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Coronary Artery Disease (CAD)
What is Coronary Artery Disease?
Heart artery disease or coronary artery disease (CAD) is a condition that causes narrowing or closing of the coronary arteries. These arteries are the vessels that deliver oxygenated blood to the heart muscle. If the muscle does not have the blood supply it needs, it is injured or can die. This is called a heart attack (or myocardial infarction). The arteries become narrowed due to deposits that develop along the inner lining of the blood vessel. These deposits are primarily made up of cholesterol type substances that over time become calcified (or hardened).
Development of this disease has been associated with several risk factors. Some cannot be changed, or are considered to be non-modifiable. These are gender (males are at higher risk), age (males at at higher risk over 45 and females over 55), and a positive family history. Other risk factors can be changed and are considered to be modifiable. These include: smoking, high blood pressure, high cholesterol panel, obesity, inactive lifestyle, and diabetes. Your physician will want you to lessen the risk factors you have by changing these modifiable factors.
Diagnosis of Coronary Artery Disease
Your physician will want to know if you have any symptoms of the disease. Some examples include: chest pain, chest pressure, discomfort in one or both arms, back, neck, jaw or stomach, shortness of breath or unusual fatigue, nausea, sweating or feeling light-headed. These symptoms most often last a few minutes and are brought on by activity, however symptoms can occur at rest also.
If your health provider is concerned that you may be at risk for CAD, they may order one of the following tests:
- Exercise stress test (involves walking on a treadmill and monitoring of your EKG and symptoms).
- Exercise stress echocardiogram (same as exercise stress test, but an ultrasound or echocardiogram of the heart is performed before and after exercise.)
- Chemical stress test (medicines are used to exercise the heart and then pictures are taken with a specialized machine.)
- Cardiac Catheterization (dye is injected into the coronary arteries through a small catheter placed in the groin and pictures are taken to detect any blockages in the coronary arteries.)
Treatment of Coronary Artery Disease
If testing determines that you have CAD, there are a variety of treatment options. In all cases, it will be recommended that you try and manage your risk factors. This means:
- Don’t smoke
- Control your blood pressure
- Control your cholesterol levels
- Exercise regularly (5 times a week for at least 30 minutes)
- Maintain your ideal weight
- If diabetic, maintain ideal blood sugar levels
You may also require intervention to open the arteries or to replace the arteries. Interventional cardiologists can manipulate catheters, balloons and stents to open a blocked artery and provide better bloodflow to the heart muscle. Angioplasty is the use of a balloon to press the cholesterol plaque into the artery wall. Stent placement is the use of a wire mesh scaffolding that can help hold open that artery. Brachytherapy is the radiation treatment of a stented artery in case it closes. This decreases the chance that it will close again.
Sometimes surgery is needed to bypass the blockages. This is called Coronary Artery Bypass Grafting. Other veins or arteries are sewn onto the heart, bypassing the blocked areas and providing new “plumbing” to carry the oxygenated blood to the heart muscle.
Heart Attack Care
A heart attack can occur when the blood supply to the heart in one or more coronary arteries is blocked. This may cause injury to the heart muscle.
If it is determined that a person is having a heart attack (or myocardial infarction), many treatments will be started to lessen the extent of heart muscle damage.
Acute (emergency) treatment may include :
- “Clot busting” medicine called thrombolytics may be given. These dissolve any blood clot that may be stopping blood flow through the coronary arteries.
- Coronary Catheterization in a Cath Lab where interventional cardiologists can open the blocked vessel.
- Occasionally emergency bypass surgery may be required.
After a heart attack, a number of treatments may be done to limit the damage of the heart attack and to decrease the workload of the heart. These include:
- Aspirin to help prevent further blood clots formation.
- Beta Blockers are a type of medicine that decreases blood pressure and slows the heart rate. These help decrease the workload of the heart and are given to all heart attack patients who can tolerate them. These are an important treatment in protecting the heart muscle.
- ACE (Angiotensin Converting Enzyme) Inhibitors are medicines that lower blood pressure and decrease the workload of the heart. These are used for many patients, but especially those with a weakened heart.
- Statins are a family of drugs which lower blood cholesterol levels or help convert the bad cholesterols to good ones. These are very commonly used for anyone with risk factors for heart disease, even if their cholesterol levels are close to normal.
- Cardiac Rehabilitation is frequently recommended after a heart attack. This organized approach to healing helps patients by teaching them healthy lifestyles and providing support. Patients are also monitored during exercise so that the nurses follow their blood pressure, heart rate and rhythm to maintain safety during exercise.
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