Coronary artery disease (CAD)
Coronary artery disease, also known as atherosclerotic heart disease or coronary heart disease, results from an accumulation of fatty substances and plaque within the walls of the coronary arteries that supply the muscle of the heart with oxygen and nutrients.
This causes a narrowing of the artery decreasing blood flow to the heart muscle. Some of these atheromatous plaques may rupture at any stage of the disease and form a blood clot that also can cut off blood flow to the heart muscle and cause a heart attack.
Coronary arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessel. The lining of the artery becomes hardened, stiffened, and enlarged with debris including calcium and fatty deposits and abnormal cells to form a plaque. Patients with CAD can have one or two plaques or many scattered throughout their coronary arteries.
Cardiologists affiliated with St. Vincent’s Regional Heart & Vascular Center are skilled in diagnosing and treating CAD.
CAD is the leading cause of death worldwide because often there are no noticeable symptoms until the disease has progressed to a more serious state. Many individuals with coronary artery disease show no evidence of disease for years as the disease progresses before the first onset of symptoms, often a "sudden" heart attack occurs.
As the disease progresses, there may be complete blockage of one or more arteries, and a heart attack may result. Heart attack or myocardial infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
The disease is the most common cause of sudden death. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. Because CAD is often due to heredity, where heart disease runs in the family, otherwise healthy individuals can lead very active lifestyles and appear physically fit while remaining completely unaware of the plaque that's been building up throughout child and young adulthood. While eating a healthy diet may reduce your risk, it doesn't preclude you from having this often inherited disease.
Symptoms, when they present themselves, are often mild and ignored - It's critical that you not ignore any of the following symptoms and be screened by a cardiologist right away. See a cardiologist or a health care professional if you experience any of these symptoms.
- Angina: Individuals with severe blockages may show signs of chronic coronary ischemia, which means the blood supplied to the tissue is inadequate. This may cause chest pain or angina.
- Shortness of breath. If your heart is not pumping enough blood, you may develop shortness of breath or fatigue with activity.
- Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack.
- Risk Factors for CAD
- High blood pressure
- High cholesterol
- Family History
There is much you can do to limit your risk for CAD. Adopt a healthy lifestyle and stop smoking. Physicians at St. Vincent’s can help you modify your risk still further or manage symptoms of CAD by using screening tools such as monitoring blood pressure and cholesterol including low-density lipoprotein (LDL), high-density lipoprotein (HDL). They can help you develop a healthy diet and guide you to resources to help you quit smoking and get the exercise you need to stay strong and manage your weight.
If symptoms indicate a problem, St. Vincent’s cardiologists can call upon a physical examination, non-invasive testing and a family history along with the most advanced technology to get to the heart of the problem including:
- Electrocardiogram (ECG or EKG) (see Electrocardiogram) A noninvasive test that checks for electrical problems of the heart to show evidence of a heart attack, lack of blood supply or a rhythm disturbance.
- Blood tests. A blood test identifies certain heart enzymes that indicate a damaged heart or risk factors for CAD.
- Chest X-ray: Can reveal damage
- Stress test. Done while patient is on a treadmill, it can show how well blood is flowing.
- Echocardiogram (Doppler echocardiogram). Produces images of the heart to identify valve function or blood flow problems using sound waves.
- Nuclear scan –Using a radioactive substance, a picture will emerge of the blood flow to your heart.
- Positron emission tomographic scan (PET). A PET scan defines areas of your heart with altered blood supply and can help to identify areas of your heart damaged previously.
- Angiogram (coronary catheterization). The most precise test to determine the extent of CAD (see Cardiac Catheterization).
- Magnetic resonance imaging (MRI). Detailed images of the heart disclosing areas of damage are produced using magnetic energy.
- CT scan. Produces images of larger coronary arteries.
Treatments for CAD include lifestyle changes, medication therapy and in some cases, medical procedures.
CAD Medication Therapy may include those to lower cholesterol, aspirin to reduce clotting and blockage of the arteries, beta blockers to lower your heart rate, blood pressure and the body’s demand for oxygen and also the risk of heart attack, nitroglycerin to open up the arteries and reduce demand for blood, other drugs to decrease blood pressure, open the arteries and reduce risk of heart attack.
When lifestyle changes and medications are not enough, cardiologists at St. Vincent’s have a range of options to help you manage CAD by improving blood flow.
Angioplasty and stent placement (see also Cardiac Catheterization)
In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery, inflates a balloon when the blockage is reached, pressing back the plaque to allow an opening. A permanent stent is often placed in the artery to keep it open. Some stents slowly release medication to help keep the artery open.
Coronary artery bypass surgery.
A surgeon creates a graft to detour the blood flow around blocked coronary arteries using a blood vessel from another part of your body. Usually this open-heart surgery is performed when an individual has more than one blockage. See Cardiovascular/Cardiothoracic Surgery.
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