Symptoms of blockage in Coronary Arteries

Symptoms of blockage in Coronary Arteries

Similar to any other organ of the body, the heart too needs its own supply of oxygen-rich blood in order to function properly. This blood is supplied to the heart through a network of arteries called coronary arteries. The four major coronary arteries (significant in size) are left main coronary artery, right main coronary artery, left circumflex artery, and left anterior descending artery.

Considering that the heart is the only organ that has to work non-stop without any rest, it’s critical for coronary arteries to be in good condition for a seamless supply of blood to the heart. This seamless supply is disrupted when there are blockages in the coronary arteries. Incidentally, such blockages can occur in arteries that supply pure blood to any part of the body, paving the way to a wide range of health conditions including stroke and deep vein thrombosis. However, for this article, we are only focused on blockages in coronary arteries, the condition being called coronary artery disease (CAD).

How Does CAD Occur?

Coronary artery disease (CAD) is caused by a condition called atherosclerosis. In this condition, a substance called plaque starts depositing slowly on the inner walls of coronary arteries. Gradually, it thickens and hardens, making it difficult to dislodge. As the plaque thickens, it narrows down the artery, which in turn restricts the blood flow. Restricted blood flow means that there is less oxygen-rich blood delivered to the heart now, so the heart function suffers in different ways. This, in short, is CAD/CHD. The arteries are said to be clogged with arterial plaque.

What Is Arterial Plaque, and How Is It Formed?

A diet rich in cholesterol causes some of the cholesterol in the blood to stick to the inner walls of the coronary arteries over time. In addition to cholesterol, there is calcium, fat, cellular waste, and fibrin, a substance involved in clotting of blood, flowing in the blood all the time. All these substances start depositing in the inner walls over time, creating a small clump of cohesive material that grows with time.

Risk Factors for CAD

• High levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL) in the blood
• Hypertension or high blood pressure
• Cigarette smoking
• Type-2 diabetes, insulin resistance, hyperglycemia, or high blood sugar
• Being obese or overweight
• Leading an inactive or sedentary lifestyle
• Unhealthy eating habits, basically consuming a diet rich in red meat, saturated fats, trans fats, salt, sugar and processed food; consuming less of fresh fruits, vegetables and whole grains
• Age: Risk increases from the mid-40s onwards
• Gender: Men are more at risk than women
• Menopause: Post-menopausal women are more at risk than younger women
• A family history of CAD/CHD or any heart disease
• Excessive or frequent alcohol consumption
• Pre-eclampsia: a history of preeclampsia during pregnancy; in this condition, the woman has high BP and high levels of protein in the urine (proteinuria)
• Obstructive sleep apnoea
• Emotional stress and depression
• High-sensitivity C-reactive protein (hs-CRP): Generally, hs-CRP increases whenever there is inflammation in the body. High level of hs-CRP is a risk factor for CAD.
• High triglycerides: Triglycerides is a type of fat found in the blood. High levels of triglycerides increase the risk of CAD, especially in older women.
• Homocysteine: This is an amino acid used by the body to make protein, build new tissue, and maintain existing tissue. High level of homocysteine is a risk factor for CAD.
• Auto-immune disorders: Diseases such as rheumatoid arthritis and lupus increase the risk of atherosclerosis and hence CAD.

Symptoms and Warning Signs

Symptoms in Men

• Angina: Angina or chest pain is the prevalent symptom of CAD. It feels like heaviness, tightness, squeezing, or burning sensations in the chest. It happens during any physical activity when the demand for oxygen-rich blood is highest, and that is what is missing in people with CAD
• Sweating
• Shortness of breath or dyspnoea
• Pain in the arms and/or shoulders
• Dizziness and fainting

Symptoms in Women

Women may face one or more of the above. In addition to that, they may experience:

• Vomiting
• Nausea
• Pain in the jaws
• Pain in the back
• Shortness of breath without chest pain

Complications from CAD

If CAD symptoms listed above are ignored, it can result in:

• Chest pain (angina): The occasional bout of angina listed under symptoms will become a regular affair now
• Heart attack (Myocardial infarction): Sometimes, the arterial plaque ruptures, so a blood clot is formed instantly at the spot. This can restrict the flow of blood in the coronary artery and trigger a heart attack. The lack of blood flow damages the heart muscle, and if emergency medical care is not provided, the extent of damage can be high.
• Heart failure: As the CAD progresses, the heart becomes more and more deprived of oxygen and nutrients from the blood. The heart muscles turn weak and are not able to pump blood. This condition is known as heart failure. And if the person has suffered a heart attack previously, the risk of heart failure increases.
• Arrhythmia or abnormal heart rhythms: The steady pace of heartbeats is regulated by electrical impulses that originate from within the heart. Damage to heart muscles from CAD can also damage these electrical impulses, leading to abnormal heart rhythms (rapid, slow, or skipped heartbeats).

Diagnosis and Treatment

There are various tests to diagnose CAD such as an electrocardiogram (to see evidence of a previous heart attack), echocardiogram (to check if all parts of the heart wall have good or impaired function), exercise stress test, nuclear stress test, cardiac catheterization along with angiogram, and CT scan. Treatment options include lifestyle changes, medication, angioplasty with stent placement, and coronary artery bypass grafting.

Outlook

If you or any of your dear ones are suffering from any of the symptoms listed above, rush to a reputed hospital. A cardiologist or cardiac surgeon will diagnose your condition precisely and decide the best course of treatment after factoring your age, overall health, and severity of CAD. Rest assured, this will put you on a path to quick recovery and rehabilitation.

Dr Gobu P

Senior Consultant & Interventional Cardiologist.