Coronary Artery Disease

Coronary artery disease can progress for years, even decades, without symptoms. But as your arteries become more and more narrowed, symptoms can manifest. Many patients, particularly women and the elderly, often have atypical symptoms.

The most common symptoms of CAD include:

• Angina, or chest pain with radiation to the neck, jaw or left arm
• Shortness of breath
• Palpitations (irregular heartbeats)
• Weakness or dizziness
• Nausea
• Sweating

Many risk factors for coronary artery disease can be controlled, helping to prevent or delay the development of CAD. Risk factors include:

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Inactivity/lack of regular exercise
• Stress
• Sleep apnea
• Family history of heart disease: your risk increases if your father or brother was diagnosed with CAD before age 55, or your mother was diagnosed before age 65.
• Age: A man’s risk for CAD increases sharply after age 45. For women, the risk jumps after age 55.
• Metabolic syndrome: Includes high blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist.
• High levels of C-reactive protein: A marker for inflammation, research suggests that high levels of CRP in the blood may raise the risk of developing CAD or having a heart attack.

What is Atherosclerosis?

Atherosclerosis, or “hardening” of the arteries, occurs when plaque builds up inside the artery walls, causing the arteries to narrow. Fat naturally begins to appear in the arteries when you are a teenager. As fat builds up over time — influenced by CAD risk factors — it can damage artery walls.

Your body’s cells release chemicals in attempt to heal the damage, which make the artery walls sticky. In turn, proteins, calcium deposits, cholesterol and other substances traveling through your blood vessels begin to stick to the artery walls, combining with fat to form plaque.

• A build-up of plaque causes the wall to “bulge” into the artery where blood normally flows, partly or completely restricting blood flow.
• Decreased blood flow to the heart can cause angina (chest pain).
• A complete blockage in an artery can cause a heart attack. Severe heart attacks can permanently damage the heart muscle, leading to heart failure or arrhythmia.

Tests to help diagnose coronary artery disease include:

• Blood tests, to check levels of certain fats, cholesterol, sugar and proteins in the blood
• Electrocardiogram (EKG or ECG)
• Holter monitor, which records your heartbeat over 24 to 48 hours
• Echocardiogram
• Stress test
• Coronary angiogram or catheterization
• CT scan

If you go to the emergency room with chest pain, some tests will be ordered immediately to find out if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.

In some cases, coronary artery disease can be managed with lifestyle changes aimed to reduce risk factors, such as:

• Quitting smoking
• Modifying your diet
• Keeping your blood pressure under control
• Exercising (check with your doctor before beginning an exercise program)
• Reducing stress

If lifestyle changes aren’t enough to control your coronary artery disease, you may need medication to help your heart and arteries function better, such as:

• Cholesterol-lowering drugs, or statins
• Aspirin or other blood thinner
• Beta-blockers
• Nitroglycerin

If you have a severe blockage in one or more arteries, you may benefit from angioplasty (percutaneous coronary intervention, or PCI), which can:

• Improve blood flow to your heart
• Relieve chest pain
• Possibly prevent a heart attack

Coronary artery bypass graft (CABG) surgery (open-heart surgery) is often performed when multiple coronary arteries are blocked or when blockages are not suitable for angioplasty or stenting. CABG surgery involves the usage of arteries or veins from other areas in your body to route blood flow around your narrowed coronary arteries. CABG can:

• Improve blood flow to your heart
• Relieve chest pain
• Possibly prevent a heart attack

CABG can sometimes be performed as a minimally invasive procedure if a patient has just one blocked artery that needs bypassing.