition. The risk of coronary artery disease increases in women after menopause.
• Smoking: Smokers have a significantly higher risk of heart disease.
• Blood Pressure: In patients with uncontrolled blood pressure the arteries harden and thicken ultimately becoming narrow. High blood pressure increases the risk of coronary artery disease.
• Cholesterol levels: Increased cholesterol levels in the blood increases the risk of plaque formation and atherosclerosis. High levels of LDL Cholesterol (Low Density Lipoprotein), also known as bad cholesterol or low levels of HDL Cholesterol (High Density Lipoprotein) also known as good cholesterol, results in the development of atherosclerosis.
• Diabetes: Diabetes or uncontrolled blood sugar levels increases the risk of coronary artery disease. It is very common in Indian population.
• Overweight or obesity: Excess weight worsens other risk factors thereby increasing the risk of coronary artery disease.
• Sedentary lifestyle: Physical inactivity is associated with coronary artery disease.
• Stress: Stress damages arteries and worsen other risk factors of coronary artery disease.
• Diet: Unhealthy diet, or diets rich in saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.

Apart from these classic risk factors, coronary artery disease can also be caused by other factors including:

• Sleep apnea: Breathing disorders during sleep resulting in strain on the cardiovascular system.
• High sensitivity C-reactive protein: A protein that is an indicator of inflammation in the body.
• High triglycerides: A type of fat (lipid) observed in the blood stream. Increased levels of TG raise the risk of coronary artery disease.
• Homocysteine: This is an amino acid observed in the body that is important of tissue build up. High levels of homocysteine increases the risk of coronary artery disease.
• Preeclampsia: It can develop in women during pregnancy and can cause high blood pressure and higher amount of protein in urine. This condition can lead to coronary artery disease in the latter part of women’s life.
• Alcohol abuse: Heavy alcohol consumption worsen other risk factors of coronary artery disease.
• Autoimmune diseases: This is a condition where the body’s own defense mechanism is affected. Conditions such as rheumatoid arthritis and lupus increases the risk of atherosclerosis.

4.How should I screen or Diagnose Blocked Heart arteries?

Regular health checkups will help to identify the condition early. Doctor will ask several questions related to your medical history and your family history. The risk of coronary artery disease increases if any of the family members or relatives had heart disease earlier.

This is followed by a thorough physical exam. Blood cholesterol and blood sugar levels are an important indicator for coronary artery disease. Your doctor may request for a routine blood test to identify any abnormalities that guide the diagnosis. Apart from these routine tests, your doctor may suggest one or more of the following tests to confirm a heart disease:

• Your doctor might recommend a simple chest X ray along with some additional tests
• Electrocardiogram also called ECG, records electrical signals as they travel through the heart. The readings are printed on an electrocardiogram strip and can often reveal any previous heart attacks or an attack that is in progress.
• Holter monitoring is a type of ECG where the individual wears a portable monitor for 24 hours while going through regular activities. The devise captures any abnormalities and can also suggest inadequate blood flow to the heart.
• Echocardiogram is another promising test that provides information about the health status of the heart. The test uses ultrasound waves to create an image of the heart. The results reveal the status of heart walls and whether they are contributing effectively to support heart’s pumping activity.
• Your doctor may recommend a stress test if you are having any signs of the disease during exercise or physical activity. You will be asked to walk on a treadmill or ride a stationary bike while you are being monitored with an ECG. This procedure is called an exercise stress test. Your doctor may use medication to stimulate your heart in some cases instead of exercise.
• In some cases your doctor my conduct stress tests using an echocardiogram. In this procedure, you will be monitored with ultrasound before and after you exercise on a treadmill or bike. Alternatively the doctor may use medication to stimulate the heart during an echocardiogram.
• MRI is an important diagnostic tool in medicine. Your doctor may use medications to stimulate the heart while conducting an MRI.
• Nuclear stress test is a procedure to evaluate blood flow to the heart muscle in resting stage and during stress. Your doctor will inject a tracer into the bloodstream and the device will monitor areas in the heart that receive less blood flow.
• Heart Angiogram is the most promising test to identify blocked arteries. In an angiogram for heart, your doctor will inject a special dye into the coronary arteries through a long, thin, flexible tube called a catheter. It is threaded through an artery, usually in the leg to the arteries in the heart. The dye outlines narrow spots and artery blockages.
• Calcium deposits are known to narrow the arteries. Your doctor may recommend a CT scan to evaluate calcium deposits as substantial amount of calcium in the arteries can establish coronary artery disease.
• A CT coronary angiogram is recommended in some cases where a contrast dye is injected intravenously during a CT scan and the images are evaluated for coronary artery disease.

