Diseases of Heart Coronary Artery Disease

DISEASES OF HEART CORONARY ARTERY DISEASE

WHAT IS IT? The heart’s muscles get its blood supply through ​coronary arteries​. When blocks develop in these arteries heart is deprived of essential blood circulation. The block or stenosis is caused by a disease process called Atherosclerosis, which is deposition of lipid rich material in the vessel walls. Depending on the severity of the blocks the symptoms vary from absence of symptoms to severe myocardial infarction (Heart attack).

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SYMPTOMS

Angina or chest pain is the commonest presenting symptom. This is generally felt as a heaviness or uneasiness in the centre of chest. It is usually brought out by effort and relieved by rest. Angina lasts for short periods and seldom lasts for more than 20 minutes. Nitrates (medicines taken to relax coronary arteries) have the ability to relieve angina very quickly (Almost instantaneously if kept under the tongue ie., sublingual).

Angina is felt usually in the centre of chest (Left sided chest pains re usually not angina).

Typically angina appears as chest discomfort. It may radiate to neck, jaws, left shoulder or left arm. Rarely it can present as back pain, headache or even abdominal pain.

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If you suffer from repeated burning sensation in your upper abdomen and not relieved by usual medicines, a detailed check up is required. Angina presenting as stomach burn has misled even doctors to make wrong judgements.

Beware of “gas trouble” which is recurrent and not relieved by usual medicati ons!

ANGINA can present as ‘stoma.

Heart attack or Myocardial Infarction (MI) is another form of presentation. While angina is almost completely reversible, MI threatens permanent myocardial damage. This happens when there is sudden complete occlusion in the coronary arteries. Usually this occlusion occurs at pre-existing stenotic lesions. The common cause is a plaque rupture (separation of the atheromatous plaque and clot formation underneath). The myocardium supplied by the particular coronary artery is under threat of permanent damage.

The pain of MI is more severe and lasts longer. Patient may vomit and sweat. It is often described as a feeling of ‘Impending death”. This condition is severe and can be fatal at times. It calls for urgent attention. Patient needs urgent hospitalisation and treatment.

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HOW TO DIAGNOSE? When the physician sees a patient with symptoms of CAD, a thorough assessment is made. A detailed history of risk factors, previous events, procedures, medications and family history is obtained. A careful physical examination is the next step.

Generally, ECG and few blood tests may be done along with the first visit. If symptoms are suggestive of CAD, further investigations are required. This may include ECHO, TMT and Coronary Angiogram depending on the type and severity of symptoms.

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TREATMENT: Of all the patients with CAD, nearly three fourth requires only medicines. Rest of the symptomatic patients may require some form of invasive treatment depending on the findings of the CAG.

Common treatments are of two types – PTCA (Percutaneous Transluminal Coronary Angioplasty) or ANGIOPLASTY and CABG or Bypass Operation. The requirement and suitability of each modality of treatment is decided by the treating specialist.

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