September 29 is World Heart Day, a day for people to be more aware of common heart problems and make efforts to prevent them. With increasing modern lifestyles, the incidence of Coronary Artery Disease is increasing globally. Coronary Artery Disease (CAD) is where coronary arteries (blood vessels supplying blood to the heart) are blocked, cutting off blood supply, and resulting in damage to part of the heart. Symptoms depend on whether a large or small vessel is occluded and whether surrounding blood vessels are able to maintain blood supply to the affected part efficiently or not. Blood circulates in the body through blood vessels with certain pressure and turbulence. The inner lining of blood vessels tends to get damaged by the turbulence of blood flow. Fat gets slowly deposited over this lining (atherosclerosis), a process that progressively leads to partial or total occlusion of the vessel. People should be aware of the risk factors of atherosclerosis. Some factors are not modifiable, like heredity and advancing age. It is said that men after the age of 40 and women above 50 years of age are susceptible to developing CAD. Up to menopause, women are protected from CAD by estrogen. i.e., feminising hormone. But after menopause, they become more susceptible to it, than men. Obesity, particularly abdominal obesity, is an avoidable risk factor for CAD. As one approaches middle age, belly bulges appear in the majority of people. Due to obesity, one tends to develop diabetes, high blood pressure, and CAD. High cholesterol levels in the blood accelerate the risk of developing CAD directly and also indirectly by augmenting obesity. Taking a healthy diet, and regular adequate physical exercise can help control this factor. Alcohol tends to increase blood glucose and cholesterol levels, both being risk factors for CAD. It also contributes to obesity by providing calories. One should quit alcohol to keep the heart healthy and prevent CAD. Nicotine present in cigarettes augments the deposition of lipids in blood vessels and also causes the narrowing of their lumen. It is, therefore, a high-risk factor for CAD. Giving up smoking is known to reduce the incidence of CAD. People who have suffered from it, are also known to improve to a great extent after quitting smoking. Hypertension and diabetes mellitus are other avoidable risk factors for developing CAD. They can be easily controlled by adhering to dietary restrictions and prescribed medicines. The other important thing needed is to avoid stress, both physical and mental. Stress leads to the release of adrenaline and cortisol in the body, which in turn increases blood pressure and tends to precipitate and augment CAD. Avoiding physical stress does not mean “bed rest”. One should indulge in physical activity according to one’s own capability. Activities like lifting or pushing heavy weights are harmful and should be avoided. Brisk walking, light jogging, yoga, etc. are useful. Any exercise should be done initially for a short time and then increased slowly in frequency and time. Mental stress leads not only to CAD but many other diseases as well. Mental relaxation is as important as physical relaxation and can be achieved by prayers, meditation, yoga, and other techniques. The most common symptom of CAD is left-sided chest pain which occurs on exertion and is relieved by rest. One feels like they are suffocating. The pain may occur on or radiate to the left upper limb, wrist, jaw, upper shoulder, and multiple sites. There may be associated sweating, tiredness, breathlessness, nausea, and other symptoms. Diagnosis is suspected clinically and confirmed by electrocardiogram, cardiac echo, and coronary angiography. Treatment is by drugs that improve blood supply within coronary arteries. Interventions involving the repair of the blocked coronary vessel by various techniques like bypass surgery or stent implantation are also useful. Dr Rachna Pande is a specialist internal medicine.
