Coronary Artery Disease

Coronary artery disease is the buildup of plaque in the arteries that supply oxygen-rich blood to your heart. Plaque causes a narrowing or blockage that could result in a heart attack. Symptoms include chest pain or discomfort and shortness of breath.

Causes #

• Coronary artery disease starts when fats, cholesterols and other substances collect on the inner walls of the heart arteries.

• This condition is called atherosclerosis.

• The buildup is called plaque.

• Plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.

Besides high cholesterol, damage to the coronary arteries may be caused by:

• Diabetes or insulin resistance

• High blood pressure

• Not getting enough exercise (sedentary lifestyle)

• Smoking or tobacco use

Symptoms #

Symptoms of a heart attack include:

• Chest discomfort (angina) described as heaviness, tightness, pressure, aching, burning, numbness, fullness, squeezing or a dull ache. The discomfort can also spread to or only be felt in your left shoulder, arms, neck, back or jaw.

• Feeling tired.

• Dizziness, lightheadedness.

• Nausea.

• Weakness.

Symptoms of a heart attack in women can be slightly different and include:

• Discomfort or pain in the shoulders, neck, abdomen (belly) and/or back.

• Feeling of indigestion or heartburn.

• Unexplained anxiety.

• Cold sweat.

Diagnosis #

Electrocardiograph tests (EKG) #

This test records the electrical activity of the heart. Can detect heart attack, ischemia and heart rhythm issues.

Exercise stress tests #

This is a treadmill test to determine how well your heart functions when it’s working the hardest. Can detect angina and coronary blockages.

Pharmacologic stress test #

Instead of using exercise to test your heart when it is working its hardest, medication is given to increase your heart rate and mimic exercise. This test can detect angina and coronary blockages.

Coronary calcium scan #

This test measures the amount of calcium in the walls of your coronary arteries, which can be a sign of atherosclerosis.

Echocardiogram #

This test uses sound waves to see how well the structures of your heart are working and the overall function of your heart.

Blood tests #

Many blood tests are ordered for factors that affect arteries, such as triglycerides, cholesterol, lipoprotein, C-reactive protein, glucose, HbA1c (a measure of diabetes control) and other tests.

Cardiac catheterization #

This test involves inserting small tubes into the blood vessels of the heart to evaluate heart function including the presence of coronary artery disease.

Treatment #

Medication #

• Medication to lower your cholesterol levels, such as statins, bile acid sequestrants, niacin and fibrates.

• Medications to lower blood pressure, such as beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers.

• Medications to stop angina, such as nitrates/nitroglycerin or ranolazine.

• Medications to reduce the risk of blood clots, such as anticoagulants (including aspirin) and antiplatelets.

Procedures and surgery #

Interventional procedures #

• These are nonsurgical treatments to get rid of plaque buildup in the arteries and prevent blockages.

• Common procedures are balloon angioplasty and stenting. These procedures are done with a long, thin tube called a catheter.

• It is inserted into an artery in the wrist or the top of the leg through a small incision and guided to the blocked or narrowed area of the artery.

• The balloon widens the diameter of the artery to restore blood flow to the heart. A stent (a small metal spring-like scaffold) is left in place to keep your artery open.

Coronary artery bypass graft (CABG) surgery #

It involves creating a new path for blood to flow when there is a blockage in the coronary arteries. In most cases, the surgeon removes blood vessels from your chest, arm or leg, and creates a new pathway to deliver oxygen-rich blood to the heart.

Enhanced external counterpulsation (EECP) #

• If traditional treatment options are not successful, your cardiologist may recommend other treatment options, such as enhanced external counterpulsation (EECP).

• In this procedure, inflatable cuffs (like blood pressure cuffs) are used to squeeze the blood vessels in your lower body.

• This helps improve blood flow to the heart and helps create natural bypasses (collateral circulation) around blocked coronary arteries.

• Enhanced external counterpulsation is a possible treatment for those with chronic stable angina who can’t have an invasive procedure or bypass surgery and don’t get relief from medication.