Coronary Artery Disease: Causes, Symptoms and Treatment Methods

What is Coronary Artery Disease?

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Coronary arteries are blood vessels that carry oxygen and nutrients to the heart muscle (myocardium). Coronary artery disease occurs when plaque buildup due to atherosclerosis (hardening of the arteries) causes narrowing or blockage in these vessels.

Plaques are composed of cholesterol, fat, calcium, and other substances. Over time, these plaques grow and narrow the artery, reducing blood flow to the heart muscle. This can lead to chest pain (angina) or heart attack when the artery becomes completely blocked.

The Atherosclerosis Process

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Atherosclerosis develops gradually over years:

1. Endothelial Damage

• High blood pressure, smoking, diabetes, or high cholesterol damages the inner lining (endothelium) of blood vessels

2. Fatty Streaking

• LDL cholesterol begins accumulating in the damaged area
• Inflammatory process begins

3. Fibrous Plaque Formation

• Smooth muscle cells and connective tissue accumulate
• Plaque thickens and narrows the vessel lumen

4. Complex Lesion

• Calcification develops
• Risk of plaque rupture increases
• Clot formation and acute coronary syndrome

Causes and Risk Factors of Coronary Artery Disease

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Non-Modifiable Risk Factors

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Age

• Men over 45 years
• Women over 55 years or post-menopausal

Gender

• Higher risk in men
• Risk increases in women after menopause

Family History

• Early heart disease in first-degree relatives
• Before age 55 in male relatives, before 65 in female relatives

Genetic Predisposition

• Familial hypercholesterolemia
• Genetic inflammatory markers

Modifiable Risk Factors

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Hypertension (High Blood Pressure)

• Constant pressure on vessel walls
• Causes endothelial damage
• Target: <130/80 mmHg

High Cholesterol

• Elevated LDL (“bad” cholesterol)
• Low HDL (“good” cholesterol)
• High triglycerides

Smoking

• Most important preventable risk factor
• Endothelial damage, oxidative stress, increased clotting
• Passive smoking is also risky

Diabetes

• Microvascular and macrovascular damage
• Acceleration of atherosclerosis
• Risk of silent ischemia

Obesity

• Especially abdominal obesity
• Insulin resistance and metabolic syndrome
• Waist circumference: Men >102cm, Women >88cm

Physical Inactivity

• Decreased cardiovascular fitness
• Increased risk of obesity and diabetes

Unhealthy Diet

• Saturated and trans fats
• Excessive salt and processed foods
• Insufficient fruits, vegetables, and fiber

Stress and Depression

• Chronic stress affects vascular health
• Unhealthy coping mechanisms

Coronary Artery Disease Symptoms

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Symptoms vary depending on the degree and rate of narrowing:

Stable Angina Pectoris

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• Chest pain or pressure triggered by exertion
• Typically in the center or left side of chest
• May radiate to arm, jaw, or back
• Lasts 5-15 minutes
• Relieved by rest or nitroglycerin

Unstable Angina

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• Pain even at rest
• New onset or worsening angina
• Longer duration pain (>20 minutes)
• Not fully relieved by medication
• May herald heart attack

Heart Attack (Myocardial Infarction)

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Diagnostic Methods

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Coronary artery disease diagnosis is made through clinical evaluation and various tests:

Non-Invasive Tests

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Electrocardiography (ECG)

• First-line test
• Ischemia findings (ST changes)
• Previous infarction signs
• Rhythm abnormalities

Exercise Stress Test

• ECG monitoring on treadmill or bicycle
• Detection of ischemia during exercise
• Functional capacity assessment

Stress Echocardiography

• Stress with exercise or medication
• Wall motion abnormalities
• Imaging with echocardiography

Myocardial Perfusion Scintigraphy (MPS)

• Heart perfusion imaging with radioactive tracer
• Detection of ischemic regions
• Viability assessment

