Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association
Coronary Artery Disease
Coronary artery disease (CAD; also atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.
CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.
As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.
A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).
What To Know About Obstructive Coronary Artery Disease
Obstructive coronary artery disease (OCAD) is a type of heart disease. It occurs when plaque builds up in the large coronary arteries. OCAD can lead to complications, including heart attacks.
However, people can take steps to help reduce their risk of developing the condition and further complications.
This articles explores the causes, symptoms, diagnosis, and treatment of OCAD in more detail. It also discusses the potential outlook for people with OCAD and tips to help prevent the condition.
Plaque is made up of the following:
Plaque can reduce blood flow and increase the risk of blood clots.
What is the difference between OCAD and NOCAD?
Both types affect the large coronary arteries, which are located on the surface of the heart. However, unlike OCAD, NOCAD does not involve a significant buildup of plaque in the coronary arteries.
Instead, NOCAD usually occurs due to issues with how the arteries work. For example, damage to the coronary artery walls may cause them to suddenly tighten and temporarily narrow. This can block blood flow to the heart.
In some cases, a person may notice episodes of angina as OCAD progresses. Angina occurs due to restriction in the flow of oxygenated blood into the heart.
Angina may cause the following feelings in the chest:
However, angina can also be a symptom of a heart attack. If a person notices possible symptoms of a heart attack, they should call 911 immediately.
Is it a heart attack?Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:
If someone has these symptoms:
If a person stops breathing before emergency services arrive, perform manual chest compressions:
Use an automated external defibrillator (AED) available in many public places:
Children with the following risk factors may also require CAD screening:
During a CAD screening appointment, a doctor may:
If someone has symptoms or a family history of CAD, a healthcare professional may also recommend some of the following diagnostic tests:
Treatment can range from lifestyle modifications and medications to surgical procedures, depending on the severity of someone's OCAD and their overall health.
Lifestyle changes
A healthcare professional may recommend a person with OCAD:
Medications
They may also prescribe medications to help lower cholesterol and manage blood pressure and weight.
Surgery
In some cases, a healthcare professional may recommend a person with OCAD has surgical procedures, such as:
The outlook for a person with OCAD will depend on their overall health and other factors, such as:
Individuals with OCAD should speak with a doctor about their individual outlook.
People should also note that, according to the AHA, complications of OCAD include heart attacks and ischemic strokes. Both of these events can be life threatening and may result in chronic health problems.
Visit our dedicated hub for more research-backed information and in-depth resources on cardiovascular health.
Obstructive coronary artery disease is a type of heart disease that occurs due to atherosclerosis.
Sometimes, a person with OCAD may notice episodes of angina. However, in many cases, a person may not know they have OCAD until they experience complications, such as a heart attack.
Angina is one possible symptom of a heart attack. Others include shortness of breath, anxiety that may feel similar to a panic attack, and lightheadedness. People should call 911 immediately if they think someone is experiencing a heart attack.
Doctors may treat OCAD with lifestyle modifications, medications, and surgical procedures. A person should visit a healthcare professional to find out more about their risk of developing OCAD.
Medical Compass: How To Proactively Improve Your Lungs
Lowering inflammation and expanding lung capacity are keysBy David Dunaief, M.D.
Welcome to autumn! It's the time of year when we revel in the beauty of changing foliage, the joy of Halloween decorations and costumes, and the prevalence "pumpkin spice" everything.
Unfortunately, it's also the time of year when we are most alert to influenza (the flu), respiratory syncytial virus (RSV), and COVID-19 variants circulating in our communities.
If you have a lung disease, such as chronic obstructive pulmonary disease (COPD) or asthma, or if you smoke or vape, the consequences of these viruses are especially concerning.
The good news is that you can do a lot to improve your lung function by exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding your lung capacity with an incentive spirometer, and quitting smoking or vaping (1).
Does diet improve lung function?
It's no surprise that your dietary choices can help or hinder your health. What is surprising is diet's impact on your lung health. Let's review some of the studies.
In a randomized controlled trial (RCT), results show that asthma patients who ate a high-antioxidant diet had greater lung function after 14 days than those who ate a low-antioxidant diet (2). They also had lower inflammation at 14 weeks, which was measured using a c-reactive protein (CRP) biomarker. Participants in the low-antioxidant group were over two times more likely to have an asthma exacerbation.
The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Using carotenoid supplementation in place of antioxidant foods did not affect inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma in a very short period.
In a longer-term analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, researchers assessed and stratified diets into three tiers to identify the impacts of diet quality on long-term lung health (3). Researchers found that a nutritionally-rich plant-centered diet was associated with significantly less decline in lung function over 20 years, even after adjusting for demographic and lifestyle factors influencing lung health.
What is the impact of fiber on COPD risk?
Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers.
In one study of men, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (4). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain. The "high-fiber" group was still below the American Dietetic Association's recommended intake of 14 grams per 1,000 calories each day.
In another study, this time with women, participants who consumed at least 2.5 serving of fruit per day, compared to those who consumed less than 0.8 servings per day, experienced a highly significant 37 percent decreased risk of COPD (5).
Both studies used apples, bananas, and pears to reduce COPD risk.
What exercise helps improve lung function?
In a study involving healthy women aged 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in just 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of stretching.
You do not need special equipment. You can walk up steps or hills in your neighborhood, do jumping jacks, or even dance around your home. It's most important to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. Your stamina will improve quickly when you do it consistently.
What is incentive spirometry?
An incentive spirometer (IS) is a device that helps expand the lungs when you inhale through a tube and cause one or more balls to rise. This inhalation expands the lung's alveoli.
Incentive spirometry has been used for patients with pneumonia, those who have had chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (8). A small study showed that those who trained with an incentive spirometer for two weeks increased their lung function and respiratory motion. Participants were 10 non-smoking healthy adults who took five sets of five deep breaths twice a day, totaling 50 deep breaths per day.
In recent years, some small studies examined the impact of IS on patient COVID-19 outcomes. One study of 48 patients in an outpatient setting found that study participants using an IS three times a day experienced a 16 percent increase in maximal inspiratory volume over a span of 30 days (9).
Another pilot study followed 10 patients diagnosed with moderate COVID-19 to determine whether IS use prevented development of Acute Respiratory Distress Syndrome (ARDS) (10). IS users had improved PaO2/FiO2 ratio, improved chest X-ray findings, shorter hospital stays, and sooner improvement of symptoms than non-users.
We all should be working to strengthen our lungs. Using a three-pronged approach including diet, aerobic exercise, and incentive spirometer can make a tremendous difference.
References:
(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Res Sq [Preprint]. 2023 Apr 26:rs.3.Rs-2845326. [Version 1] (4) Epidemiology Mar 2018;29(2):254-260. (5) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (6) J Phys Ther Sci. Aug 2017;29(8):1454-1457. (8) Ann Rehabil Med. Jun 2015;39(3):360-365. (9) Cureus. 2021 Oct 4;13(10):e18483. (10) Eur Resp J 2022 60: 268.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.Medicalcompassmd.Com or consult your personal physician.
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