Tag: Angina Pectoris

  • Symptoms of Coronary Artery Disease

    Symptoms of Coronary Artery Disease

    Overview

    Understanding these symptoms is crucial because early detection and management can significantly improve outcomes. The way Coronary Artery Disease presents can vary greatly among individuals, ranging from no noticeable symptoms to severe and life threatening events. It’s important to be aware of the different ways this condition can manifest, as recognizing them promptly can lead to timely medical attention.

    Symptoms of Coronary Artery Disease

    Here is a quick list of common symptoms associated with Coronary Artery Disease:

    • Chest pain or discomfort (Angina Pectoris)
    • Shortness of breath (Dyspnea)
    • Fatigue
    • Nausea
    • Sweating (Diaphoresis)
    • Fainting (Syncope)
    • Palpitations (a feeling of your heart pounding or racing)
    • Cardiac arrest or sudden cardiac death
    • Atypical symptoms, especially in women, the elderly, and diabetics
    • Silent ischemia (no symptoms at all)

    In Details:

    1. Angina pectoris

    The most common symptom of Coronary Artery Disease is angina pectoris, often simply called angina. This is a clinical syndrome characterized by discomfort in the chest. People often describe it as a tight, squeezing, heavy, or pressure like feeling, rather than a sharp pain. This discomfort can be felt in the center of the chest (substernal) and may spread or radiate to other areas, such as the jaw, shoulder, back, arms (especially the left arm, or both arms), or even the teeth and upper abdomen (epigastric region).

    Angina is typically brought on by increased demand on the heart, such as during physical exertion, emotional stress, after a heavy meal, or exposure to cold. It usually lasts for several minutes and can be relieved by rest or by taking medication like sublingual nitroglycerin.

    2. Dyspnea

    Another significant symptom is dyspnea, or shortness of breath. More commonly, shortness of breath occurs alongside chest discomfort, described as a feeling of tightness across the chest or a restriction in breathing. Dyspnea can also indicate more advanced Coronary Artery Disease, such as if there’s ischemic left ventricular dysfunction (when the heart’s main pumping chamber is weakened due to lack of blood flow), or other complications like pulmonary venous congestion or pulmonary oedema.

    3. General symptoms

    Beyond chest discomfort and breathlessness, Coronary Artery Disease can manifest with other general symptoms. These can include nausea, sweating (diaphoresis), and fatigue. Fatigue is particularly common in patients with Coronary Artery Disease, sometimes due to the psychological impact of the disease or when combined with cardiac failure. Some individuals might experience palpitations, a sensation of their heart pounding or racing, or episodes of syncope (fainting).

    4. Atypical symptoms

    It’s important to be aware of atypical symptoms, which are more frequently observed in certain populations like women, the elderly, and individuals with diabetes mellitus. In these groups, Coronary Artery Disease might not present with the classic chest pain. Instead, it could appear as isolated symptoms such as palpitations, extreme fatigue, unusual discomfort (e.g., in the neck, jaw, or back without chest pain), or even lead directly to cardiac arrest without prior noticeable signs. The diagnosis of these atypical presentations can be challenging and requires careful clinical assessment.

    5. Silent ischemia

    A particularly concerning aspect of Coronary Artery Disease is silent ischemia. This refers to episodes where the heart muscle is not receiving enough blood (ischemia) but the person experiences no pain or discomfort at all. This lack of symptoms means that significant heart damage can occur without any warning. Silent ischemia is more prevalent among the elderly and people with diabetes mellitus.

    In some tragic cases, the very first manifestation of Coronary Artery Disease is a heart attack (myocardial infarction), which can be fatal. In fact, for approximately one in four people, the first symptom of coronary artery disease is what is termed sudden cardiac death. In these instances, there may be no prior warning signs or symptoms at all. However, for some who experience cardiac arrest, there might have been “warning symptoms” like chest pain or dyspnea in the days or weeks leading up to the event.

    Other similar questions

    Can I have coronary artery disease without any symptoms?

    Yes, it is possible. Many individuals, especially the elderly and those with diabetes, can have what is called “silent ischemia,” where they experience reduced blood flow to the heart without any noticeable pain or discomfort

    Do men and women experience Coronary Artery Disease symptoms differently?

    While the core symptoms are similar, women, the elderly, and diabetics are more prone to “atypical symptoms” which might not include classic chest pain. These can manifest as fatigue, shortness of breath, nausea, or discomfort in areas like the jaw, neck, or back, rather than the chest.

    When to seek medical attention ?

