Coronary Atheroma - Cause, Symptoms, and Treatment

Introduction

Heart conditions like coronary artery disease are fairly frequent. The coronary arteries are the primary blood channels feeding the heart. When these channels have deposits of atheromas (also known as plaque), within them, it results in decreased blood supply to the heart. This deprives the heart muscle of nutrients and oxygen. Coronary artery disease slowly progresses over many years and often symptoms go unrecognized until a substantial blockage creates severe complications. A healthy lifestyle can aid in preventing the formation of atheromas, which in turn helps in preventing cardiac diseases.

What Is Coronary Atheroma?

Coronary atheroma refers to the fatty substance deposited within the coronary blood vessels. Atheroma, commonly known as atherosclerotic plaque, is composed of lipids (such as cholesterol), blood cells, calcium, proteins, and inflammatory cells. The process of formation of atheromas is known as atherosclerosis. Coronary atheromas block the coronary blood vessels, gradually narrowing the lumen. They may also dislodge from the vessel, resulting in the formation of a blood clot. This in turn impedes the blood flow to the heart and results in various diseases such as coronary artery disease, stroke, etc.

How Do Coronary Atheromas Form and Cause Heart Disease?

The formation of a coronary atheroma is an intricate process and occurs in the following manner-

• The first stage in the development of a coronary atheroma is damage to the coronary vessel wall. Deposits of fatty material, called plaque, build up within the damaged portion of the walls.

• This reduces or completely blocks blood flow. Substances traveling in the blood, such as cholesterol, fats, and cellular waste products, accumulate inside the damaged area in the walls of the blood vessels.

• Plaque is formed when cholesterol builds up and oxidizes, triggering an inflammatory response. Monocytes, a type of white blood cell, enter the blood vessel’s damaged portion and develop into macrophages.

• As the size of plaque increases, the walls of the blood vessels harden and thicken. This decreases the blood vessel’s lumen, leading to reduced blood flow.

• Furthermore, when the plaque deposit suddenly breaks or dislodges from the blood vessel wall, it causes injury to the walls of the blood vessels, resulting in a bleed within the vessel wall.

• To cease this bleeding, platelets act together and form a blood clot, preventing the blood flow to the cardiac tissues. Platelets are minuscule blood cells that form clots in the event of bleeding or injury.

• This reduced or diminished blood flow further starves the heart tissue of nutrients and oxygen, causing cardiac ischemia. Eventually, the heart tissue dies, leading to a heart attack.

What Are the Causes of Coronary Atheroma?

A coronary atheroma can be caused by :

• Sedentary lifestyle.

• Tobacco abuse.

• Hypertension (high blood pressure).

• Hyperlipidemia (increased levels of cholesterol and triglycerides).

• Diabetes (increased blood sugar levels).

• Obesity.

What Are the Signs and Symptoms Associated With Coronary Atheroma?

The following signs and symptoms are associated with coronary atheromas -

• Angina (Chest Pain) - A feeling of increased pressure or chest tightness is observed when the coronary blood vessels are blocked. Most often, the chest discomfort is central or left-sided. The pain can also be sharp or piercing and radiate to the neck, back and arms.

• Dyspnea (Shortness of Breath) - When the heart is starved of blood supply, it impacts the process of oxygenation, resulting in shortness of breath.

• Fatigue - As the blood vessels associated with the heart's blood supply are blocked, the heart cannot distribute oxygen-rich blood to the entire body, resulting in tiredness.

• Light-headedness- Due to inadequate blood supply, the brain is deprived of oxygen which can lead to light-headedness or dizziness.

• Arrhythmias (Irregular Heart Rhythm) - Deposits of plaque within the coronary blood vessels and their associated structures can lead to malfunction in the conduction of electrical impulses, resulting in irregular heartbeats.

• Palpitations - With decreased blood supply to the heart, the chambers tend to malfunction (contract and relax out of turns) and lead to heart palpitations.

• Hyperhidrosis (Excessive Sweating Which Does Not Result From Exercise or Heat) - The body produces more sweat than usual to maintain the body temperature while the heart works harder to pump blood through the congested blood vessels.

What Are the Risk Factors Associated With the Formation of Coronary Atheromas?

Several factors make an individual susceptible to coronary atheromas. They include -

• Hereditary (family history of heart disease).

• High levels of C-reactive protein.

• Consumption of a high-fat diet.

• Tobacco abuse.

• Diabetes.

• Hyperlipidemia.

• Hypertension.

• Alcohol abuse.

• Decreased physical activity.

Which Tests Are Used to Identify a Coronary Atheroma?

Several tests can be employed to identify coronary atheromas. They include -

• Electrocardiogram (ECG or EKG).

• Doppler ultrasound.

• Cardiac catheterization

• Coronary calcium scan.

