Coronary artery disease is almost always due to the gradual build-up of cholesterol and other fatty materials (called atheroma or atherosclerotic plaque) on the wall of a coronary artery. This process is called atherosclerosis. As the atheroma grows, it may bulge into the artery, narrowing it and partially blocking the blood flow. If the blockage is significant, it causes myocardial ischaemia, which can result in angina pain. If the atheroma ruptures suddenly, it triggers the formation of a blood clot (thrombus), which can further narrow or completely block the artery. The consequences of this acute ischaemia are referred to as acute coronary syndrome. In a heart attack, the area of the heart muscle supplied by the blocked artery dies, a process called myocardial infarction.
The classic symptoms of coronary artery syndrome include a feeling of pressure in the chest, a squeezing or full sensation or actual chest pain. This may be accompanied by pain in one or both arms, jaw, back, stomach or neck. Other symptoms include shortness of breath, nausea, vomiting, light-headedness and sweating. Symptoms develop when the heart is working harder and goes away with rest. At the other end of this spectrum is acute myocardial infarction (heart attack), when the blood supply to the heart is completely cut off. In a heart attack, symptoms can be much worse and pain occurs even at rest. There may be associated breathlessness and sweating. Angina drugs do not help — this is a medical emergency.
Some overlooked warning signs of clogged arteries include:
- Atypical signs
Women are more likely than men to experience symptoms of acute coronary syndrome that do not occur in this typical fashion. Instead, they experience more of the other symptoms, such as light-headedness, nausea, extreme fatigue, fainting, dizziness or pressure in the upper back with or without chest pain
- Silent ischaemia
This is of particular concern for diabetics. They are more likely to be without chest pain in the setting of unstable angina or a myocardial infarction and thus late presentation contributes to a higher mortality (risk of dying) in these patients in terms of late diagnosis and presentation. It is believed that diabetes-related nerve damage blunts the heart pain and hence symptoms are not noticed.
- Erectile dysfunction
This is an inability to get and keep an erection firm enough for sex. This could be an early-warning sign of current or future heart problems. In the past, it was believed that plaque build-up reduces the blood flow in the penis, making erections difficult. It is now believed that this occurs due to the dysfunction of the inner lining of the blood vessels and smooth muscle, leading to a reduction of blood supply to the heart and the penis.
- Peripheral artery disease
There is a narrowing of the peripheral arteries to the legs, stomach, arms and head — most commonly in the arteries of the legs. This is again due to atherosclerosis. The most common symptom is cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs, which goes away with rest but returns when one walks again. If left untreated, it can result in ulcers and gangrene. Such patients frequently have concomitant coronary artery disease, heart attack and stroke.
- A diagonal ear lobe crease
Studies have indicated that this could signal the presence of 5 cardiovascular disease. The symptom is also called Frank’s sign.