Coronary artery disease (CAD) occurs when fatty deposits accumulate along
the innermost layer of the coronary arteries. The process may begin as
early as childhood and continue throughout your life span. This thickening
of the artery walls, called atherosclerosis, narrows the arteries and
can decrease or block the flow of blood to the heart.
Are you at risk?
Risk factors for coronary artery disease (CAD) are mostly lifestyle related.
Controlling these risk factors is the key to preventing illness and death from CAD.
Diabetes
Diet high in saturated fat
High blood pressure (hypertension)
High LDL cholesterol, high triglycerides levels and reduced HDL cholesterol
Physical inactivity
Smoking
Obesity
Diagnosing Coronary Artery Disease
Some patients with coronary artery disease (CAD) have no symptoms, while
others experience a variety of symptoms, including:
Heaviness, tightness, pressure and/or pain in the chest, behind the breastbone
Pain radiating in the arms, shoulders, jaw, neck and/or back
Shortness of breath
Weakness and fatigue
If CAD cuts off the supply of oxygen-rich blood to the heart, the result
is a heart attack and the heart muscle starts to die.
If any of these symptoms occur or if you have a heart attack, your doctor
will order one or more of these tests to confirm the diagnosis:
Electrocardiogram (ECG or EKG) — to record the electrical activity
of the heart, show abnormal rhythms and detect heart muscle damage from
a previous heart attack
Echocardiogram — to look for evidence of structural heart problems
and a previous heart attack
Stress test (also called treadmill or exercise ECG) — to monitor
the heart, breathing and blood pressure during exercise
Angiography or arteriography — a type of cardiac catheterization
for locating the narrowing, occlusions and other abnormalities of arteries
using X-rays and contrast die
Cardiac Nuclear Scan — by injecting radioactive material through
an IV site, physicians will be able to identify areas of the heart that
are not allowing blood to flow properly.
At Anderson Regional Heart Center, interventional cardiologists use both
the femoral artery in the groin and the radial artery in the wrist to
perform cardiac catheterization.
Treating Coronary Artery Disease
Doctors at Anderson Regional Heart Center can choose from a variety of
treatments for coronary artery disease, depending on your age, overall
health and the extent of the disease.
Treatments include:
Lifestyle Modifications Quitting smoking, losing weight and exercising can all help you reduce
your blood pressure, cholesterol and glucose levels, thus lessening your
risk of coronary artery disease. Controlling diabetes and treating sleep
apnea is also important in reducing the risk of CAD.
Medications Doctors can treat the side effects of coronary artery disease (CAD) with
Antiplatelet medications — to decrease the ability of platelets in
the blood to stick together and cause clots
Anticoagulants — "blood thinners" that decrease the blood’s
ability to clot
Antihyperlipidemics — to lower lipids (fats) in the blood, such as
statins and bile acid sequestrants
Antihypertensives — to lower blood pressure
Coronary Angioplasty If lifestyle modifications and medication do not alleviate your symptoms,
you may need a diagnostic heart catheterization to determine the severity
of the blockages. If intervention is needed, an interventional cardiologist
will perform a percutaneous transluminal coronary angioplasty (PTCA) to
create a bigger opening in the blood vessel to increase blood flow into
the heart.
PTCA procedures include:
Balloon angioplasty — a balloon is inserted through a catheter to
the blocked blood vessel and inflated slightly to create a bigger opening
to increase blood flow
Atherectomy — a tiny device on the end of a catheter shaves away
the blocked area inside the artery
Coronary artery stent installation — a tiny coil expands inside a
blocked artery and is left in place to keep the artery wide open
Drug-eluting stent — a coil coated with medications helps prevent
an artery from re-clogging after angioplasty or surgery
A catheter can be introduced through a blood vessel in the groin or the wrist.
Coronary Artery Bypass Graft (CABG) If blockages cannot be cleared in the heart catheterization lab because
of their location or the number of blood vessels involved, bypass surgery
may be recommended. During bypass surgery, the surgeon grafts a piece
of a vein above and below the blocked area of a coronary artery, enabling
blood to flow around the obstruction. Veins are usually taken from the
leg, but arteries from the chest or arm may also be used to create a bypass graft.
Cath Lab Preparation and Recovery
Prior to your procedure, you’ll meet the care staff assisting with
your catheterization as they:
Draw blood
Take a chest X-ray
Review your medications
Answer your questions
Start your IV
Sign the consent forms
Discuss any questions with the doctor and staff
Receive medication to help you relax during the procedure
You may spend about four to six hours in the recovery area. During this time:
Your interventional cardiologist will discuss the outcome of your procedure
and may show your family the heart images taken during the procedure.
You should drink plenty of fluids to help flush the dye from your system.
Your nurse will monitor the puncture site and vital signs (Note: It is
not uncommon to have a harmless, pea-sized bump at the puncture site that
will disappear in 60-90 days.)
If you had a diagnostic catheterization only, you will return home after
your recovery period. Because the procedure requires sedation, you must
have someone drive you home and help you follow your specific discharge
instructions.
If you undergo an interventional catheterization, you will remain in the
hospital overnight, and most likely be discharged the following day.
Risk factors for coronary artery disease (CAD) are mostly lifestyle related.
Controlling these risk factors is the key to preventing illness and death from CAD.
Dale Touchstone, MDCardiologyView Profile