6.Prevention of Coronary Artery disease

Coronary Artery Disease is a progressive disease and once diagnosed can be managed through treatment. It can also be prevented from developing by leading a healthy lifestyle and keeping the arteries free of plaque.

Here are some measures that can be followed to prevent coronary artery disease:

• Smoking is a key risk factor that promotes vascular injury. Quitting smoking can help in preventing the condition.
• Other risk factors that need attention are high blood pressure, high cholesterol and diabetes. Managing these conditions can help in preventing coronary artery disease
• Sedentary lifestyle prompts coronary artery disease. Being active every day, ideally for 30 minutes or more per day can be very helpful
• Foods that are low in trans fats, saturated fats, simple sugars and sodium can be helpful.
• Maintain optimal body weight
• Learn effective ways to manage stress

7.Treatment and Surgery

Once coronary artery disease is diagnosed, patients have several options to manage or treat it. Your doctor might recommend lifestyle changes along with treatment with drugs. In some cases, your doctor might suggest a surgical procedure based on the seriousness of the condition.

Lifestyle changes

Your doctor might recommend the following lifestyle measures to maintain healthy arteries or manage blood cholesterol levels.

• Quit smoking: Smoking is a major risk factor for CAD. The blood vessels are constricted with nicotine forcing the heart to work harder. On the other hand, carbon monoxide reduces oxygen in the blood and damages the lining of blood vessels. Vascular injury is the main reason for plaque formation. Quitting smoking can help in maintaining healthy arteries.
• Manage blood pressure: Blood pressure should be checked regularly, especially in those who have blood pressure higher than normal or have a history of heart disease. Follow the doctor's advice in managing blood pressure with drugs and diet.
• Manage cholesterol: You have to manage blood cholesterol levels regularly to keep a check. It includes observing the levels of LDL, HDL and TG. Know more about the good cholesterol and bad cholesterol and the foods that help in managing them.
• Manage blood sugar levels: In patients who are diabetic, tight blood sugar management can help manage coronary artery disease.
• Following a healthy diet: Eat healthy food that includes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts and also food which is low in saturated fat, cholesterol and sodium. This can help you control your weight, blood pressure and cholesterol. Avoid saturated fat and trans fat, excess salt, and excess sugar.
• Exercise regularly: Keeping active with exercise can help you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. These are all risk factors for coronary artery disease.
• anage body weight: The risk of coronary artery disease increases with weight. Losing even a small percentage of weight can help in dramatically reducing risk factors of coronary artery disease.
• Manage stress: Practice techniques to manage stress.

Drugs

If lifestyle changes are not adequate, or for better results, your doctor might recommend medication to keep the heart healthier. It is important to follow the dose and take the medication regularly.

