Coronary heart disease: The number one cause of death worldwide

But worldwide, according to the latest figures from the World Health Organization (WHO), coronary heart disease is the first cause of death, accounting for 16% of all deaths annually(2)

What is coronary artery disease?
Coronary artery disease is the narrowing of the arteries that supply blood to the heart (the so-called coronary vessels), and which is due to the creation of atheromatous plaque within these vessels.

Symptoms of coronary artery disease:
Usually, coronary artery disease is manifested by chest pain (angina). The pain may spread to other parts of the body (eg lower jaw, upper limb, shoulders). Other symptoms of the disease besides pain may be shortness of breath or easy fatigue.

Clinical manifestations of coronary artery disease?

1. Asymptomatic patients. A percentage of patients show no symptoms at all. This usually happens in patients with diabetes mellitus, in atheromatous disease that does not cause significant narrowing of the coronary vessels or in cases with collateral circulation from the heart vessels themselves.

2. Stable angina pectoris: In stable angina, the symptoms appear on exertion or exercise and subside after rest or taking medication.

3. Acute coronary syndromes: In this category the symptoms usually have an acute or recent onset and appear at rest. This includes unstable angina and acute myocardial infarction. They are emergency situations due to significant acute or recent blockage of the coronary vessels and require immediate treatment.

Predisposing factors:
The atherosclerotic plaque that leads to coronary artery disease is essentially composed of fats and other cellular elements, while any damage to the artery wall from toxic agents contributes to its formation.

The main factors that increase the likelihood of coronary heart disease are:
-Smoking
-Diabetes
-Arterial hypertension
-Hyperlipidemia
-Obesity
-Lack of physical exercise
-Heredity. People with first-degree relatives who developed coronary heart disease at a young age (for men < 55 years and women < 65 years) have an increased chance of developing coronary disease
-Gender: Men are more likely to develop coronary heart disease as well as postmenopausal women

Prevention of coronary heart disease:
In order to reduce the possibility of coronary heart disease, it is recommended to modify the risk factors. Therefore, abstinence from smoking, exercise and avoiding a sedentary lifestyle, a healthy diet, regulation of cholesterol, sugar and pressure are the main way to prevent coronary heart disease.

Coronary artery disease diagnosis:
Coronary artery disease is suspected when the above-mentioned symptoms appear.
– In acute situations, usually the electrocardiogram and the laboratory test (troponin) establish the diagnosis of acute infarction and lead the patient to the hemodynamic laboratory for further diagnosis and treatment (coronary angiography and angioplasty)
– In chronic and stable patients, the diagnostic approach can be done either with non-invasive methods (fatigue test, stress echo, myocardial scintigraphy, stress MRI, axial coronary angiography) or with the invasive method of coronary angiography.

Treatment of coronary artery disease:
The treatment of coronary artery disease usually requires knowledge of the anatomy of the coronary vessels and the narrowings present in them by performing coronary angiography.

The treatment options are as follows:
1. Pharmaceutical Education: for modification and stabilization of atherosclerotic plaque. Drugs commonly used are statins
2. Coronary angiography: It is the most modern method of treating narrowings of the heart with the use of “balloons” and intracoronary stents.
3. By-pass: It is the so-called heart surgery where an open incision is made in the chest to place the grafts and bypass the damage to the coronary vessels. This method is preferred in complex diseases (such as extensive trunk disease or 3-vessel disease).

Information on Coronary Artery / Angioplasty

-With coronary angiography the goal is to visualize any narrowings of the heart’s vessels in order to plan the further treatment (preservatives, balloon/Stent or surgical treatment).
The examination is carried out either through the arteries of the hand (method of choice), or through the arteries of the leg (femoral artery in the groin). No general anesthesia is required, only local anesthesia in the arm or groin depending on the access method. During the examination the patient remains fully conscious.
The time of diagnostic coronary angiography is calculated on average at 20-30 minutes.
In case no therapeutic intervention is required, the patient can be discharged the same day (usually two hours after the operation) and return to his daily activities immediately.

– Vascular surgery is the method by which the narrowing of the blood vessels of the heart (coronary vessels) is treated invasively. It is essentially a continuation of coronary angiography, as the same access channel is used through the arteries of the arm or leg. During angioplasty, the lesions of the coronary vessels are opened using balloons (commonly called ΄΄balloons΄΄) and intracoronary prostheses (commonly called ΄΄Stent΄΄). During the procedure the patient remains fully conscious as general anesthesia is not required.

Hospitalization for 24 hours is usually required after the angioplasty procedure.

Eleftherios Kontopodis
Interventional Cardiologist
Director of Cardiology Department
Private Clinic CRETA INTERCLINIC
Member of the HHG Group
63 Minoos, 713 04, Heraklion, Crete
Tel. 2810 373800
Fax: 2810 314900
www.cic.gr, e-mail: [email protected]

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