Ask the expert: what is coronary artery disease?

10 February 2020

As February is National Heart Month, Dr Peter Henriksen gives us insight into coronary artery disease.

What is coronary artery disease?
Coronary (heart) artery disease is caused by build-up of fatty deposits inside the lining of the coronary arteries that supply blood to the heart muscle. Eventually the arteries may become so narrow that the heart muscle does not receive enough blood flow. This results in symptoms called angina. These symptoms may come on when the heart muscle is in need of extra blood flow when the patient is active eg walking or exercising. In some patients the fatty deposits and lining of the coronary artery may suddenly break or rupture. This leads to sudden clot formation and blockage of the artery. Blood flow to the heart muscle is stopped resulting in a heart attack (myocardial infarction).

What are the symptoms of angina? How do I know if I am having a heart attack?
Angina is a term used to describe a collection of symptoms related to coronary disease. Symptoms come on during walking and are more prominent on inclines or in cold weather. Patients often describe a tightness or discomfort in the chest, arms or neck. This may be accompanied by shortness of breath and symptoms improve quickly with rest. Additional symptoms including fatigue, nausea, light headedness. More varied patterns of chest discomfort may be described by some patients. These additional symptom patterns are sometimes referred to as ‘atypical’ and are more commonly described by women. Heart attack symptoms occur at rest and build up rapidly. Chest discomfort is usually intense and in addition to all the symptoms listed above the patient may start sweating and vomit.

What causes coronary artery disease? Can it be prevented?
Risk factors increase the rate of fatty build up in the lining of the arteries and make blood clot formation and heart attack more likely. Many risk factors can be identified easily and controlled. These risk factors include; smoking, high blood pressure, high blood cholesterol concentrations, diabetes, being overweight and not exercising. Treating and reducing risk factors is an effective way of preventing the onset of angina or heart attack. We are getting better at doing this and death rates from coronary artery disease in UK have fallen by 40% in the last 20 years. Unfortunately, despite improvements in our understanding and treatments, heart attacks remain a leading cause of death and many heart attack patients die before reaching hospital.

How is angina related to coronary artery disease diagnosed? What tests are available?
The symptoms the patient describes to the doctor are key to making the diagnosis of angina and raising a suspicion of underlying coronary disease. Assessment will also include identification of the risk factors outlined above. Blood pressure measurement and blood tests for cholesterol and sugar (glucose) will be taken. Patients with coronary artery disease usually have no physical signs and with varied symptoms the diagnosis can be challenging. Without additional testing it is easy to miss patients with underlying coronary disease and incorrectly diagnose patients who do not have it. Recently, a research group led by cardiologists in Edinburgh, demonstrated that CT coronary angiography, conducted in a CT X-ray scanner, leads to better diagnosis and assessment of patients with possible angina. The researchers demonstrated that health outcomes for patients assessed by CT coronary angiography were better including lower rates of heart attack and death. CT coronary angiography helps the doctor ensure that the right treatment gets to the right patient. Spire Shawfair Park Hospital provides rapid access to cardiology consultant led assessment and CT coronary angiography for patients with possible angina.

If you have any concerns or would like to find out more about our cardiology service, contact us on 0131 316 2507 or info@spireedinburgh.com.

 

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