• Medication to manage blood cholesterol: Blood cholesterol is the main reason behind the plaque formation that clogs the arteries. Your doctor may recommend drugs to manage bad cholesterol (LDL) or improve the good cholesterol (HDL). He may also recommend medication to manage triglycerides (TGs). Your doctor may choose from a range of cholesterol lowering medication including statins, niacin, fibrates and bile acid sequestrants.
• Aspirin: Aspirin or agents called blood thinners can reduce the tendency of blood to clot. Blood clots can block arteries and hence taking aspirin or blood thinners daily can help in preventing the formation of clots. Aspirin can also prevent future heart attacks however in some cases it may be inappropriate such as in patients having bleeding disorder. You have to inform your doctor in advance if you have any bleeding disorder.
• Beta blockers: These medications slow the heart rate and decrease blood pressure, which decreases the heart's demand for oxygen. Beta blockers reduce the risk of future attacks in patients who had attacks earlier.
• Calcium channel blockers: In cases where beta blockers are not effective or if the patient is unable to take beta blockers the doctor might recommend calcium channel blockers. This medication can help in improving the symptoms of chest pain (angina).
• Ranolazine: Your doctor may prescribe this drug along with a beta blocker or instead of a beta blocker if you cannot take it. It helps in managing chest pain (angina).
• Nitroglycerin: Nitroglycerin is available as tablets, sprays and patches and can help in controlling the chest pain. It temporarily dilates coronary arteries and reduce the heart’s demand for blood.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): These drugs decrease blood pressure and may help prevent progression of coronary artery disease.

Surgical procedures

Sometimes more aggressive procedures are needed to restore and improve blood flow, these include.

• Angioplasty and stent placement (percutaneous coronary revascularization): In this procedure a long, thin tube called a catheter is inserted into the narrowed part of the blocked artery. The surgeon will insert a wire with a deflated balloon through the catheter to the narrowed area of the blocked artery. Once in place, the balloon is then inflated resulting in the compression of the plaque deposits against the artery wall. The heart artery surgery might often leave the stent in the artery to keep it open. Some stents will have the ability to release medication to keep the arteries open.
• Coronary artery bypass grafting: In this procedure a surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of the body. After the procedure the blood flows around the blocked or narrowed coronary artery. This surgery is done through open heart procedure and is often reserved for cases of multiple narrowed coronary arteries. You will be advised to stay in the hospital for at least 5 days.

9.Coronary Artery Disease FAQs: All your concerns addressed

Q.  What are the possible causes for my signs and symptoms?

1. The main reason for your signs and symptoms could be due to a heart problem. Your doctor can make a diagnosis based on your family history, physical examination and blood tests. He may also recommend some additional tests like ECG, Echocardiogram or Heart Angiogram. Identifying the condition early can help in managing the condition appropriately.

Q.  Do I need any tests?

1. Your doctor might request for blood tests initially to evaluate the blood cholesterol and blood sugar levels. He might be also evaluating other markers to check for any inflammation. Based on the physical examination and blood tests, your doctor might recommend additional tests like electrocardiogram, echocardiogram or angiogram for heart to evaluate if the arteries are blocked and understand the health status of the heart.

Q.  Should I see a specialist?

1. Based on the seriousness of the condition your doctor might recommend a specialist. In early stages the condition can be managed with medication. However in serious cases with a blocked artery or multiple blocked arteries, your doctor might recommend a specialist to guide further treatment.

Q.  Should I follow any restrictions while I wait for my next appointment?

1. Your doctor might recommend certain lifestyle changes and diet improvements to keep the cholesterol in control and avoid any further vascular injury.

Q.   What emergency signs and symptoms should prompt a call to emergency medical help?

1. Your doctor can explain to you about signs and symptoms that are indicative of a heart attack. Since immediate medical treatment is important in these cases, you need to understand the symptoms that are suggestive of a heart attack. Seek medical help if you have any of the following symptoms:
• Chest pain
• Discomfort in any part of the upper body
• Shortness of breath
• Nausea or vomiting with lightheadedness, dizziness, or cold sweat

Q.   I am getting a coronary bypass graft procedure. Will it impact my work after the surgery?

1. This is an open heart surgery and your doctor will inform you about the procedure in detail. In many cases patients can join the work after a few weeks. However your doctor will discuss post-operative measures while understanding your work requirements.

Q.  What should I do to prepare for a doctor’s appointment?

1. Be aware of any pre-appointment restrictions. Speak to your doctor in advance.
• Write down any symptoms you're experiencing prior to the meeting.
• Write down your key medical information including any details like family history of heart disease.
• Find a family member or friend who can join you for the meeting.
• Write down questions to ask your doctor. It is important to know about the disease, lifestyle measures, treatment and post-operative care.

