Coronary Artery Disease

What are the coronary arteries?

Coronary arteries supply blood to the heart muscle. The coronary arteries consist of three main arteries: the left anterior descending artery (LAD), the left circumflex artery, and the right coronary artery (RCA).

What is coronary artery disease (CAD)?

CAD is caused most frequently by the accumulation of fatty deposits along the inner layer of the coronary arteries. This process can start in childhood and continue to progress throughout one’s lifetime.  This thickening, called atherosclerosis, narrows the arteries and can either decrease or completely block the flow of blood to the heart.  Coronary artery disease is extremely common affecting nearly 13 million Americans. CAD is the #1 killer for both men and women in the US.

What are the risk factors for coronary artery disease?

Risk factors for CAD often include:

• Diabetes
• High LDL cholesterol (bad cholesterol), high triglycerides levels and reduced HDL cholesterol (good cholesterol)
• High blood pressure
• Smoking
• Obesity
• High saturated fat diet
• Physical inactivity
• Early family history of CAD

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

What are the symptoms of coronary artery disease?

CAD symptoms depend on many factors including gender, age, underlying medical conditions such as diabetes as well as the severity and number of blocks in your arteries. Some have no symptoms, while others may have the more classic chest discomfort or “angina” which may or may not radiate into the arms, shoulders, jaw, neck, and/or back. Other associated symptoms include shortness of breath as well as fatigue and nausea.

If the blocks in the arteries are progressive, symptoms may be subtle at first and become increasingly more apparent with limited exertion.  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 referred to as a "silent" heart attack.

IF YOU BELIEVE THAT YOU ARE HAVING A HEART ATTACK,
YOU NEED TO GET TO THE HOSPITAL AS SOON AS POSSIBLE.

What should you do if you think that you are having a heart attack?

1. Take an adult aspirin (325mg).
2. Get to the hospital as soon as possible (CALL 911/Emergency Medical Service)!

How is CAD diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for coronary artery disease may include any, or a combination of, the following:

• Electrocardiogram (ECG) – records the electrical activity of the heart, showing abnormal rhythms (arrhythmias), and can detect heart muscle damage.
• Exercise stress test – patient walks on a treadmill while monitoring the heart by ECG during exercise.
• Stress echocardiogram – treadmill exercise or medication-induced stress test while having ultrasound pictures taken of your heart.
• Nuclear scanning – radioactive material is injected through an IV and then is observed using a camera as it is taken up by the heart muscle.
• Cardiac CT Angiography – CT scan that looks directly at the coronary arteries.
• Cardiac catheterization – day procedure in hospital in which contrast dye is injected the coronary arteries to directly locate narrowing or blockages in the arteries.

How is coronary heart disease treated?

• Risk factor modification – Stopping smoking, increasing exercise, improving one’s diet, controlling one’s cholesterol levels, blood pressure and blood glucose levels, and losing weight.
• Medications – Antiplatelet agents (aspirin, Plavix);  Cholesterol lowering medications (statins such as Lipitor, Crestor, & Simvastatin; see more information on cholesterol); Blood pressure medications that control pressure and heart rate; Anti-anginal medications that decrease episodes of chest discomfort (nitroglycerin)
• Coronary angioplasty & stenting – Non-surgical technique used to open up blocked or narrowed arteries that feed the heart.  Typically referred to as an “outpatient procedure” with limited recovery time needed.
• Coronary Artery Bypass Grafting (CABG) – “Open heart” surgery to bypass blocks in the coronary arteries.  During the surgery, a bypass is created by grafting a non-diseased artery or piece of a vein beyond the blockage, enabling blood to flow around the obstruction.