Coronary artery disease

In coronary artery disease, a buildup of fats attaches in the coronary arteries that run along the surface of the heart, narrowing the vessel over time so that blood cannot flow normally to the heart muscle. As blood flow becomes more difficult, the heart begins to suffer from a lack of oxygen in stressful situations, such as during exercise. The lack of oxygen to the heart causes the symptoms of coronary artery disease.

Coronary artery disease is a chronic disease that can be managed well with good preventive care, and its progression can be slowed down with medication.

The narrowing point of coronary arteries may also block suddenly causing an acute, life-threatening heart attack – in which case you should call the emergency number 112 without delay. The pain of a myocardial infarction is often described as exceptionally strong, but the symptom can also be milder – it can be sensed as an unpleasant feeling radiating to the neck, teeth, upper limbs, back between the shoulder blades or upper abdomen.  It’s not uncommon if especially the elderly and diabetics don’t feel symptoms at all.

Symptoms of coronary artery disease

The most typical symptom of coronary artery disease is a squeezing chest pain (angina pectoris) that occurs during exertion or with a strong emotional reaction. The pain can radiate to the left upper arm or shoulder, neck or jaw. Shortness of breath under exertion or over-all fatigue are also common. For example, when walking up a familiar hill or stairs, you may start feel more out of breath, feel exhausted, or experience symptoms similar to heartburn. The symptoms usually intensify especially during physical or mental exertion, and ease within minutes at rest or by slowing down your pace. Symptoms may be more difficult to recognize with women and the elderly. It’s also possible that coronary artery disease appears as vague weakness or nausea.

Coronary artery disease occurs in both women and men, but sudden cardiac death is the first sign of coronary artery disease more often with women than with men, which refers that coronary artery disease is more often underdiagnosed with women. It has been proved that estrogen levels protects women to certain extent from coronary artery disease – after menopause, the odds to get a coronary artery disease increases.

Risk factors and prevention

We cannot influence all of the risk factors of coronary artery disease, such as our age, gender and heredity. The risk of getting coronary artery disease increases with age, and it has also been noted that men often get it at with younger age than women. It increases the risk if there’s heart diseases within your closest family; first-degree relative, either a parent or sibling, has got coronary artery disease at a young age (men under 55 and women under 65).

Fortunately there are also factors that we can influence. The most importantly quitting smoking, not getting type 2 diabetes, high blood pressure and high cholesterol levels are the factors that we can influence. For example, by quitting smoking, the risk of coronary artery disease is halved in two years and in 10 years it drops to the level of non-smokers. Regular exercise, weight management and a healthy diet can prevent the development of coronary artery disease, hypertension and diabetes. Treating diabetes or hypertension can prevent or delay coronary artery disease.

It is important to intervene the risk factors early, as getting a coronary artery disease is the sum of many factors, and only by anticipating can the greatest benefit be achieved. For example, by treating cholesterol levels, the risk of having a coronary artery disease event can be reduced by up to a third.

Do you know your cholesterol level?

Cholesterol is essential for the body, but excessive cholesterol in the blood is harmful and a significant risk factor for coronary artery disease. Cholesterol gets attached in the walls of the arteries narrowing them slowly. High cholesterol cannot be felt or detected in other way than by measuring it. It would be a good idea to measure it for the first time before the age of 40 and then regularly every 3-5 years. By treating cholesterol, the onset of coronary artery disease can be prevented, and the progression of the disease can be slowed in patients with coronary artery disease. Total cholesterol needs to be 5 mmol/l or lower, LDL or so-called bad cholesterol less than 3 mmol/l, HDL or good cholesterol in men over 1 mmol/l and in women over 1.2 mmol/l and triglycerides less than 1.7 mmol/l. The target values ​​are more precise if you have arterial disease or have risk factors for it.

How is coronary artery disease tested?

The first step is to assess your cardiovascular risk with your doctor. The risk is based on an doctor’s interview, your symptoms and your individual risk factors and examinations performed by the doctor, such as a heart film and listening to heart sounds with a stethoscope.

Coronary artery disease can be examined with a clinical stress test, computed tomography or angiography. Stress tests can usually be done in every cardiologist’s appointment in our Heart Centers. Only in Helsinki a stress test must be booked separately.

Angiographies are performed at Sydänkeskus Helsinki, and computed tomography examinations of the coronary arteries are performed in the CT truck of the Heart Center that travels around Finland. However, examinations are always applied at the cardiologist’s office – the doctor assesses the needs of the examinations.

Treatment of coronary artery disease

Various drugs are used in the treatment of coronary artery disease. Cholesterol drugs to prevent the progression of the disease. Beta blockers are used to calm the heart rate and reduce the need for oxygen. Acetylsalicylic acid prevents the formation of blood clots. Nitrates and calcium blockers relaxes the blood vessel walls and they reduce the chest pain symptom. Invasive treatment (balloon angioplasty or bypass surgery) to correct the blood circulation of the heart muscle is needed if the symptoms cannot be treated with medication or if the disease otherwise requires it.