    If you experience symptoms that suggest Coronary Artery Disease, such as chest pain or discomfort, shortness of breath, or unexplained fatigue, you should seek medical attention promptly. For severe or sudden symptoms like crushing chest pain, especially if it radiates or is accompanied by sweating or nausea, call for emergency medical help immediately.

    Resources

    • Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology, 234(10), 16812–16824.
    • Bergmark, B. A., Mathenge, N., Merlini, P. A., Lawrence-Wright, M. B., & Giugliano, R. P. (2021). Acute coronary syndromes. The Lancet, 398(10300), 741–756.
    • Smith, J. N., Negrelli, J. M., Manek, M. B., Hawes, E. M., & Viera, A. J. (2015). Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update. Journal of the American Board of Family Medicine, 28(2), 283–293.
    • Geller, B. J., & Abella, B. S. (2018). Evolving Strategies in Cardiac Arrest Management. Cardiology Clinics, 36(1), 73–84.
    • Granfeldt, A. (2019). In-Hospital Cardiac Arrest. JAMA, 321(16), 1618-1619.
    • Krahn, A. D., Tfelt-Hansen, J., Tadros, R., Steinberg, C., Semsarian, C., & Han, H.-C. (2022). Latent Causes of Sudden Cardiac Arrest. JACC: Clinical Electrophysiology, 8(6), 806–821.
    • Gallone, G., Baldetti, L., Pagnesi, M., Latib, A., Colombo, A., Libby, P., & Giannini, F. (2018). Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome. Journal of the American College of Cardiology, 72(23), 2886–2903.
    • Bahit, M. C., Korjian, S., Daaboul, Y., Baron, S., Bhatt, D. L., Kalayci, A., Chi, G., Nara, P., Shaunik, A., & Gibson, C. M. (2023). Patient Adherence to Secondary Prevention Therapies After an Acute Coronary Syndrome: A Scoping Review. Clinical Therapeutics, 45(9), 1119–1126.
    • Gaviria-Mendoza, A., Zapata-Carmona, J. A., Restrepo-Bastidas, A. A., Betancur-Pulgarín, C. L., & Machado-Alba, J. E. (2020). Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome. Journal of Primary Care & Community Health, 11, 2150132720946949.
    • Silverio, A., Cancro, F. P., Esposito, L., Bellino, M., D’Elia, D., Verdoia, M., Vassallo, M. G., Ciccarelli, M., Vecchione, C., Galasso, G., & De Luca, G. (2023). Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets. Journal of Clinical Medicine, 12(6), 2161.
    • Fitchett, D. H., Leiter, L. A., Lin, P., Pickering, J., Welsh, R., Stone, J., Gregoire, J., McFarlane, P., Langer, A., Gupta, A., & Goodman, S. G. (2020). Update to Evidence-Based Secondary Prevention Strategies After Acute Coronary Syndrome. CJC Open, 2(4), 402–415.
    • Isted, A., Williams, R., & Oakeshott, P. (2018). Secondary prevention following myocardial infarction: A clinical update. British Journal of General Practice, 68(669), 151–152.
    • Bavishi, A., Howard, T., Ho-Kim, J., Hiramato, B., Pierce, J. B., Mendapara, P., Alhalel, J., Wu, H.-W., Srdanovich, N., & Stone, N. (2018). Treatment Gap in Primary Prevention Patients Presenting with Acute Coronary Syndrome. The American Journal of Cardiology, 123(2), 237–242.
    • Sun, Z. (2013). Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease. Journal of Clinical & Experimental Cardiology, S6(e001), 1–4.
    • Ford, T. J., & Berry, C. (2020). Angina: Contemporary diagnosis and management. Heart, 106(5), 387–398.
    • Libby, P., & Theroux, P. (2005). Pathophysiology of Coronary Artery Disease. Circulation, 111(25), 3481–3488.
    • Mayo Clinic. (n.d.). Coronary artery disease – Diagnosis and treatment. Retrieved from.
    • Albus, C., Barkhausen, J., Fleck, E., Haasenritter, J., Lindner, O., & Silber, S. (2017). The Diagnosis of Chronic Coronary Heart Disease. Deutsches Ärzteblatt International, 114(42), 712–719.
  • Complications of Coronary Artery Disease

    Complications of Coronary Artery Disease

    Overview

    Understanding the potential complications of Coronary Artery Disease is crucial for patients and their loved ones, as it highlights the importance of early diagnosis, effective management, and adopting healthy lifestyle.

    Coronary Artery Disease itself is an atherosclerotic disease, meaning it involves the buildup of plaque inside the arteries, which is inflammatory in nature. This plaque accumulation starts when the lining of the arterial wall is disrupted, leading to lipoprotein droplets gathering in the coronary vessels. Over time, these plaques can disrupt or erode, potentially leading to serious complications.

