Coronary Artery Disease Treatment in Delhi, India

Coronary artery disease is a condition characterised by the narrowing or blockage of the coronary arteries, which are responsible for delivering oxygen-rich blood to the heart muscle. This blockage is primarily caused by accumulation of fatty deposits, known as plaques, within the artery walls. Over time, these plaques can harden and narrow the arteries, reducing blood flow and leading to a range of symptoms such as chest pain (angina), shortness of breath, and fatigue. 

If a coronary artery becomes completely obstructed, it can result in a heart attack (myocardial infarction), which can cause significant damage to the heart muscle. Factors contributing to CAD include high cholesterol levels, high blood pressure, smoking, diabetes, and a genetic predisposition to heart disease.

• Stable Angina: This form of CAD occurs predictably during physical activity or stress, and the discomfort is usually relieved by rest or medication. It is a sign that the heart is not getting enough oxygen during exertion, but is not usually a cause for immediate concern.
• Unstable Angina: Unlike stable angina, unstable angina can occur unpredictably and at rest. It is more severe and may last longer, potentially indicating a higher risk of a heart attack. This form of CAD requires prompt medical attention to prevent serious complications.
• Variant Angina (Prinzmetal's Angina): This type of angina is caused by spasms in the coronary arteries that temporarily reduce blood flow. It often occurs at rest, especially during the night, and can be severe but is typically relieved by medication that addresses the arterial spasm.
• Myocardial Infarction (Heart Attack): A myocardial infarction happens when a coronary artery is completely blocked, leading to a significant reduction in blood flow to a part of the heart muscle. This can cause severe damage or death to the heart tissue and requires immediate medical intervention to restore blood flow and minimise heart damage.

Atherosclerosis

The primary cause of CAD is atherosclerosis, a condition where fatty deposits, cholesterol, and other substances accumulate on the artery walls. This build-up, known as plaques, causes the arteries to become narrowed and hardened, restricting blood flow to the heart muscle. Over time, this can lead to angina (chest pain) and heart attacks if the blood supply to the heart is severely reduced or blocked.

High Cholesterol Levels

Elevated cholesterol levels, particularly high levels of low-density lipoprotein (LDL) cholesterol, contribute directly to the development of atherosclerosis. LDL cholesterol can deposit in the arterial walls, leading to plaque formation. Additionally, low levels of high-density lipoprotein (HDL) cholesterol, which helps remove LDL cholesterol from the bloodstream, can exacerbate the problem.

High Blood Pressure

Chronic high blood pressure, or hypertension, can damage the inner lining of the arteries, making them more susceptible to plaque accumulation. The increased pressure can also accelerate the progression of existing plaque and contribute to the narrowing of the arteries, further impeding blood flow to the heart.

Smoking

Smoking is a significant cause of CAD as it introduces harmful chemicals into the bloodstream that damage the arteries. Nicotine increases heart rate and blood pressure, while other chemicals in cigarettes can contribute to the formation of plaques. Smoking also reduces the level of HDL cholesterol, further promoting the development of CAD.

Diabetes

Diabetes, particularly when poorly controlled, can lead to elevated blood sugar levels that damage the blood vessels and promote plaque formation. People with diabetes often have higher levels of triglycerides and lower levels of HDL cholesterol, which can contribute to the development of CAD.

Inflammation

Chronic inflammation, often due to underlying conditions like autoimmune diseases or infections, can damage the arterial walls and contribute to the development of atherosclerosis. Inflammatory markers in the blood are associated with an increased risk of CAD and can exacerbate the progression of the disease.

Several factors can increase the likelihood of developing coronary artery disease. These risk factors include:

• Age: The risk of developing CAD increases with age, affecting men over 45 and women over 55.
• Family History: A family history of heart disease can increase the likelihood of CAD, indicating a genetic predisposition.
• Gender: Men are generally at a higher risk of CAD at a younger age compared to women. Women’s risk increases and can surpass men’s risk after menopause.
• Obesity: Excess body weight, particularly around the abdomen, is linked to a higher risk of CAD.
• Physical Inactivity: A sedentary lifestyle contributes to obesity and other risk factors, raising the risk of CAD.
• Unhealthy Diet: Diets high in saturated and trans fats, as well as processed foods, can increase the likelihood of CAD by promoting plaque build-up.
• Excessive Alcohol Consumption: Heavy drinking can raise blood pressure and contribute to other risk factors for CAD.
• Chronic Stress: Long-term stress may contribute to unhealthy lifestyle choices and physiological changes that increase CAD risk.

