Chronic Coronary Artery Disease

What is coronary artery disease?

The heart sends blood to the whole body, and to itself, through the coronary arteries. The coronary arteries supply blood to the walls of the heart and supply it with the necessary components for its function. The term 'coronary artery disease' is used to describe the narrowing of these arteries. The narrowing is caused by the accumulation of atherosclerotic material in their lumen. So imagine a small tube, which year after year becomes clogged. Because of the narrowing, the heart muscle is not supplied with enough blood - especially in situations of increased need - and this causes 'myocardial ischaemia'.

Ischaemia means a lack of oxygen, which the heart needs to keep beating and keep contracting. Ischemia is primarily manifested by severe chest pain.

What are the main symptoms of coronary artery disease?

Coronary artery disease is manifested by severe chest pain, which is called angina pain. The angina pain manifests itself in the human body in the following ways:

• Pain and discomfort in the centre of the chest, which may be tightness, burning or pressure.
• Reflection of the stethache pain on the arms, back between the two shoulder blades, lower jaw, upper abdomen and neck.
•  Sweating, nausea or vomiting when the pain is severe.

When should you see a doctor?

If you suspect you are having a myocardial infarction, call for help immediately, even if you are alone. Your priority is to get to the hospital and get medical care. 

If you have more than one risk factor for coronary heart disease, such as high cholesterol levels, hypertension, obesity or diabetes mellitus, or if you have any of the above symptoms, contact your doctor, even in the absence of symptoms. 

How does coronary artery disease develop?

Most often, coronary artery disease is caused by the progressive accumulation of atherosclerotic material, which shrinks the lumen of the arteries and causes myocardial ischemia. Atherosclerotic material is a soft, fatty material that builds up inside the arteries. The accumulation of atherosclerotic material creates an atherosclerotic plaque, which over the years is "hardened" by the deposition of calcium. Sometimes, pieces of this plaque break away and clots form.

Risk factors for coronary heart disease

A risk factor is defined as anything that increases a person's chances of developing a condition. These factors can be things you can change, such as your diet or smoking. Others cannot be changed, such as gender or age. Risk factors for developing coronary heart disease include:

• Age: As the years go by, the more likely one is to develop artery damage.
• Gender: The disease tends to occur more often in men, but the risk for women increases significantly after menopause.
• Family history: When there is a family history of cardiovascular disease, the risk of coronary heart disease increases, especially if a family member developed a problem at a young age.
• The high level of cholesterol in the blood: A high level of cholesterol in the blood increases the risk of atherosclerosis and atherosclerosis. High cholesterol is dangerous when it is in the form of LDL, known as "bad cholesterol". Low HDL, known as 'good cholesterol', can also be a risk of atherosclerosis.
• Smoking: This habit significantly increases the risk of coronary heart disease and heart disease. Even passive smoking can increase the risk.
• Hypertension: Uncontrolled hypertension in the long term can lead to hardening and thickening of your arteries and narrowing of the lumen through which blood passes.
• Diabetes mellitus: Diabetes is associated with coronary heart disease, as type II diabetes in particular has common risk factors for development, such as obesity and hypertension.
• Obesity: Being overweight exacerbates risk factors.
• Lack of physical exercise: Lack of exercise is associated with both coronary heart disease itself and its risk factors.
• Intense stress: uncontrolled and intense stress can damage both your heart health and physical health in general.

When a patient has more than one risk factor, the risk of developing coronary heart disease increases more. Also, the presence of one risk factor can lead to the development of a second one, e.g. obesity can lead to the development of type II diabetes and hypertension.

What are the manifestations of coronary artery disease?

1. The period without symptoms. The process of atherosclerosis leading to coronary artery disease causes no symptoms. Also, in patients who do not have severe coronary artery stenoses, symptoms may not appear.

2. Constant angina. Constant angina is the occurrence of anginal pain either during physical activity or during intense emotional stress. 