    In Detail
    Complications of Coronary Artery Disease

    Here’s a quick list of the main complications of Coronary Artery Disease:

    The manifestations and complications of Coronary Artery Disease can vary, from less severe symptoms to life threatening events.

    Angina Pectoris

    Angina Pectoris, or chest pain, is a common clinical syndrome associated with myocardial ischemia. This discomfort can be felt in the chest, jaw, arm, or other areas. While often described as a tight, squeezing, or heavy feeling, its localization can be vague, and there’s considerable individual variation. Angina can be stable, unstable, or even manifest as variant angina (Prinzmetal angina) or microvascular angina. It is important to know that many patients experiencing angina, about half, do not have obstructive coronary artery disease (blockages visible on angiography) but rather have microvascular angina (MVA), which involves problems with the very small blood vessels of the heart, and/or vasospastic angina (VSA), caused by sudden narrowing or spasm of the heart arteries. A critical point is that angina symptoms do not always directly correlate with the severity of the underlying atherosclerosis, and some patients can have considerable myocardial ischemia without any pain, a condition known as ‘silent ischemia’, which is more common in the elderly and individuals with diabetes mellitus.

    Myocardial Infarction (MI) or heart attack

    One of the most serious complications is a Myocardial Infarction (MI), commonly known as a heart attack. This occurs when there is evidence of myocardial necrosis (heart muscle death) due to acute myocardial ischemia, meaning the heart muscle doesn’t get enough blood flow. A heart attack can be classified as either an ST-segment elevation myocardial infarction (STEMI), a severe type where there’s a complete blockage of a heart artery, or a non-ST-segment elevation myocardial infarction (NSTEMI), where blood flow is severely reduced but not completely blocked. For about half of people, a heart attack is the very first symptom they experience from Coronary Artery Disease, and sadly, half of these initial heart attacks can be fatal. Heart attacks are associated with substantial morbidity and mortality and can even lead to mechanical complications such as acute ventricular septal rupture (a hole in the heart wall), acute mitral regurgitation (a leaky heart valve), or free wall rupture. Previous research also indicates that recurrent heart attacks are linked to worse outcomes than the initial event.

    Sudden Cardiac Death (SCD)

    Another devastating complication is Sudden Cardiac Death (SCD), also known as Cardiac Arrest (CA). In fact, for one out of four people, sudden cardiac death is the very first symptom of coronary artery disease. Coronary artery disease is the most common cause of cardiac arrest, accounting for over 80% of all cases. The prognosis for sudden cardiac arrest remains poor, with a survival rate to hospital discharge typically between 6% and 10%. Many individuals unfortunately die before even reaching the hospital. Even among those successfully resuscitated, there is a high rate of in-hospital mortality. In survivors of cardiac arrest, a post resuscitation syndrome is commonly observed, which frequently includes transient myocardial dysfunction.

    Arrhythmias

    Coronary artery disease can also lead to Arrhythmias, which are irregular heartbeats. For instance, atrial fibrillation, a common type of irregular heartbeat where the upper chambers of the heart beat rapidly and irregularly, is observed in 20% of patients with Coronary artery disease. More severe arrhythmias, such as ventricular tachycardia (a fast, abnormal heart rhythm starting in the lower chambers of the heart), can also occur. These irregular heartbeats can sometimes lead to complications like atrioventricular block or, in the most severe cases, sudden collapse and death.

    Heart failure (HF)

    Heart failure (HF), a condition where the heart cannot pump enough blood to meet the body’s needs, is another common consequence of Coronary artery disease. This often indicates advanced coronary artery disease, perhaps due to a prior heart attack or widespread myocardial fibrosis (scarring of the heart muscle) resulting from previous ischemic episodes.

    In some cases, Coronary artery disease may present with peripheral arterial embolism (a blockage of an artery in the arms or legs) and embolic stroke (a type of stroke caused by a blood clot traveling to the brain), typically following a heart attack where a blood clot forms within the heart’s left ventricle.

    The pervasive impact of Coronary artery disease extends beyond individual health to society at large. Patients with conditions like microvascular angina and vasospastic angina often experience a profound and long-term impact on their physical and mental well-being, leading to repeated hospitalizations and a reduced quality of life. This underscores the critical need for effective prevention and management strategies.

    Other Similar Questions

    How does Coronary artery disease affect the body beyond the heart?

    Coronary artery disease can lead to issues such as peripheral arterial embolism and embolic stroke, usually after a heart attack. It can also contribute to overall decreased quality of life due to chronic symptoms like fatigue and dyspnea.

    Can Coronary artery disease be present without any symptoms?