Coronary artery disease manifests through various symptoms, which can vary in severity and duration. Common symptoms include:

• Chest Pain (Angina): One of the most common symptoms, chest pain or discomfort often occurs during physical exertion or emotional stress. The pain may feel like pressure, squeezing, fullness, or a burning sensation in the chest. It typically subsides with rest or medication but can also occur unpredictably in some cases.
• Shortness of Breath: Difficulty breathing or shortness of breath may occur, especially during physical activity or when lying flat. This symptom arises due to reduced blood flow to the heart, which can impair the heart’s ability to pump blood efficiently.
• Fatigue: Unusual or extreme fatigue can be a sign of CAD. This fatigue often occurs even with minimal exertion and may be associated with other symptoms like chest pain or shortness of breath.
• Dizziness or Lightheadedness: Reduced blood flow to the heart can lead to feelings of dizziness or lightheadedness. This can be particularly noticeable during physical activity or sudden movements.
• Nausea or Indigestion: Some individuals may experience nausea, indigestion, or a feeling of fullness in the stomach, which can be mistaken for gastrointestinal issues rather than heart-related problems.
• Sweating: Unexplained or excessive sweating, especially when accompanied by other symptoms like chest pain or discomfort, can be an indicator of CAD or a heart attack.
• Pain in Other Areas: Pain or discomfort may radiate to other areas of the body, such as the arms (especially the left arm), shoulders, neck, jaw, or back. This referred pain can occur along with or in place of chest pain.
• Palpitations: Irregular or rapid heartbeats, known as palpitations, can occur as a result of CAD. This symptom may be accompanied by feelings of fluttering or pounding in the chest.
• Swelling in the Legs or Feet: In advanced cases of CAD, fluid can accumulate in the legs or feet, leading to swelling. This occurs due to the heart's reduced ability to pump blood effectively, causing fluid retention.

It is important to note that symptoms can vary widely among individuals, and some people with CAD may experience atypical symptoms or none at all.

Diagnosing coronary artery disease involves a combination of medical history, physical examinations, and diagnostic tests. Early detection is crucial for managing the condition and preventing serious complications. Common diagnostic methods employed at a coronary artery disease hospital include:

• Physical Examination and Medical History: A doctor will assess risk factors like smoking, diabetes, family history, and lifestyle habits, along with checking for symptoms like chest pain, shortness of breath, and fatigue.
• Blood Tests: These tests measure cholesterol levels, blood sugar, and markers of heart disease, helping to identify risk factors for CAD.
• Electrocardiogram (ECG or EKG): This test records the heart's electrical activity and can detect irregularities, such as a previous heart attack or abnormal heart rhythms, that may indicate reduced blood flow to the heart.
• Echocardiogram: An ultrasound of the heart that shows the heart’s structure and function. It helps identify areas of the heart that may not be pumping efficiently due to reduced blood flow.
• Stress Test: This test monitors the heart’s function during physical activity (or with medication to simulate exercise). It helps determine how well the heart works when it is under stress and can identify areas with reduced blood flow.
• Coronary Angiography: This invasive test involves injecting a dye into the coronary arteries through a catheter. X-ray imaging then reveals blockages or narrowing in the arteries, providing a detailed view of the coronary vessels.
• CT Coronary Angiogram: A non-invasive imaging test that uses a CT scan and contrast dye to produce detailed images of the coronary arteries. It helps detect blockages or atherosclerosis.
• Cardiac MRI: This imaging test provides detailed images of the heart and blood vessels, helping assess heart function and detect any areas of reduced blood flow or damage.

Coronary artery disease treatment focuses on improving blood flow to the heart, reducing symptoms, and preventing complications such as heart attacks. Treatment approaches can vary depending on the severity of the disease and may include lifestyle changes, medications, and surgical procedures.

Medications

• Cholesterol-lowering Drugs: Statins and other medications can reduce cholesterol levels, slowing the progression of plaque build-up in the arteries.
• Antiplatelet Drugs: Medications like aspirin can help prevent blood clots, reducing the risk of heart attacks.
• Beta-blockers: These drugs reduce the heart’s workload by slowing the heart rate and lowering blood pressure, which helps prevent chest pain and other symptoms.
• ACE Inhibitors and ARBs: These medications lower blood pressure and reduce strain on the heart, helping to improve blood flow.
• Nitrates: Often used to relieve chest pain, nitrates help widen the coronary arteries, improving blood flow to the heart muscle.

