What is coronary artery disease and what are its risk factors?

Understanding Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD), also known as atherosclerosis, remains the leading cause of death and morbidity worldwide. This condition involves the narrowing or blockage of the arteries that supply blood to the heart muscle. While it can develop at any age, its progression is significantly influenced by various biological and lifestyle factors.

Once CAD develops, it has a persistent tendency to progress and trigger serious cardiovascular complications. Therefore, identifying the disease early and managing risk factors is critical. Combating these factors is the most effective way to prevent the emergence of the disease or to slow down its progression in diagnosed patients.

Risk Factors for Coronary Artery Disease

The development and speed of coronary artery disease are closely linked to several key risk factors. When multiple factors are present, the disease often manifests at an earlier age. The primary risk factors include:

• Genetic background and family history
• Smoking and tobacco use
• Hypertension (high blood pressure)
• Diabetes mellitus
• Hyperlipidemia (high cholesterol levels)
• Sedentary lifestyle and lack of physical activity
• Chronic stress and obesity

Common Symptoms of Coronary Artery Disease

In many cases, patients with coronary artery disease may remain asymptomatic until the arterial stenosis reaches a critical level. The most frequent clinical manifestation is chest pain. This pain is typically described as a burning sensation or pressure located on the left side of the chest, often triggered by physical exertion or emotional stress.

In addition to chest pain, other significant symptoms include:

• Shortness of breath (dyspnea)
• Palpitations
• Dizziness
• Nausea

Diagnostic Methods for CAD

Modern medicine utilizes several classical and advanced methods to accurately diagnose coronary artery disease. The choice of method depends on the patient's clinical status and the severity of the symptoms. The primary diagnostic tools are:

1. Electrocardiography (ECG)
2. Exercise stress test
3. Echocardiography
4. Myocardial perfusion scintigraphy (Thallium Scintigraphy)
5. Coronary angiography

Coronary Angiography: The Gold Standard

Coronary angiography (CA) is currently considered the gold standard for evaluating the anatomical structure of the coronary arteries. While alternative methods like Magnetic Resonance Angiography (MRA) and Multi-Slice Computed Tomography (MSCT) exist, they cannot yet fully replace the precision of a traditional angiography. The risk of major complications, including mortality, during this procedure is approximately 2%.

How is Coronary Angiography Performed?

The procedure is performed under local anesthesia, making it a painless experience for the patient. A catheter is inserted through either the femoral artery (groin) or the radial artery (wrist). An opaque substance (dye) is then injected into the vessels to capture detailed X-ray films of the heart's blood supply.

Coronary Balloon and Stent Procedures

Balloon and stent procedures are interventional treatments used to open narrowed or blocked coronary vessels. From a patient's perspective, the experience is very similar to angiography. The patient remains awake and under local anesthesia, generally feeling no pain throughout the process.

These procedures can be performed immediately following a diagnostic angiography or scheduled for a later date in specific cases, such as for patients with kidney disease. The process involves:

• Balloon Inflation: A small balloon is guided to the narrowed area and inflated for 30-60 seconds to widen the vessel.
• Stent Placement: Once the balloon is deflated, a stent is permanently placed to maintain the opening and ensure healthy blood flow.