    Yes, it is possible to have significant myocardial ischemia without experiencing any symptoms, a condition known as ‘silent ischemia.’ This is more common in elderly patients and those with diabetes mellitus.

    Why is it important for family members to be aware of Coronary artery disease complications?

    Because sudden cardiac death can be the first manifestation of Coronary artery disease, and many cases are unexplained even after investigation, family screening for inherited disorders, especially when sudden death occurs before 40-45 years of age, is important to identify at-risk individuals. Awareness of symptoms and risk factors can prompt earlier medical attention.

    Resources

    • Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology, 234(10), 16812–16824.
    • Bergmark, B. A., Mathenge, N., Merlini, P. A., Lawrence-Wright, M. B., & Giugliano, R. P. (2021). Acute coronary syndromes. The Lancet, 398(10300), 741–756.
    • Smith, J. N., Negrelli, J. M., Manek, M. B., Hawes, E. M., & Viera, A. J. (2015). Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update. Journal of the American Board of Family Medicine, 28(2), 283–293.
    • Geller, B. J., & Abella, B. S. (2018). Evolving Strategies in Cardiac Arrest Management. Cardiology Clinics, 36(1), 73–84.
    • Granfeldt, A. (2019). In-Hospital Cardiac Arrest. JAMA, 321(16), 1618-1619.
    • Krahn, A. D., Tfelt-Hansen, J., Tadros, R., Steinberg, C., Semsarian, C., & Han, H.-C. (2022). Latent Causes of Sudden Cardiac Arrest. JACC: Clinical Electrophysiology, 8(6), 806–821.
    • Gallone, G., Baldetti, L., Pagnesi, M., Latib, A., Colombo, A., Libby, P., & Giannini, F. (2018). Medical Therapy for Long-Term Prevention of Atherothrombosis Following an Acute Coronary Syndrome. Journal of the American College of Cardiology, 72(23), 2886–2903.
    • Bahit, M. C., Korjian, S., Daaboul, Y., Baron, S., Bhatt, D. L., Kalayci, A., Chi, G., Nara, P., Shaunik, A., & Gibson, C. M. (2023). Patient Adherence to Secondary Prevention Therapies After an Acute Coronary Syndrome: A Scoping Review. Clinical Therapeutics, 45(9), 1119–1126.
    • Gaviria-Mendoza, A., Zapata-Carmona, J. A., Restrepo-Bastidas, A. A., Betancur-Pulgarín, C. L., & Machado-Alba, J. E. (2020). Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome. Journal of Primary Care & Community Health, 11, 2150132720946949.
    • Silverio, A., Cancro, F. P., Esposito, L., Bellino, M., D’Elia, D., Verdoia, M., Vassallo, M. G., Ciccarelli, M., Vecchione, C., Galasso, G., & De Luca, G. (2023). Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets. Journal of Clinical Medicine, 12(6), 2161.
    • Fitchett, D. H., Leiter, L. A., Lin, P., Pickering, J., Welsh, R., Stone, J., Gregoire, J., McFarlane, P., Langer, A., Gupta, A., & Goodman, S. G. (2020). Update to Evidence-Based Secondary Prevention Strategies After Acute Coronary Syndrome. CJC Open, 2(4), 402–415.
    • Isted, A., Williams, R., & Oakeshott, P. (2018). Secondary prevention following myocardial infarction: A clinical update. British Journal of General Practice, 68(669), 151–152.
    • Bavishi, A., Howard, T., Ho-Kim, J., Hiramato, B., Pierce, J. B., Mendapara, P., Alhalel, J., Wu, H.-W., Srdanovich, N., & Stone, N. (2018). Treatment Gap in Primary Prevention Patients Presenting with Acute Coronary Syndrome. The American Journal of Cardiology, 123(2), 237–242.
    • Sun, Z. (2013). Cardiac Imaging Modalities in the Diagnosis of Coronary Artery Disease. Journal of Clinical & Experimental Cardiology, S6(e001), 1–4.
    • Ford, T. J., & Berry, C. (2020). Angina: Contemporary diagnosis and management. Heart, 106(5), 387–398.
    • Libby, P., & Theroux, P. (2005). Pathophysiology of Coronary Artery Disease. Circulation, 111(25), 3481–3488.
    • Mayo Clinic. (n.d.). Coronary artery disease – Diagnosis and treatment. Retrieved from.
    • Albus, C., Barkhausen, J., Fleck, E., Haasenritter, J., Lindner, O., & Silber, S. (2017). The Diagnosis of Chronic Coronary Heart Disease. Deutsches Ärzteblatt International, 114(42), 712–719.