Surgical and Interventional Procedures

• Angioplasty and Stenting: A procedure that involves inserting a balloon to open narrowed arteries and placing a stent (a small mesh tube) to keep the artery open. This improves blood flow to the heart.
• Coronary Artery Bypass Grafting (CABG): This surgical procedure involves taking a healthy blood vessel from another part of the body and using it to bypass the blocked coronary arteries, restoring blood flow to the heart.
• Enhanced External Counterpulsation (EECP): A non-invasive treatment for chronic angina that improves blood flow by inflating cuffs around the legs to promote circulation during heartbeats.

Cardiac Rehabilitation

A structured program that includes supervised exercise, education, and lifestyle counselling to help patients recover from heart surgery or manage CAD more effectively. It helps reduce symptoms and improve quality of life.

Lifestyle Changes

• Healthy Diet: A heart-healthy diet that is low in saturated fats, cholesterol, and sodium can help reduce plaque build-up in the arteries.
• Exercise: Regular physical activity helps strengthen the heart, improve circulation, and manage risk factors like high blood pressure and high cholesterol.
• Smoking Cessation: Quitting smoking significantly reduces the risk of CAD and other cardiovascular complications.
• Weight Management: Maintaining a healthy weight through diet and exercise can help control blood pressure, cholesterol, and diabetes.

Coronary artery disease can lead to a range of serious complications if left untreated. These complications arise due to reduced blood flow to the heart muscle, resulting in damage to the heart over time. Some of the most common complications include:

• Heart Attack (Myocardial Infarction): When a coronary artery becomes completely blocked, it cuts off blood supply to a portion of the heart muscle, leading to a heart attack. This can cause severe chest pain, shortness of breath, and even sudden death if not treated immediately.
• Heart Failure: CAD can weaken the heart muscle over time, making it harder for the heart to pump blood efficiently. This condition, known as heart failure, leads to fatigue, shortness of breath, and fluid build-up in the body, including the lungs and legs.
• Arrhythmias: Reduced blood flow to the heart can cause irregular heartbeats or arrhythmias. These abnormal heart rhythms can range from mild palpitations to life-threatening conditions like ventricular fibrillation, which can cause sudden cardiac arrest.
• Angina: Chronic chest pain, or angina, is a common complication of CAD. It occurs when the heart doesn’t receive enough oxygen-rich blood during physical exertion or stress. While it may not always result in a heart attack, angina can severely limit daily activities.
• Sudden Cardiac Arrest: In severe cases, CAD can cause sudden cardiac arrest, where the heart unexpectedly stops beating. This is usually caused by a severe arrhythmia and requires immediate medical intervention to prevent death.
• Stroke: CAD increases the risk of stroke due to plaque build-up in the arteries that supply blood to the brain. A stroke occurs when a blood clot or narrowed artery blocks blood flow to the brain, potentially leading to long-term neurological damage.

Preventing Coronary Artery Disease involves adopting heart-healthy habits and managing risk factors. While some risk factors like age and family history cannot be controlled, many lifestyle choices can significantly reduce the risk of developing CAD. Here are key prevention strategies:

