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Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease (CAD) is a type of heart disease. Your heart gets oxygen and nutrients from the blood that flows through the coronary arteries. When you have CAD, thick patches of fatty substances stick to the walls of the coronary arteries. These patches are called plaque. As the plaque thickens, the artery opening gets narrow and the blood flows more slowly. This means the heart gets less blood and oxygen. The plaque, or a blood clot that forms on the plaque, may completely block an artery and stop all blood flow. This narrowing or blockage of the arteries increases your risk for heart attack and sudden death.

How does it occur?

Coronary artery disease is caused by gradual blockage of the coronary arteries. Your risk for CAD may be higher if you:

  • Have a family history of coronary artery disease.
  • Smoke.
  • Have high blood pressure.
  • Have diabetes.
  • Are very overweight.
  • Don't get enough exercise.
  • Have high levels of blood fat--for example, cholesterol.

There may be other things that may increase your risk that we do not yet know about.

What are the symptoms?

Coronary artery disease may have no symptoms. When there are symptoms, the most common one is chest pain, called angina. The symptoms of angina may include pain in the chest that lasts for more than 2 minutes. Or the pain may go away and come back. It can feel like pressure, squeezing, fullness, or pain. There may be pain in other parts of the upper body, such as in one or both arms, the back, neck, jaw, or stomach. You may also be short of breath, break out in a cold sweat, or feel lightheaded or sick to your stomach.

Angina tends to happen when you are being active, after a heavy meal, or with emotional stress. However, angina may also happen when you are resting. The pain happens more in cold weather.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. Your provider will also ask about your personal and family medical history.

You will have blood tests to check the levels and types of fats (lipids) in your blood. Your provider will order an electrocardiogram (also called a ECG or EKG).

Your provider may want to know how your heart works when you exercise. You may have an exercise treadmill test. An echocardiogram (ultrasound images of the beating heart) may be done before and after you exercise on the treadmill. Another test that may be done is a scan of the heart. The scan may be done before and after you exercise. The scan will use a radioactive dye that is injected into one of your veins. If there is a problem with blood flow though an artery, the pictures will show that the dye is not getting to the heart muscle. A special kind of CT scan may also show coronary artery disease.

Your provider may recommend an angiogram. An angiogram takes X-ray pictures of the coronary arteries. A special dye that can be seen on an X-ray is injected into a blood vessel through a thin tube called a catheter. It allows your provider to check blood flow, including the number, location, and size of any blockages. This information will help determine the best treatment for you.

How is it treated?

The goal of treatment is for you to get back to a full and active lifestyle. Your treatment depends on many factors, such as your age, heart muscle function, and other health problems.

At first, treatment may include diet changes and an exercise program.

Your healthcare provider may prescribe medicine, such as an ACE inhibitor or angiotensin receptor blocker (ARB).

  • Benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril are generic names for common ACE inhibitors.
  • Candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan are generic names for common ARBs.

ACE inhibitors and ARBs help to relax the blood vessels and lower blood pressure. As a result, the heart does not have to work as hard. Taking an ACE or ARB medicine has several benefits, including:

  • Helps control high blood pressure
  • Helps prevent heart attacks and strokes
  • Lowers the risk for heart failure
  • Lowers the risk of death from CAD

Your provider may recommend a daily low dose of aspirin. Taking an aspirin daily has several benefits, including:

  • Helps to stop blood clots from forming
  • Lowers your risk of heart attack or stroke

Your provider may also prescribe other types of medicine, such antiplatelet medicine, a beta blocker, or medicine to lower blood fat (cholesterol).

If your coronary arteries are badly blocked, the blockages may need to be opened up with balloon angioplasty or bypassed with surgery.

  • In balloon angioplasty, a small balloon is inserted into the artery and moved to the blockage. The balloon is then blown up to flatten the blockage against the artery wall. A stent may be put into the blocked artery to keep the artery open and improve blood flow.
  • If you have many blockages, or if they are bad, your healthcare provider may recommend coronary artery bypass surgery. Arteries from the chest or veins from the legs or arms are used to make a path around blocked areas in the heart artery.

How long will the effects last?

Many people do well after balloon angioplasty or bypass surgery. They are able to go back to very active lives, sometimes more active than before their diagnosis. If you have advanced heart disease with complications when you are diagnosed, or you do not change to a healthier lifestyle, you are less likely to do well.

How can I take care of myself?

  • Follow your provider's advice about activity, exercise, medicine, and follow-up visits.
  • Lower the amount of salt, saturated and trans fats, and cholesterol in your diet.
  • Work with your healthcare provider to control diabetes, blood pressure, or other health problems you may have.
  • Lose weight if you are overweight.
  • Don't smoke.
  • Call 911 if:
    • You have chest pressure, squeezing or pain that lasts more than 5 minutes or goes away and comes back.
    • You have pain or discomfort in one or both arms, neck, jaw, or back that lasts more than 5 minutes or goes away and comes back AND lightheadedness, trouble breathing, nausea, or sweating.

How can I help prevent coronary artery disease?

Eating a healthy diet, staying fit with the right kind of exercise, and not smoking are the best ways to prevent CAD. Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know what you can do to lower your risk for coronary artery disease.

If you have a strong family history of CAD, a healthy lifestyle may slow the start of the disease and maybe even keep you from getting it. However, you must have regular checkups to keep a close watch on the health of your heart.


HIA File card3618.htm Release 13/2010

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