coronary artery disease

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

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 dye
• 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.

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.

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 2-4 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 most likely 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 may remain in the hospital overnight, and most likely be discharged the following day. Your physician may decide to discharge you home on the day of your procedure if no complications arise.