• Magnetic resonance angiography (MRA).

• Positron emission tomography (PET) scan.

• Blood tests which include tests for hyperlipidemia, diabetes, and C-reactive protein (CRP).

• Intravascular ultrasound imaging (IVUS).

• Fractional flow reserve (FFR).

Can Coronary Atheroma Be Reversed?

Once developed, coronary atheromas cannot be reversed. However, a person can take several measures to halt the development of coronary atheromas. A few examples of such measures include the following -

• Consuming a Healthy Balanced Diet - A well-balanced diet rich in omega-3 fatty acids can help prevent the formation of atheromas.

• Smoking Cessation - Smoking predisposes a person to atheromas, dyslipidemia, insulin resistance, and vascular inflammation, all of which lead to cardiac disease.

• Routine Health Checkups - Regular checkups act as a dashboard for monitoring health. It helps to identify and treat illness as early as possible.

• Increasing Physical Activity - Regular exercise can help prevent coronary atheroma by reducing and regulating lipid and blood pressure levels.

What Is the Management for Coronary Atheroma?

The management of coronary atheroma can be divided into the following categories -

1. Preventive Therapy

Preventive therapy includes diet modification, weight management, smoking cessation, reduction in alcohol consumption, increased physical activity, and routine health checkups. Regular monitoring of blood sugar, cholesterol levels, and blood pressure can help identify problems at an early stage.

2. Drug Therapy

The following medications are prescribed when the coronary blood vessels have atheromas -

• Drugs Having Anticoagulant Action - These drugs, also known as blood thinners, differ from antiplatelet drugs in their functionality. These drugs reduce the ability of the blood to clot. Examples include Heparin and Warfarin.

• Drugs Having Antiplatelet Action - These drugs, such as Aspirin and Clopidogrel, prevent blood clots by minimizing the platelet's capacity to adhere to each other.

• Drugs to Regulate Cholesterol Levels - These drugs are prescribed to reduce bad cholesterol levels, also known as LDL or low-density lipoproteins. Several classes of medication can be used for lowering lipid levels in the blood, and they include - statins (for example- Simvastatin), bile acid sequestrants (for example-cholestyramine), cholesterol absorption inhibitors (for example - Ezetimibe), etc.

• Drugs to Regulate Blood Pressure - Several drugs regulate high blood pressure. They include - ACE inhibitors (for example -Enalapril), angiotensin-2 receptor blockers (for example-Losartan), calcium channel blockers (for example- Amlodipine), diuretics (for example-indapamide), beta-blockers (for example-atenolol), etc.

3. Surgical Intervention

Surgical interventions are made when all other treatment modalities fail to improve the severity of the condition or when the patient is critical. There are several surgical options available for the treatment of coronary atheroma. They include-

• Percutaneous Coronary Intervention (PCI) - This surgical procedure is also known as coronary angioplasty with stent placement. The primary goal of this procedure is to improve blood flow by unblocking the clogged blood vessels. In this procedure, a catheter (a flexible thin long wire-like tube) is guided to the constricted section of the coronary blood vessels. Once the catheter is in the desired position, it slowly widens the affected part of the blood vessel by inflating a tiny balloon within the vessel walls. This improves blood flow. Once proper blood flow is established, angioplasty is performed, during which a stent is placed within the blood vessel. A stent is a tiny mesh-like structure that not only prevents the narrowing of the blood vessel but also slowly releases medications into the blood vessel, further assisting in maintaining the blood vessel's patency.

• Coronary Artery Bypass Graft Surgery (CABG) - This open heart surgery typically takes about three to six hours. In this procedure, a blood vessel from a different body part (mainly the arm, leg, or chest) acts as a graft. This graft bypasses the blocked blood flow by joining it with the affected coronary blood vessels ahead of the blockage. In this way, the graft feeds to the affected coronary blood vessel with a constant blood supply without being affected by the atheroma. The number of grafts required varies for every case, depending on the heart disease's severity and blockage.

What Are the Complications Associated With Coronary Atheroma?

If timely intervention is not made, a coronary atheroma can further progress and lead to the following complications-

• Coronary Artery Disease.

• Heart Attack.

• Stroke.

• Aortic Aneurysm.

Conclusion

Atherosclerosis is a fairly common condition and is particularly more common in individuals aged above 60 years. It also has a strong association with genetics. It results from the accumulation of fatty deposits, known as atheromas. Atheromas contain other substances, such as blood cells, inflammatory cells, and calcium. Atheromas can form in all blood vessels, and when they are formed within the coronary blood vessels, they are referred to as coronary atheromas. They are of significant concern since they are the primary cause of coronary artery disease. It is not a reversible disease, but lifestyle modifications and regular health checkups can help prevent the formation of coronary atheromas and their associated complications.