Coronary CT Angiography

• Non-invasive angiography
• 3D imaging of coronary arteries
• Calcium scoring
• Plaque characterization

Cardiac MRI

• Myocardial structure and function
• Perfusion and viability
• Scar tissue detection

Invasive Tests

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Coronary Angiography

• Gold standard diagnostic method
• Catheter via groin or wrist
• Vessel imaging with contrast dye
• Degree and location of narrowing
• Treatment (stent) possible in same session

Intravascular Ultrasound (IVUS)

• Ultrasound imaging from within the vessel
• Plaque composition
• Stent optimization

FFR (Fractional Flow Reserve)

• Assessment of functional significance of stenosis
• Helps in stent decision
• FFR ≤0.80 indicates significant stenosis

Treatment Methods

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Coronary artery disease treatment is planned according to risk level and symptom severity:

Lifestyle Modifications

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Smoking Cessation

• Most important modifiable risk factor
• Risk decreases 50% within 1 year
• Professional support and medication

Heart-Healthy Diet

• Mediterranean diet recommended
• Saturated fat <7%
• Omega-3 fatty acids (fish)
• Plenty of fruits, vegetables, whole grains
• Salt restriction (<2g/day)

Regular Exercise

• 150 minutes moderate-intensity aerobic per week
• Or 75 minutes vigorous exercise
• Gradual increase
• Cardiac rehabilitation

Weight Control

• BMI 18.5-24.9 target
• Waist circumference goals
• Calorie restriction

Medication Therapy

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1. Antiplatelet Drugs

• Aspirin (75-100 mg/day)
• Clopidogrel, prasugrel, ticagrelor
• Prevents clot formation

2. Statins

• Lowers LDL cholesterol
• Plaque stabilization
• Target LDL: <70 mg/dL (high risk)
• Atorvastatin, rosuvastatin

3. Beta Blockers

• Reduces heart rate and workload
• Angina control
• Post-infarction protection
• Metoprolol, bisoprolol

4. ACE Inhibitors / ARBs

• Vasodilator effect
• Prevents cardiac remodeling
• Particularly important in diabetic patients

5. Calcium Channel Blockers

• Vasodilator
• For angina treatment
• Amlodipine, diltiazem

6. Nitrates

• Acute angina relief
• Sublingual nitroglycerin
• Long-acting nitrates

7. PCSK9 Inhibitors

• When LDL target not achieved with statins
• Injectable form
• Evolocumab, alirocumab

Interventional Treatments

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Percutaneous Coronary Intervention (PCI/Stent)

• Vessel widening with balloon angioplasty
• Stent placement
• Drug-eluting stents (DES)
• Preferred in acute coronary syndrome

Coronary Artery Bypass Grafting (CABG)

• In multi-vessel disease

• In left main coronary stenosis

• In diabetic patients

• Saphenous vein or mammary artery graft

• Severe, crushing chest pain

• Lasts more than 30 minutes

• Sweating, nausea, vomiting

• Shortness of breath

• Fear of death

Atypical Symptoms

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Prevention of Coronary Artery Disease

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Primary and secondary prevention strategies are vitally important:

Primary Prevention (Before Disease)

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• Regular health check-ups
• Early detection and control of risk factors
• Healthy lifestyle habits
• Early screening if family history present

Secondary Prevention (After Disease)

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• Full adherence to medication therapy
• Maintaining lifestyle changes
• Regular cardiology follow-up
• Cardiac rehabilitation programs

When to See a Doctor

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Consult a cardiologist if you experience:

• Chest pain or pressure triggered by exertion
• Chest discomfort with shortness of breath
• If you have risk factors (diabetes, hypertension, smoking, family history)
• Men over 40 and post-menopausal women
• Regular check-ups if you have known heart disease

Frequently Asked Questions (FAQ)

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Schedule an Appointment

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If you have risk factors for coronary artery disease or have chest pain symptoms, you can schedule an appointment for comprehensive cardiac evaluation.