In most cases, the phenomenon of obstructed coronaries is due to "atherosclerosis and the thrombo-embolic effects that the latter can trigger"; more rarely, it follows coronary vasculitis or coronary spasm.
Associated with symptoms such as chest pain, dyspnoea, profuse sweating, dizziness, etc., the presence of obstructed coronary arteries is always a cause for serious concern, as it is the basis for conditions such as angina pectoris and myocardial infarction.
Treatment of obstructed coronary artery disease involves adopting a healthy lifestyle and, depending on the degree of occlusion, drug or surgical therapy.
What are the Coronaries: a brief review
Coronaries are the arteries that supply the myocardium, the heart muscle, with oxygenated blood. In other words, the coronaries are the arterial blood vessels that keep the heart alive, as they are the supply of oxygen and nutrients essential for survival for the heart's tissues.
The coronaries originate in the very first tracts of the ascending aorta; in fact, they represent the first branches of the aorta.
The presence of obstructed coronary arteries is an obstacle to the flow of oxygenated blood into the myocardium and this sets the stage for a very dangerous medical condition, known as myocardial ischemia or ischemic heart disease, in which the blood supply to the heart muscle it is less than real needs.
All synonyms for Coronarie Ostruite
In addition to coronary artery occlusion, coronary artery disease and coronary artery disease, another medical term that defines obstructed coronaries is coronary artery stenosis.
Obstructed Coronaries and Myocardial Ischemia: What Consequences?
The "ischemia of the myocardium resulting from the presence of obstructed coronary arteries can be transient (therefore, after a certain period of time, the blood directed to the myocardium will resume circulating) or permanent (ie there is no possibility of a restoration of blood circulation in the site of occlusion).
The first circumstance is an example of angina pectoris, while the second situation is an example of myocardial infarction (or heart attack).
As can be understood, between angina pectoris and myocardial infarction, the most serious consequence of obstructed coronary arteries is heart attack.
Epidemiology: How Common is Coronary Artery Disease?
Obstructed coronary arteries are a very widespread problem, so much so that ischemic heart disease closely connected to them represents the main cause of death in the countries of the so-called Western World.
Until a few decades ago, the presence of obstructed coronaries afflicted men much more frequently than women; today, however, the gap between male and female patients has narrowed considerably, mainly due to an increase in the number of second women.
Did you know that ...
In 2015, myocardial ischemia caused the death of 8.8 million people worldwide (as much as 15.5% of world deaths!), Ranking first among the reasons of death.
) and its vascular effects (thrombo-embolism) and, as less common causes, coronary vasculitis and episodes of coronary spasm.
Coronary atherosclerosis
Atherosclerosis is the process of hardening and thickening of the arteries of medium and large caliber, which over time induces the formation of atheromas on the wall of the arterial vessels just mentioned.
Also known as atherosclerotic plaque, an atheroma is an aggregate of lipid material (especially cholesterol), protein and fibrous, which, in addition to narrowing the vessel lumen during formation, can also suffer injury and / or fragmentation.
From any lesions a coagulation process arises, which, by attracting platelets in place, has the involuntary effect of expanding the atheroma itself (thrombosis), thus worsening the extent of the vessel narrowing. or more emboli, that is mobile bodies which, circulating freely in the blood, can lead to the complete occlusion of a blood vessel of the same size, even at a considerable distance from the site of origin.
When it is related to atherosclerosis, therefore, the phenomenon of obstructed coronary arteries can depend on an atheroma within the coronary arteries, which, following an injury, has attracted platelets, has further enlarged and caused occlusion, or from a circulating fragment in the blood of an atheroma located in a vessel other than the coronary arteries.
Did you know that ...
When obstructed coronaries are the result of an atheroma localized in the coronaries themselves, doctors identify the phenomenon in question with the term "coronary thrombosis".
What are the Causes of Atherosclerosis?
Various conditions cause the phenomenon of atherosclerosis, including: hypertension, hypercholesterolemia, high triglycerides, old age, cigarette smoking and smoking in general, diabetes mellitus, obesity and some inflammatory diseases such as systemic lupus erythematosus.
Coronary vasculitis
In medicine, the word "vasculitis" means inflammation of the vascular walls; consequently, with coronary vasculitis, doctors mean inflammation of the walls of the coronary arteries.
Currently, the precise cause of coronary vasculitis episodes is unclear; it is a fact, however, the existence of a correlation between inflammations of the vascular wall and:
- Infections (eg: hepatitis B and hepatitis C);
- Autoimmune diseases (eg: rheumatoid arthritis, juvenile dermatomyositis and scleroderma);
- Allergic reactions to chemical solvents (eg: pesticides) or drugs (eg: NSAIDs, sulfonamides and quinolones);
- Blood cell tumors (eg leukemia).
Coronary spasm
Coronary spasm is the sudden narrowing of a coronary artery, due to the abrupt and sudden contraction of the muscular component of a portion of the vessel wall.
Various factors can trigger / promote coronary spasms, including:
- The use of drugs such as cocaine, amphetamines and methamphetamines;
- Excessive exposure to cold;
- Strong emotional stresses;
- Tobacco smoke.
