Answer:

Coronary artery disease occurs when the coronary arteries that supply blood to the heart muscle become narrowed or blocked due to the buildup of plaque (composed of cholesterol, fat, calcium, and inflammatory cells). This reduces the flow of oxygen-rich blood to the heart, causing angina or chest pain. This is often described as a squeezing, heavy, or tight sensation in the center of the chest, sometimes radiating to the neck, jaw, left shoulder, left arm, or back. Symptoms typically appear during exertion, such as brisk walking, carrying heavy objects, exercising, or climbing stairs, and diminish with rest. Some individuals also experience shortness of breath, a choking sensation, or a dull ache in the chest, prompting them to pause and regain their breath.

Chest tightness when climbing stairs in middle-aged individuals, especially those with high blood pressure like yourself, can be an early sign of coronary artery disease. Climbing stairs is a typical strenuous activity that requires the heart to pump more blood. In healthy individuals, the coronary arteries dilate to meet the increased oxygen demand of the heart muscle. However, in individuals with narrowed coronary arteries, this response is limited, leading to reduced blood flow to the heart and causing angina.

Fatigue and shortness of breath while climbing stairs are not always indicative of heart disease. These symptoms can also be influenced by factors such as age, physical condition, weight, lung conditions, anemia, or a sedentary lifestyle. However, if fatigue occurs frequently and disproportionately to the level of exertion, it could be an early warning sign of cardiovascular or respiratory problems.

Here are some benchmarks to help you assess your health when climbing stairs:

If you cannot climb a single flight of stairs (about 10 steps) or have to stop midway due to chest pain, shortness of breath, or dizziness, it is a clear sign that your heart or lung function is impaired, and you should seek medical attention promptly.

If you can climb about two flights of stairs continuously (equivalent to 20-25 steps) but experience noticeable chest tightness and shortness of breath, it could be an early sign of reduced blood flow to the heart or chronic lung diseases like chronic obstructive pulmonary disease (COPD). Medical consultation is recommended for accurate diagnosis.

If you can climb 4 flights of stairs (60-70 steps) but have to stop due to significant fatigue, chest tightness, cold sweats, dizziness, or shortness of breath, do not ignore these symptoms. They could be related to coronary artery disease, arrhythmia, or uncontrolled high blood pressure and require a thorough medical evaluation.

Without prompt treatment, coronary artery disease can progress to a heart attack, heart failure, arrhythmia, or sudden death. Screening for coronary artery disease is recommended for individuals at high risk, especially men over 45 or women over 55 with cardiovascular risk factors.

Treatment depends on the extent of artery damage and the patient's symptoms. In the early stages or mild cases, doctors may recommend lifestyle changes (reducing salt and fat intake, quitting smoking, regular exercise, and weight management) combined with medication. In cases of severe coronary artery damage (left main coronary artery stenosis of 50% or more, other major branches stenosis of 70% or more), patients may undergo coronary angioplasty with stent placement to restore blood flow to the heart muscle.

If the damage is complex and not suitable for stent placement, such as excessive calcification, widespread damage, involvement of multiple coronary artery branches, or coexisting severe valve disease requiring repair, coronary artery bypass grafting (CABG) surgery may be necessary. In this procedure, the surgeon uses a healthy blood vessel from another part of the body to create a bypass around the blocked or narrowed artery.

Dr. Nguyen Thi Tuyet

Cardiology Department, Tam Anh General Hospital Hanoi