C O R O N A R Y A R T E R Y D I S E A S E
What are the symptoms of Coronary Artery Disease?
"Angina" is a discomfort often experienced by patients with coronary artery disease. Despite the fact that the pain may not be severe, it is still important since it indicates that the heart muscle is not getting enough blood. The discomfort can be very different in different patients. It may involve the chest, arms, neck or back. It generally occurs with exertion, but may occur with rest. Very sharp and short pains lasting one or two seconds are generally not caused by heart problems. Patients who note the new onset of angina or a worsening of their usual pattern of angina (more frequent, more severe, not relieved with nitro as it had been formerly, or occurring with less activity than before), should contact their physician. Severe pains, prolonged pains, or pains associated with marked shortness of breath or heavy sweating should prompt an immediate call to a physician.
Although pains in the chest, neck or arms may be an indicator of underlying heart disease, not all of the pains in these areas are necessarily from the heart. Pains that are caused from heart disease:
- Usually occur when one is exerting.
- Generally last from 1 - 20 minutes (pains lasting less than 5 seconds are generally not from heart disease, nor are pains which last continuously for days at a time)
- Are consistent, occurring in the same area time after time
- Are often not severe
- Are often eased by taking nitroglycerin
The most common pains which patients experience which are not from the heart:
- Are very short in duration (less than 5 seconds) and "sharp" in character
- Occur at different areas around the chest
- Are caused by movements or a deep breath (as opposed to exertion such as walking)
If you have questions regarding pains you are experiencing, it is best to get in contact with medical personnel so that it can be evaluated properly. Don't worry about "crying wolf"!
What can happen with Coronary Artery Disease?
With mild blockages, there is still room for adequate amounts of blood to flow to supply the needs of the heart muscle served by the particular artery. In moderate blockage, there may be lack of enough blood flow under situations of increased demand, such as exercise. In these cases, one may experience discomfort in association with the inadequate blood flow, and this is termed "angina". Permanent muscle damage does not occur with a bout of angina.
If an artery closes completely and suddenly and there is no flow to the heart muscle, that part of the muscle will die and eventually scar over. This is termed a "myocardial infarction". The common term for this is a "heart attack" when used correctly, although many lay persons use this term much more loosely.
Many people have no symptoms despite having a substantial amount of blockage. They can still be shown to have lack of blood supply with exercise tests, but simply don't perceive it as others do. This is termed "asymptomatic ischemia".
What is a heart attack?
A "heart attack" (or "myocardial infarction") occurs when the heart muscle suddenly loses most of its blood supply over a period of time (usually at least 20 minutes). This occurs most commonly due to the sudden closure of the artery which supplies that part of the muscle with blood. Generally, the vessel closes due to the presence of cholesterol plaque which ruptures or is eroded, leaving the contents open to the blood stream. The blood clots off the cholesterol, but this clot also totally blocks the flow of blood.
What is the prognosis?
The prognosis of coronary artery disease is highly variable, and depends on many factors. Chief among these are how well the heart muscle is functioning and how many vessels are involved with blockages. The long-term prognosis can be greatly influenced by the patient's behavior including smoking, control of blood pressure and cholesterol, follow-up with diet and exercise programs, etc.
©COPY 1997 HeartPoint Updated July 1997
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