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Narrowed artery

September 23rd, 2015

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Narrowed artery

Coronary arteries narrowing causes angina pectoris (chest pain from heart does not get enough blood), and sometime a heart attack (if any of the arteries is totally blocked), and it can be quite confusing whether to say a person has angina (coronary artery narrowing) or a heart attack (blocked artery). In short, narrowed artery results in less blood supply flowing to the heart muscle, causing angina pectoris and blocked artery results in no blood supply to the heart muscle, causing a heart attack.

Coronary artery is a branch of aorta (the largest artery in the body, originating from the left ventricle of the heart and extending down to the abdomen) from which oxygenated fresh blood flows to all parts of the body. It is quite similar to a pipe or a straw, with a hollow hole inside for blood to pass through.

There are two things that can go wrong with these “tubes” – acute clogging and progressive clogging. I will first touch upon the progressive type, as it is more common. It starts with just a little inflammation at the internal wall of the artery, and cholesterol in the blood is trapped on these damaged tissues, along with calcium and plaque. Collectively, these build-ups are called atherosclerotic plaque (This is why this condition is call coronary artery atherosclerosis) , and they cause the texture of the artery wall to be bumpy and irregular kind of like a rusty pipe. Once these little bumps start to grow bigger, less and less blood can flow through, causing angina or chest pain when patients exerts themselves and the heart has to work harder. At some stage, disregarding the severity of narrowing, their may be some erosion or crack on the surface of the plaque attracting formation of blood clot or thrombus on its surface within the tiny artery. This will result in acute and sometime completely blocked artery causing a heart attack.

If the narrowing is minimal, it is not a problem. However, if the artery is more than 75% narrowed in diameter, the heart does not get enough fresh blood, causing myocardial ischemia (lacking O2 and blood supply), and angina pectoris. Along the way, as the narrowing gets more severe, the heart muscle around it has to adjust to the reduced supply. This is why people with narrowed artery get tired easily and can only do light activities. The heart is not capable of shouldering heavy tasks such as intense exercise because they require a lot of oxygen and blood supply. The most obvious symptom that the heart cannot produce enough to keep up with the demand is the heaviness feeling in the chest.

To be more precise, this discomfort feels like something heavy pressing on the chest, and sometimes it radiates to the left shoulder or the jaw. It becomes worse when engaged in a heavy activity or under stress, and gets better when fully rested. In some people, especially those with diabetes or older people, there might be no pain, but they will feel easily tired.

Narrowed artery, mild or severe, is a cause for concern. It does not necessarily mean it will lead to a heart attack, but the chance is greater. The aim is to prevent the artery from becoming more narrowed or totally blocked. Having a narrowed artery does not mean you will always get blocked artery. Certain medicine such as aspirin and regular exercise will lower the risk. To qualify for that, there must be blood clot to block the artery and of course this will make it more complicated and more dangerous.

A patient of mine was a 57-year-old man with a beer belly, high blood pressure and high cholesterol level. Although he knew he had problems with his coronary artery, he took medicines inconsistently and skipped it more than he should. He’d never really exercised. He started feeling tightness in his chest when he walked up the stairs, but would feel better if he rested. Echocardiogram and treadmill test results showed that there was insufficient blood supple to his heart muscles, indicating that there must be narrowing in his coronary arteries.

Coronary angiogram result proved my suspicion right. The narrowing, by that time, was already severe, so stent placement was required. After a successful and simple treatment I also asked him to lose weight and exercise, as well as told him the importance of taking medication seriously because if he did not do so, he would have a high chance of rapid progression of his disease.

On the other hand mild narrowed artery which does not cause any warning symptom, is not a minor problem at all, because it can develop into something fatal if not addressed to when the artery is suddenly blocked by a clot. These kind of patients will have a heart attack without any warning symptom like the patient I mentioned. They usually come to hospital with a large heart attack or sudden death. A growing number of patients come to see me because of this problem, and I hope that this article will somehow spark a change in lifestyle for some readers, and reduce the number of people who will have to see a doctor because of narrowed artery with sudden death!!!
Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

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