3. Unstable angina. Unstable angina is the occurrence of anginal pain at rest. It is a more dangerous form of coronary artery disease, which is why it has been called pre-infarction angina, i.e. it precedes infarction. 

4. Acute myocardial infarction. It is the necrosis of a region of the heart muscle and is manifested by typical angina pectoris, but it is of prolonged duration, does not stop with rest and lasts more than half an hour. 

5. Sudden cardiac death. It is the most dramatic manifestation of the entire clinical spectrum of coronary heart disease. Coronary artery disease and its complications account for about 80% of sudden cardiac deaths. 

How the diagnosis is made

The diagnosis of a disease is a long and multifactorial process. In order to make a correct diagnosis, the doctor follows certain steps, which have to do with both the patient's appearance and behaviour, but also with specific tests the patient undergoes. Among the diagnostic steps are:

• Taking a medical history: During this fundamental stage, the doctor takes into account the patient's exact symptoms and risk factors. This is the key factor in determining the patient's symptoms and symptoms.
• Clinical examination: During the clinical examination, blood pressure is checked. 
• Diagnostic cardiology tests: After the clinical examination, the patient undergoes certain tests, depending on what the doctor deems necessary. Thus, an electrocardiogram, an ultrasound scan, an exercise test, an imaging test or possibly a cardiac catheterisation and others may be required. 
• Blood tests: Routine blood tests are important, both for checking the cholesterol level in the blood and for the general profile of the patient. Blood tests are performed at least 12 hours after your last meal. So make sure you are fasting for at least 12 hours before you give blood.

These tests will help the doctor to understand the existence and extent of coronary artery disease, its effect on the heart and decide on the best treatment.

Is there a cure?

Coronary artery disease is an insidious condition that requires constant awareness and vigilance, both on the part of the sufferer and the treating physician. The disease does not always give warning, usually manifests itself suddenly and is potentially fatal. However, with the continued advances in modern cardiology, coronary artery disease is a largely treatable, if not curable, condition. 

• Lifestyle changes: Treatment of coronary heart disease requires primarily individual effort and motivation at a personal level. Thus, we advise our patients to stop smoking and adopt a healthy lifestyle, with physical exercise, less stress, and more fruits and vegetables. 
• Medication: In terms of drugs, new substances are constantly being added to the cardiologists' therapeutic quiver, substances that significantly improve patients' symptoms and, more importantly, prolong their survival. 
• Interventional cardiology: Interventional cardiology, with coronary artery angioplasty and the use of the latest balloons and metallic stents, can treat the vast majority of patients who are not treated with drugs,.
• Coronary artery bypass: the well-known by-pass remains an excellent and radical treatment option, without any noteworthy complications.
• Modification of risk factors: Primary prevention, either through healthy lifestyle or pharmaceutical support, is the most important measure that can potentially modify the natural course of the disease and limit as far as possible its dramatic consequences.

Tips for preventing coronary heart disease

Preventing coronary heart disease requires certain lifestyle changes. A healthy lifestyle, without harmful health habits, can keep your blood vessels clean by beating atherosclerosis with small and simple changes in your daily routine. To improve your health and build a protective wall against coronary artery disease, make sure you do the following:

• Stopping smoking
• Control of other conditions such as hypertension, high cholesterol or diabetes
• Physical exercise most days of the week
• A healthy diet, low in fat and rich in fruits and vegetables
• Weight regulation and avoiding obesity
• Regulation of emotional stress

POTTERY

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What is angioplasty?

As part of the diagnosis of coronary artery disease, the patient undergoes coronary angiography to evaluate the stenosis. If the stenosis occupies more than 70% of the diameter of the artery, it is advisable to correct it by angioplasty. 

Angioplasty is performed by interventional cardiologists and seeks: 

• the opening of coronary artery stenoses from large atherosclerotic plaques and/or clots 
• the restoration of blood flow

How is angioplasty done?