Q.  What do you mean by a blockage of heart arteries?

1. Arteries are blood vessels that transport oxygen-rich blood throughout the body. The Arteries are composed of smooth inner walls which helps the blood to flow easily. When these arteries are blocked they are known as clogged arteries. Clogged arteries occur when there is a buildup of plaque in the inner lines of the artery walls. This can cause a blockage in the flow of blood. You should be careful about clogged arteries since they greatly increase the chances of heart attack, stroke, and even death. It can happen to you at any age so it’s important to avoid the accumulation of arterial plaque.

Q.   How do I find out if my arteries are blocked?

1. Most arterial blockages already form by the time people reach their 20s. Some of the warning signs of blocked arteries that you should be aware of are:
• Stroke - When the plaque accumulates in the carotid arteries, it can result in stroke
• Fatigue - Reduced oxygen as a result of poor blood flow can cause fatigue and dizziness. This occurs especially in women.
• Shortness of breath - The lack of oxygen can cause you to feel shortness of breath.
• Lower Back Pain - Lower blood flow can cause the disks connecting the vertebrae to become weak, thereby causing sudden pain from pinched nerves.
• Chest Pain - Reduced blood flow to the heart can cause angina or chest pain.
• Numb Hands and Feet - Reduced blood flow can cause numbness in your hands and feet
• Erectile dysfunction - If the blood flow to the genitals is less, it can cause erectile dysfunction.

Q.   Which is more effective in diagnosing coronary heart disease - stress tests or coronary angiogram?

1. It depends on the situation. A coronary angiogram or a heart catheterization test is a safe test but is invasive whereas a stress test is non-invasive. A stress test is used more as a screening test. In many cases, a heart cath test is considered to be the first step towards diagnosing a coronary heart disease.

Q.   What are the different treatment options I can look at for a coronary artery disease?

1. There are three different treatment options that you can choose for corona artery disease, depending on the severity of your symptoms:
• Lifestyle changes - You can begin with certain lifestyle changes such as limiting smoking, drinking, reducing stress, and exercising.
• Medications - You can take cholesterol-modifying drugs, aspirin, beta and calcium channel blockers, ranolazine, and nitroglycerin.
• Procedures - Treatment procedures can involve angioplasty and stent placement and coronary artery bypass surgery.

Q.   Does smoking increase the chances of coronary artery disease?

1. Studies find out that smoking contributes to a lot of heart diseases. In fact, it’s found that smokers have witnessed a two to four-fold increase in coronary artery diseases and a 70% higher death rate as compared to non-smokers. This is because smoking causes atherosclerosis or a buildup of fatty substances in the arteries. This causes the inner lining of the arteries to weaken and be filled with fat and plaque deposits that impedes blood flow. Since enough oxygen-rich blood can’t reach the heart, this can increase chances of heart attack.

Q.   Can a coronary artery disease be hereditary?

1. Coronary artery disease is one of the many cardiac disorders that can be inherited. Various characteristics of the cardiovascular system such as the strength of the blood vessels or the coordination between the cells and the heart are controlled by genes. Sometimes, even the smallest genetic mutation can cause a heart disease. Hence, it’s important that if one member of the family develops a coronary artery disease, others should get screened too. This can help detection in the early stages of the disease. Even in the case of the family of a person deceased due to coronary artery disease, it’s important to get screened to remove any possibilities of risk. Preventive treatment options include drug therapies and implantable diseases.

Q.   Are there any dietary changes I need to make to reduce the risk of a coronary artery disease?

1. Dietary changes are important in reducing the risk of coronary artery disease. In case you’re not sure about what to change in your diet, your doctor can suggest one to you. For example, you should avoid diets with saturated fat and cholesterol as they can cause buildup of plaque. Saturated fat and cholesterol can be found in animal and dairy products, lard, palm and coconut oils. You should also decrease your low-density lipoprotein (LDL) cholesterol intake while increasing your high-density lipoprotein (HDL) cholesterol intake. You should also make healthier choices such as fresh fruits and vegetables, lean meats, and fish.