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Coronary Artery Disease — Symptoms, Risk Factors and Treatment in Hyderabad

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Coronary Artery Disease — Symptoms, Risk Factors and Treatment in Hyderabad

Coronary artery disease (CAD) is the narrowing or blockage of the arteries that supply blood to the heart muscle. It is the leading cause of death in India and the primary driver of heart attacks, angina, and heart failure. The good news: with modern interventional cardiology, most patients with CAD — including those with complex disease previously deemed untreatable — can be effectively treated and go on to live well.

How coronary artery disease develops

The coronary arteries are three major vessels supplying the heart muscle with oxygen-rich blood. CAD begins when low-density lipoprotein (LDL) cholesterol enters the arterial wall and triggers an inflammatory response. Over years, a plaque of cholesterol, immune cells, and fibrous tissue grows inside the wall. As the plaque enlarges, it narrows the vessel lumen — reducing blood flow. If the plaque ruptures, a blood clot forms rapidly, potentially blocking the artery completely and causing a heart attack.

Risk factors — especially relevant in India

Diabetes India has the world's second-largest diabetic population. Diabetes accelerates atherosclerosis and is an independent predictor of worse outcomes after heart attacks.
Hypertension The most prevalent modifiable cardiovascular risk factor in India — accelerates plaque formation and increases the risk of plaque rupture.
High LDL cholesterol The primary driver of plaque growth. Target LDL below 55 mg/dL after a heart attack or stent.
Elevated Lp(a) A genetically elevated cholesterol particle found in 25% of South Asians — not measured on standard lipid panels. A major cause of premature CAD in younger Indian patients.
Smoking A 2 to 4 times increased cardiovascular risk — dose-dependent. Even passive smoking is harmful.
Family history First-degree relative with heart disease before age 55 (men) or 65 (women) significantly elevates personal risk.
Sedentary lifestyle Independent cardiovascular risk factor — particularly relevant in Hyderabad's IT sector workforce.
Stress Chronic psychological stress activates the sympathetic nervous system, promoting hypertension, inflammation, and clot formation.

Symptoms

  • Stable angina — Chest tightness, pressure, or pain on exertion, relieved by rest or nitrates. Suggests chronic significant coronary narrowing.
  • Unstable angina — Chest pain at rest or with minimal exertion. A medical emergency indicating plaque instability and imminent heart attack risk.
  • Heart attack (STEMI or NSTEMI) — Complete or near-complete coronary blockage causing heart muscle death. Requires emergency treatment.
  • Silent ischaemia — Reduced blood flow to the heart without symptoms, common in diabetics. Often discovered on stress testing or ECG.
  • Breathlessness — Reduced heart function from prior heart attacks leading to heart failure.

Diagnosis

ECG Identifies prior heart attacks, ST changes suggesting active ischaemia, and arrhythmias.
Stress test (TMT / stress echo) Provocative test to detect ischaemia during exercise. Abnormal result triggers further investigation.
CT coronary angiogram Non-invasive mapping of coronary artery anatomy — detects both calcified and non-calcified plaque. High negative predictive value for ruling out significant CAD.
Coronary angiogram Gold standard — catheter-based X-ray imaging of the coronary arteries. Allows simultaneous angioplasty when significant blockages are found.
IVUS / OCT / FFR Advanced intravascular imaging and physiology assessment — used during angiogram to optimise stent placement and assess borderline lesions.

Treatment

  • Medical therapy — Aspirin, statins (target LDL below 55 mg/dL), ACE inhibitors, beta-blockers, and SGLT2 inhibitors in diabetics. Essential for all patients regardless of whether revascularisation is performed.
  • Coronary angioplasty (PCI) — Opens blocked arteries using a balloon and stent via a catheter inserted through the wrist or groin. Recovery usually occurs within a few days. Dr. Bhishma Chowdary performs complex PCI procedures including CTO, left main, and calcific PCI at AIG Hospitals.
  • Bypass surgery (CABG) — Creates new pathways around blocked arteries using blood vessels from the leg or chest. Offers better long-term outcomes for diabetics with triple vessel disease.
  • Lifestyle modification — Includes a heart-healthy diet, regular exercise, smoking cessation, weight control, and stress management. Equally important as medication in long-term heart health.

Frequently asked questions

Can coronary artery disease be reversed?
Atherosclerotic plaque cannot be completely reversed, but its progression can be significantly slowed and plaques can be stabilised with aggressive risk factor management. High-intensity statin therapy reduces plaque lipid content and stabilises the fibrous cap, while lifestyle changes help reduce vascular inflammation. The primary goal is to prevent plaque rupture and heart attacks rather than eliminate existing plaque.

If I have no symptoms, does CAD need treatment?
Yes. Asymptomatic coronary artery disease may still require treatment if blockages are haemodynamically significant on FFR or stress testing, or if high-risk anatomy is present, such as left main disease or severe triple vessel disease with reduced ejection fraction. In non-obstructive asymptomatic CAD, aggressive medical therapy and lifestyle modification are the preferred treatments rather than stenting, which does not reduce heart attack risk in stable disease without proven ischaemia.

How often does CAD recur after stenting?
Modern drug-eluting stents have restenosis rates below 5% at the treated site. However, coronary artery disease is a systemic condition, and new blockages may develop in other arteries if risk factors are not adequately controlled. Maintaining LDL below 55 mg/dL, controlling blood pressure, keeping HbA1c below 7%, exercising regularly, and stopping smoking are the most effective strategies to reduce recurrence risk.

Consult Dr. Bhishma Chowdary at AIG Hospitals, Hyderabad

Relevant procedures: Coronary angioplasty, coronary angiogram, CTO-PCI, IVUS/OCT

Call: +91-9000352998

Email: bhishmachowdary@gmail.com

Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM