Going further with the analogy of road blockages, it would be interesting to know what happens in the cases where the road blocks in the coronary arteries supplying your heart happen gradually. This is what we call chronic stable angina.

Unlike a heart attack, chronic stable angina is an enemy that comes quietly, stays on and causes damage gradually. How often we notice that some roads, which were once a pleasure to walk on, have now become totally unfriendly due to the chaos of the traffic and pollution?

Our coronaries are no less spared. Unhealthy lifestyle capped upon certain metabolic disorders gradually erodes the inner lining of our coronary arteries encouraging gradual deposition of unwanted material on them. This causes development of what is called a white thrombus inside the coronaries. This white thrombus starts causing hindrances in the normal flow within the coronary arteries and subsequently deprives the heart muscle of its vital blood supply.

A heart which is suffering from this chronic disease gets distressed in situations where it has to work that extra mile. The distress call is in the form of symptoms which we call as angina. This chest pain is due to compromised blood supply to the heart muscle. There are also some symptoms which are equally important in recognizing that the heart is suffering. These are unexplained fatigue, shortness of breath or a feeling of dizziness. In the initial stages, this can occur only at high workloads like uphill climbing, prolonged walking or jogging. Gradually, as the road blocks in the coronaries start progressing, the symptoms start coming earlier during exertion. Walking to that next chowk starts becoming difficult due to the pain, and one needs to sit often to get rid of the pain and fatigue. At times the symptoms develop after meals because at this time the body is diverting the blood flow to the intestines and the heart remains deprived. This is called post prandial angina. If the pain is even when you are at rest and lasts for more than 10 minutes, it is a warning sign that this could be a developing heart attack and needs immediate medical attention.

So in whom is the likelihood of developing these slow road blocks more? Well, not in you if you have adopted a disciplined and healthy way of living.  Metabolic diseases like diabetes, high levels of cholesterol, uncontrolled blood pressure and obesity are the culprits that top the list. If coronary artery disease is running in your family, there could be an additional need of vigilance. It goes without saying that tobacco in any form is the most notorious agent of death. Lack of exercise and poor eating habits only add to the dismay of your heart.

Earlier you notice the symptoms, better it is to get the status of the road blocks evaluated. Your primary physician would be aware of the status of the control of the metabolic disorders if any. It will help him stratify your risk profile. A resting ECG usually has less to tell about the chronic stable angina, because, it is during exertion that the heart cries in distress. Hence a stress test or a Treadmill Test is recommended to see how your ECG changes when you are subjected to gradual increase in exertion. This is a reflection that your heart is being compromised of blood supply. It is sometimes advisable to perform a 2 D Echo (a sonographicvisualization of the heart) before you stand for a conventional tread mill test. This gives us an idea of the strength of your heart and confirms absence of structural problems if any. In case the baseline ECG shows some problems, which makes the stress test interpretation difficult, your doctor might advise you other forms of this test, like a stress echocardiogrphy or thalium stress test. CT scan aided angiography of CT Angiography is another tool which has been added to the toolbox of diagnosis in he recent years. . It gives an idea of the calcium deposition in the coronary arteries and helps to give a fair idea of the severity of the disease. Of late cardiac MRI and PET scan have been added to the kitty of cardiac diagnostics which are used in special circumstances where decisions are difficult.

However the mainstay of the exact diagnosis and severity evaluation of this chronic coronary artery disease is a coronary angiography. In one of the sections we will be discussing fairly in detail about this procedure. A coronary angiography gives us a clear picture of the blockages. Technology has made so many advances that the significance of each roadblock and utility of opening the road block can be readily evaluated during the procedure.

In addition to this interventional therapy, medical management with drugs is equally important. Various drugs act at different levels to keep your heart functioning well. Some cause the coronaries to open better, some decrease the requirement of oxygen of the heart. Simultaneously, it is also important to keep the blood pressure, blood sugar and cholesterol levels in the right range. Particularly interesting is the concept of the cholesterol control. If you are really visualizing your arteries as a network of roadways, different types of cholesterol represent the vehicles on the road. Of particular importance are LDL, HDL and Triglycerides. The LDL is like the two wheelers on Indian roads, the Triglycerides are like the cars and HDL represents the public transport system. As common sense would suggest that we should have minimum vehicles and maximum utilization of public transport system to prevent frequent traffic jams, so goes with our lipids. A good HDL and low Triglycerides and LDL are necessary to keep your coronaries with smooth traffic flow.

So, in conclusion:

• Slow development of blockages in the coronary arteries leads to chronic stable angina.
• Diabetes, Hypertension, Raised cholesterol levels along with unhealthy lifestyles are responsible to cause the disease in those who are particularly affected in families.
• Early evaluation with a stress test and subsequently with a coronary angiography prevents the long term complications in the heart.
• Holistic healthy living with control of vital parameters of the blood is equally needed for control of the disease.

Stay informed, be empowered!