Step 1

Initially, after local anaesthesia is applied to the catheter entry site, the catheter is advanced to the stenosed coronary artery (fig.1). 

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Step 2

Next, a guide wire is advanced into the stenosis and then the catheter with a special balloon at its end, which is inflated with fluid once it reaches the site of the stenosis. This compresses the atherosclerotic plaque, resulting in the opening of the narrowed artery (fig. 2).

Step 3

After the balloon catheter is withdrawn, another balloon catheter is advanced, which has a compressed metal mesh wrapped on its surface (stent). As the balloon is dilated, the stent is deployed, which remains at the site of the lesion after the balloon is removed and keeps the vessel lumen open (fig. 3). 

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What comes after angioplasty?

Follow-up for any complications for 24 hours or more, depending on the co-existing problems and clinical syndrome.

Are there any complications?

Yes, there are complications during surgery, but also more distant complications, but in a small percentage of patients. Here are some of them:

• Αιμάτωμα-αιμορραγία από το σημείο της παρακέντησης, αγγειακό εγκεφαλικό επεισόδιο, οξύ έμφραγμα μυοκαρδίου (θανατηφόρο ή μη) μπορούν να συμβούν κατά την επέμβαση σε ποσοστό < 2%.  

• In the long term, stenosis (restenosis) at the site of surgery may recur at a rate of about 5% or more in patients with complex procedures or comorbidities.
• Θρόμβωση του stent που οδηγεί σε έμφραγμα, σε ποσοστό < 1%. Ο κυριότερος παράγοντας για θρόμβωση του stent είναι η κακή συμμόρφωση του ασθενή με τη φαρμακευτική αγωγή και συγκεκριμένα η διακοπή της διπλής αντιαιμοπεταλιακής αγωγής, πριν από το διάστημα που έχει καθορίσει ο γιατρός που έκανε την επέμβαση. Συμβουλευτείτε τον καρδιολόγο που σας έκανε την επέμβαση προτού κάνετε μετατροπές στην αντιαιμοπεταλιακή σας αγωγή. 

How to prepare for your appointment

In many cases, coronary artery disease will not show any symptoms, especially when it is in its early stages. But this does not mean that the processes of atherosclerosis have not already started. Most of the time, coronary artery disease is a symptomatic finding that is detected after routine tests, such as measuring blood pressure or blood cholesterol levels. If you know you have risk factors or symptoms of coronary artery disease, referral to a cardiologist is inevitable. The following information will help you prepare for your first appointment.

What you can do before your appointment

• Before your appointment, make sure you respect all the restrictions and instructions your doctor has given you, such as fasting for at least 12 hours before your blood tests.
• Write down or write down your symptoms so that you don't miss any when taking your medical history.
• Write or write down any other conditions you have or procedures you have had in the past.
• Find someone to accompany you to your first cardiologist appointment so that you don't risk forgetting anything from the doctor's instructions.
• Write down anything you want to ask your doctor during the visit.

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Questions you can ask your cardiologist on your first visit

• What do you think led to the development of coronary heart disease?
• What tests will I have to undergo?
• Do I have to follow specific instructions until my next appointment?
• In which cases should I call for immediate assistance?
• What is my diagnosis?
• What is the risk of long-term complications?
• In case of drug treatment, what are the possible side effects?
• Am I a candidate for invasive therapies?
• What changes should I make to my lifestyle?
• How often do I have to come back for a review?

Questions you may be asked to answer

• What are your symptoms?
• When did the symptoms first appear?
• Did the symptoms get worse over time?
• Do you have shortness of breath or chest pain?
• Have you noticed a worsening of your symptoms during physical exercise?
• Does anyone in your family have heart problems?
• Do you suffer from any other disease?
• What medicines are you taking?
• How much do you exercise?
• What is in your diet?
• Do you smoke or have you smoked in the past?
• Do you drink alcohol? Approximately how much?

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