- Chest pain or chest pressure
- Pain which, from the chest, may radiate to the back, arm, shoulder, neck, jaw and / or stomach;
- Dyspnea, i.e. shortness of breath;
- Nausea with or without vomiting;
- Limitation of physical abilities. For example, the patient feels tired after any effort, even if minimal;
- Profuse sweating;
- Dizziness;
- Sense of anxiety.
Of these manifestations just listed, the most characteristic of obstructed coronary arteries is undoubtedly the pain / sense of pressure in the chest.
Obstructed Coronaries: Why Do They Cause Symptoms?
The symptoms of obstructed coronary arteries are the manifestation of the greater fatigue that the myocardium encounters in pumping blood into the circulation, when it receives a quantity of oxygenated blood lower than it needs.
Like any other tissue in the human body, in fact, the heart muscle lives and functions at its best only when the supply of oxygen (guaranteed by the blood) is adequate to the demands.
Obstructed Coronary Artery: Complications
The phenomenon of obstructed coronary arteries leads to complications, when the vascular occlusion is permanent and the myocardium, due to a prolonged lack of oxygenated blood, undergoes necrosis, ie death.
The death of the myocardium is an irreversible event and seriously compromises the functions of the heart, so much so as to be fatal in many cases for the individual concerned.
Specifically, the complications attributable to the presence of obstructed coronary arteries include severe cardiac arrhythmias (eg: ventricular fibrillation) and heart failure.
Important: Myocardial death due to permanent coronary obstruction coincides with myocardial infarction, which is the more severe of the two variants of ischemic heart disease mentioned in the opening passages of this article.
When to contact the doctor?
Especially in a subject at risk of obstructed coronary arteries, the apparently unjustified appearance of chest pain, combined with other disorders such as, for example, dyspnea, is always a valid reason to consult a doctor, or go to the nearest hospital center. nausea, profuse sweating, anxiety and dizziness.
, echocardiogram, electrocardiogram, stress test, blood tests, coronary angioTAC and coronary angiography.
Report of Symptoms, Physical Examination and Anamnesis
- The report of the symptoms by the patient provides very useful information for diagnostic purposes; unfortunately, however, in the most serious situations, that is, those in which the patient is unable to express himself due to a strong state of suffering, it is not a viable path;
- The physical examination and the anamnesis serve to further clarify the symptomatological picture and to identify the possible causal factors of the condition in progress.
Echocardiogram
The echocardiogram is the ultrasound of the heart; it has various functions, including showing the alterations of the myocardium due to the presence of a "occlusion of the coronary arteries.
Electrocardiogram
The electrocardiogram evaluates the heart rate, which is the rhythm at which the heart beats.
A possible abnormality in the heart rate could be the signal of the reduced blood supply to the myocardium, observable in the presence of a severe obstruction of the coronary arteries.
Effort Test
The exercise test is used by the physician to evaluate the effects of physical activity on the patient.
Blood analysis
Blood tests are used to quantify substances, such as creatine kinase or troponin (cardiac biomarker), whose levels tend to increase when damage to the myocardium occurs.
Coronary angioTAC
Coronary angioTAC is a radiological examination that allows the study of blood circulation in the coronary arteries.
In a context of obstructed coronaries, it is a source of information on the degree of vascular occlusion.
Coronarography
Coronary angiography is a radiological examination that allows to specifically analyze the blood flow inside the coronary arteries and precisely identify the location and severity of a possible occlusion.
In a context of obstructed coronary arteries, coronary angiography represents the diagnostic confirmation test par excellence.
Pharmacological therapy
Among the drugs used in the presence of obstructed coronaries, there are:
- Anticoagulants (eg heparin) and antiplatelet agents (eg aspirin). They are beneficial because they improve the symptom picture, reduce the size of any atheromas present, dissolve any abnormal blood clots and prevent the formation of new atheromas.
- Nitroglycerin. It is a drug with dilating effects on coronary arteries, which however is effective only in the middle of an episode of angina pectoris or heart attack.
- Beta-blockers, ACE inhibitors and angiotensin II receptor antagonists are useful in the presence of obstructed coronary arteries associated with hypertension, as their intake induces a reduction in blood pressure.
- Statins. They are of benefit in the presence of obstructed coronary arteries associated with hypercholesterolemia, as their intake produces a reduction in cholesterol levels.
Surgery
Among the surgical treatments suitable for countering the phenomenon of obstructed coronary arteries, there are angioplasty with stenting and coronary artery bypass surgery.
Did you know that ...
In some particular cases of obstructed coronary arteries, doctors consider it essential to resort to both the use of drugs and surgery.
Stenting Angioplasty
Angioplasty is the medical procedure that allows to eliminate or, at least, reduce the narrowing or narrowing of a blood vessel, through the use of a particular catheter.
The stenting, on the other hand, consists in the placement of a metal prosthesis (stent) inside a blood vessel - previously occluded and reopened by angioplasty - in order to keep it open over time and avoid second occlusions.
In a context of obstructed coronary arteries, it is possible to understand "angioplasty with stenting has as its object the coronary or coronary arteries victims of occlusion (coronary angioplasty with stenting).
Coronary bypass
Coronary artery bypass surgery consists in creating an alternative path for the passage of blood to the occluded one, by means of the insertion of a new coronary vessel.
In other words, during a coronary bypass surgery, the operating doctor inserts a new coronary artery, the purpose of which is to replace the obstructed original coronary artery in the functions.
Coronary artery bypass grafting is a somewhat delicate surgery.
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