Coronary Artery Disease

Coronary artery disease is narrowing of the arteries that supply the heart muscle, caused by fatty deposits called plaque building up in their walls over decades. It is the usual cause of angina and heart attacks.

A narrowing can limit blood flow during exertion, giving predictable chest discomfort. A plaque can also split suddenly and form a clot, which causes a heart attack. Treatment lowers the chance of that event and relieves symptoms, but the underlying tendency remains and needs lifelong attention.

Symptoms

• Chest tightness, pressure or heaviness on exertion, easing with rest
• Discomfort spreading to the arm, neck, jaw or back
• Breathlessness on effort
• Unusual tiredness, more often reported by women
• Indigestion-like discomfort or nausea with exertion
• No symptoms until a heart attack, particularly in people with diabetes

Causes and risk factors

Plaque forms where the artery lining is damaged and cholesterol enters the wall. The main risk factors are smoking, high LDL cholesterol, high blood pressure, diabetes, obesity, inactivity, chronic kidney disease and a family history of early heart disease. Risk rises with age and begins earlier in men. Raised lipoprotein(a), which is inherited, and inflammatory conditions such as rheumatoid arthritis add to it.

How it is diagnosed

• ECG and blood tests: A resting ECG may be normal. Cholesterol, glucose and kidney function are measured, and troponin if a heart attack is suspected.
• CT coronary angiography: A non-invasive scan that shows plaque and narrowing directly. Commonly the first test for stable chest pain.
• Stress testing: Stress echocardiography, nuclear perfusion or stress MRI show whether a narrowing actually limits blood flow.
• Invasive coronary angiography: Dye injected through a wrist or groin artery gives the definitive picture and allows treatment in the same sitting. Pressure-wire measurement helps judge borderline narrowings.
• Echocardiography: Assesses pumping function and damage from earlier events.

Treatment options

• Lifestyle change: Stopping smoking, a Mediterranean-style diet, regular exercise and weight control.
• Preventive medicines: A statin, often with ezetimibe or a PCSK9 inhibitor, low-dose aspirin and blood pressure control lower the risk of heart attack.
• Anti-anginal medicines: Beta blockers, calcium channel blockers and nitrates relieve symptoms.
• Angioplasty and stenting (PCI): A balloon opens the narrowing and a drug-coated stent holds it open. It is life-saving in a heart attack and relieves angina in stable disease.
• Coronary artery bypass grafting (CABG): Arteries or veins from elsewhere route blood past the blockages. Preferred for disease of the left main artery or several vessels, especially with diabetes.
• Cardiac rehabilitation: Supervised exercise and education after an event or procedure improves recovery and outlook.

When it is urgent

Chest pain lasting more than 15 minutes, pain at rest, or pain with sweating, nausea, breathlessness or faintness may be a heart attack. Call your local emergency number at once. Minutes matter, and no one should travel for this.

Travelling to Türkiye for treatment

For stable disease, a visit can cover CT or invasive angiography, a considered opinion on stents versus bypass, and the planned procedure itself. Allow about 3 to 5 days for angioplasty and 2 to 3 weeks for bypass surgery before flying. After a stent you must take two antiplatelet medicines without interruption for months, so make sure a doctor at home will supervise this. Unstable symptoms need local care first.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions