Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is a is a prevalent and serious condition which occurs when the coronary arteries, which supply blood, oxygen, and nutrients to the heart muscle, become narrowed or blocked due to the buildup of plaque. This plaque is composed of fat, cholesterol, calcium, and other substances found in the blood. Over time, the plaque hardens and narrows the arteries, reducing blood flow to the heart.  

Treatment for coronary artery disease (CAD) in Cuba is through a combination of lifestyle changes, medications, and surgical procedures aimed at improving blood flow to the heart.
 

When left untreated CAD can lead to severe and potentially life-threatening complications, including: 

• Damage to the heart tissue  
• Chest pain, shortness of breath, and fatigue 
• Arrhythmias 
• Heart attack 
• Heart failure 

Causes and Risk Factors 

Coronary artery disease (CAD) is primarily caused by plaque (a sticky substance composed of fat, cholesterol, calcium, and other elements found in the blood) buildup in the walls of the coronary arteries. Several factors contribute to the development of CAD, including: 

• High Cholesterol 
• High Blood Pressure 
• Smoking 
• Diabetes 
• Obesity 
• Sedentary Lifestyle 
• Poor Diet 
• Family History 

Symptoms 

Coronary artery disease often develops gradually, and symptoms may not appear until the disease has significantly progressed. Common symptoms include: 

• Chest Pain (Angina): A feeling of pressure or tightness in the chest, often triggered by physical activity or stress. 
• Shortness of Breath: Difficulty breathing, especially during exertion. 
• Fatigue: Unusual tiredness and lack of energy. 

Diagnosis 

Diagnosing coronary artery disease (CAD) involves a comprehensive assessment that includes a detailed medical history, physical examination, and several diagnostic tests including: 

• Medical History: Assessment of risk factors (such as smoking, high blood pressure, high cholesterol, diabetes, and family history of heart disease), lifestyle, and any previous medical conditions is carried out. 

• Physical Examination: Examining signs of heart disease, such as high blood pressure, abnormal heart sounds, or other physical indicators. 

• Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can detect abnormalities that may indicate CAD, such as irregular heartbeats or evidence of a previous or current heart attack. 

• Stress Testing: This test evaluates how the heart performs under physical stress. The patient exercises on a treadmill or stationary bike while being monitored with an ECG. Stress testing can reveal problems with blood flow within the heart. 

• Echocardiogram: This ultrasound test uses sound waves to create images of the heart’s structure and function. It helps assess the heart’s chambers, valves, and overall function, and can detect areas of the heart muscle that may be damaged or not contracting properly 

• Blood Tests: These tests are carried out to measure levels of cholesterol, triglycerides, and other substances that can indicate the risk of CAD. Tests for markers of inflammation, such as C-reactive protein (CRP), may also be conducted. 

• Coronary Angiography: This is a crucial, invasive test in which a catheter is inserted into a blood vessel, usually in the groin or arm, and guided to the coronary arteries. A special dye is injected through the catheter, making the coronary arteries visible on X-ray images. This test allows the visualization of blockages or narrowing in the arteries. 

• Cardiac MRI: Magnetic resonance imaging (MRI) of the heart to provide detailed images of the heart’s structures and assess its function. It is useful for evaluating damage to the heart muscle and blood flow issues. 

Treatment Options 

The specific treatment plan for CAD is personalized and is dependent on the severity of the disease, the extent of artery blockage, and the patient’s overall health.  Treatment usually begins with medication and lifestyle changes to reduce risk factors, improve heart health, and prevent the progression of the disease. This includes the practice of heart-healthy diet, regular exercise, weight management, stress management, smoking cessation and limiting alcohol intake. 

Minimally invasive treatment 

For patients with more severe CAD or those who do not respond to lifestyle changes and medications, medical procedures may be necessary to restore adequate blood flow to the heart: 

• Angioplasty: Also known as percutaneous coronary intervention (PCI), is a common treatment for CAD carried out to improve blood flow to the heart. The procedure involves the insertions of catheter with a small balloon at the tip into a blood vessel, usually in the groin or wrist, and guides it to the blocked artery in the heart. The balloon is then inflated to push the plaque buildup against the artery walls, widening the artery. 

• Stent Placement: In many cases, a stent (a small mesh tube) is placed at the site of the blockage after the ballon is deflated to ensure improved blood flow to the heart, to prevent re-narrowing and to stabilize the artery. 

The stent is mounted on the balloon catheter and expands when the balloon is inflated. The stent remains in place to keep the artery open after the balloon is deflated and removed. 

A stent is used with angioplasty for coronary artery disease (CAD) treatment to help keep the artery open after the procedure and ensure improved blood flow to the heart. Here’s a detailed explanation in layman’s terms: 

Surgical treatment 

Coronary artery bypass grafting (CABG), also known as heart bypass surgery or bypass surgery, is typically needed for CAD treatment when:  

• Severe Blockages: Multiple or severe blockages in the coronary arteries that cannot be treated with angioplasty and stent placement. 

• Left Main Coronary Artery Disease. This is when the blockage is in the left main coronary artery, which supplies a large portion of blood to the heart muscle. Blockages in this artery are particularly dangerous and often require CABG. 

• Failed Angioplasty or Stent: When previous angioplasty or stent procedures have failed, or if the blockages have reoccurred, CABG might be necessary. 

• Diabetes: Patients with diabetes usually have more diffuse and severe coronary artery disease. 

• Impaired Heart Function: Patients with reduced heart function or heart failure. 

During CABG a healthy blood vessel is taken from another part of the patient’s body, such as the leg, arm, or chest, and then grafted to the blocked coronary artery to bypass the blocked artery, creating a new pathway for blood to flow to the heart muscle and to improve oxygen and nutrient delivery. 

CABG is a major and complex procedure; however it is a highly effective treatment for severe coronary artery disease, significantly improving symptoms, quality of life, and survival rates for many patients.