Coronary Artery Disease

Risk factors for CAD often include:

• Smoking

• High LDL cholesterol, high triglyceride levels, and low HDL cholesterol

• High blood pressure (hypertension)

• Physical inactivity

• Obesity

• High saturated fat diet

• Diabetes
• Family history

Controlling risk factors is the key to preventing illness and death from CAD.

The symptoms of coronary heart disease will depend on the severity of the disease. Some people with CAD have no symptoms, some have episodes of mild chest pain or angina, and some have more severe chest pain.

If too little oxygenated blood reaches the heart, a person will experience chest pain called angina. When the blood supply is completely cut off, the result is a heart attack, and the heart muscle begins to die. Some people may have a heart attack and never recognize the symptoms. This is called a "silent" heart attack.

Symptoms of coronary artery disease include:

• Heaviness, tightness, pressure, or pain in the chest behind the breastbone

• Pain spreading to the arms, shoulders, jaw, neck, or back

• Shortness of breath

• Weakness and fatigue

In addition to a complete medical history and physical exam, tests for coronary artery disease may include the following:

• Electrocardiogram (ECG or EKG). This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and detects heart muscle damage.

• Stress test (also called treadmill or exercise ECG). This test is given while you walk on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, or to determine safe levels of exercise after a heart attack or heart surgery. This can also be done while resting using special medicines that can synthetically place stress on the heart.

• Cardiac catheterization. With this procedure, a wire is passed into the coronary arteries of the heart and X-rays are taken after a contrast agent is injected into an artery. It's done to locate the narrowing, blockages, and other problems.

Nuclear scanning. Radioactive material is injected into a vein and then is observed using a camera as it is taken up by the heart muscle. This indicates the healthy and damaged areas of the heart.

Treatment may include:

• Modification of risk factors. Risk factors that you can change include smoking, high cholesterol levels, high blood glucose levels, lack of exercise, poor dietary habits, being overweight, and high blood pressure.

• Medicines. Medicine that may be used to treat coronary artery disease include:

  • Antiplatelets. These decrease blood clotting. Aspirin, clopidogrel, ticlopidine, and prasugrel are examples of antiplatelets.

  • Antihyperlipidemics. These lower lipids (fats) in the blood, particularly low density lipid (LDL) cholesterol. Statins are a group of cholesterol-lowering medicines, and include simvastatin, atorvastatin, and pravastatin, among others. Bile acid sequestrants--colesevelam, cholestyramine and colestipol--and nicotinic acid (niacin) are other medicines used to reduce cholesterol levels.

  • Antihypertensives. These lower blood pressure. Several different groups of medicines work in different ways to lower blood pressure.

• Coronary angioplasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PCI procedures, including:

  • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.

  • Coronary artery stent. A tiny mesh coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.

  • Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.

  • Laser angioplasty. A laser used to "vaporize" the blockage in the artery.

• Coronary artery bypass. Most commonly referred to as simply "bypass surgery" or CABG (pronounced "cabbage"), this surgery is often done in people who have chest pain (angina) and coronary artery disease. During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the blockage. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft. Sometimes, multiple bypasses may be needed to fully restore blood flow to all regions of the heart.