• Maintain a Healthy Diet: Eating a balanced diet that is rich in fruits, vegetables, whole grains, and lean proteins while low in saturated fats, trans fats, and cholesterol can help prevent the build-up of plaque in the arteries. Reducing salt intake is also important for managing blood pressure.
• Exercise Regularly: Engaging in regular physical activity helps improve heart health, lower blood pressure, and maintain a healthy weight. Aim for at least 150 minutes of moderate-intensity exercise each week, such as brisk walking, cycling, or swimming.
• Quit Smoking: Smoking is a major risk factor for CAD, as it damages the arteries and reduces blood flow to the heart. Quitting smoking significantly reduces the risk of heart disease, even in long-term smokers, and the benefits begin soon after quitting.
• Manage Blood Pressure and Cholesterol: High blood pressure and high cholesterol are significant contributors to CAD. Regular monitoring and managing these conditions through lifestyle changes or medications can help reduce the risk of artery damage and plaque formation.
• Control Diabetes: Diabetes increases the risk of CAD by contributing to plaque build-up in the arteries. Managing blood sugar levels through diet, exercise, and medication is critical for preventing heart disease in people with diabetes.
• Maintain a Healthy Weight: Excess weight, especially around the abdomen, increases the risk of CAD. Maintaining a healthy weight through a balanced diet and regular exercise can reduce risk factors like high cholesterol, high blood pressure, and diabetes.
• Limit Alcohol Consumption: While moderate alcohol intake may have some cardiovascular benefits, excessive alcohol consumption can raise blood pressure and contribute to heart disease. Limiting alcohol intake to moderate levels can help protect heart health.
• Manage Stress: Chronic stress can lead to unhealthy habits such as overeating, smoking, or drinking alcohol, all of which increase the risk of CAD. Practising stress-relieving techniques such as mindfulness, yoga, or meditation can improve overall heart health.

By making these lifestyle changes and working with healthcare professionals to manage existing conditions, individuals can significantly reduce their risk of developing Coronary Artery Disease and its associated complications.

Can Coronary Artery Disease be reversed?

Coronary Artery Disease (CAD) cannot be completely reversed, but its progression can be slowed or even halted with lifestyle changes and medical interventions. Eating a heart-healthy diet, exercising regularly, quitting smoking, managing cholesterol and blood pressure, and taking prescribed medications can help reduce the risk of further plaque build-up. In some cases, surgical procedures like angioplasty or bypass surgery may be necessary to restore proper blood flow.

What is the difference between Coronary Artery Disease and a heart attack?

CAD is a condition where the coronary arteries become narrowed or blocked due to plaque build-up, limiting blood flow to the heart muscle. A heart attack, or myocardial infarction, occurs when a coronary artery becomes completely blocked, cutting off blood supply to a portion of the heart muscle. CAD develops gradually over time, while a heart attack is a sudden event, often caused by a rupture of the plaque that leads to a complete blockage.

How does stress contribute to Coronary Artery Disease?

Chronic stress can contribute to Coronary Artery Disease by increasing blood pressure, promoting inflammation, and leading to unhealthy behaviours such as overeating, smoking, or excessive alcohol consumption. Stress can also cause the body to release hormones like adrenaline, which raise heart rate and blood pressure, putting additional strain on the heart. Over time, this can increase the risk of developing plaque in the arteries, leading to CAD.

What impact does sleep have on Coronary Artery Disease risk?

Poor sleep quality and insufficient sleep can increase the risk of Coronary Artery Disease. Lack of sleep is linked to higher blood pressure, inflammation, and elevated stress hormones, all of which contribute to the development and progression of CAD. Sleep disorders such as sleep apnoea are also associated with increased risk, as they can cause repeated drops in oxygen levels during the night, putting strain on the heart.

Is Coronary Artery Disease hereditary?

Yes, Coronary Artery Disease can be hereditary. A family history of heart disease, especially in first-degree relatives (parents, siblings), increases the risk of developing CAD. Genetics can influence cholesterol levels, blood pressure, and how the body handles inflammation, all of which are risk factors for CAD. However, lifestyle choices such as diet, exercise, and smoking habits still play a significant role in whether the disease develops.

Can women experience different symptoms of Coronary Artery Disease than men?

Yes, women may experience different or more subtle symptoms of Coronary Artery Disease compared to men. While chest pain is a common symptom for both, women are more likely to experience symptoms such as shortness of breath, nausea, fatigue, dizziness, or discomfort in the neck, jaw, shoulder, or upper back. These symptoms may be overlooked or misinterpreted, which can delay diagnosis and treatment in women.

How does high blood sugar affect Coronary Artery Disease progression?

High blood sugar, particularly in people with diabetes, accelerates the progression of Coronary Artery Disease. Elevated blood sugar levels can damage the inner lining of blood vessels, making it easier for plaque to form and narrow the arteries. It also increases inflammation, raises cholesterol levels, and promotes the formation of blood clots, all of which contribute to the worsening of CAD and an increased risk of heart attacks. Managing blood sugar levels is crucial for reducing CAD risk in people with diabetes.

Reviewed by Dr. Vijay Kohli, Vice Chairman & Chief, Cardiac Surgery on 17 Dec 2024.