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Coronary Artery Disease


What is coronary artery disease?

Coronary artery disease (also known as coronary heart disease) occurs when a waxy, fatty substance called plaque builds up over years inside the coronary arteries that supply oxygen-rich blood to the heart.

Starting at a young age, cholesterol in the blood starts to deposit in the walls of blood vessels. As the plaque builds, it releases a chemical that promotes healing—but also makes the blood vessel walls sticky. Over time, other substances traveling through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium begin to stick to the vessel walls. As the plaque builds, the smooth, elastic arteries become hard and rigid and start to narrow, which becomes a condition called atherosclerosis.

When atherosclerosis develops, the heart becomes starved of the oxygen and vital nutrients it needs to function properly. This can cause angina (pain or discomfort that may feel like a pressure or squeezing in the chest) or a heart attack (also called myocardial infarction). A heart attack occurs if the plaque becomes unstable and ruptures, causing a blood clot to form at the rupture site, then blocking the flow of blood to the heart.

As time goes on, coronary artery disease can weaken the heart muscle, leading to arrhythmias—which are problems with the rate or rhythm of the heartbeat—or even heart failure, when the heart is unable to pump sufficiently and maintain blood flow to meet the body’s needs.

Coronary artery disease is the most common form of heart disease in the United States, and is the number one cause of death in both men and women. For unknown reasons, coronary artery disease appears to develop slightly differently in women than men, which researchers are still trying to understand.

What are the symptoms of coronary artery disease?

The most common symptom of coronary artery disease is angina, which is also referred to as chest pain. Angina is also described as chest discomfort, heaviness, pressure, tightness, burning, aching, numbness, fullness, squeezing, or a painful feeling in the chest. It can also be felt in the left shoulder, arms, neck, throat, back, or jaw. Angina tends to get worse with activity and disappear with rest, and it is sometimes mistaken for heartburn or indigestion.

Other common symptoms of coronary artery disease include:

  • shortness of breath
  • palpitations (irregular heartbeats, skipped beats, or a flip-flop feeling in the chest)
  • a faster heartbeat
  • dizziness
  • extreme weakness
  • nausea
  • sweating

Women often have different symptoms of coronary artery disease than men. For instance, symptoms of a heart attack in women may include:

  • pain or discomfort in the chest, left arm, or back
  • unusually rapid heartbeat
  • shortness of breath
  • nausea or fatigue

For men and women, the severity of symptoms can vary with coronary artery disease. Symptoms may get worse as the buildup of plaque continues to narrow the coronary arteries.

If you experience any of these symptoms or if they have become more frequent or severe, call your doctor right away.

How is coronary artery disease diagnosed?

The diagnosis of coronary artery disease begins with a discussion with your doctor about your medical history, your family history, and your risk factors for the disease.

Next, your doctor will want to perform a physical exam. During the exam, the doctor will listen to your heart with a stethoscope to evaluate heart and valve function. The doctor will feel your pulse to check your heart’s rate and rhythm and take your blood pressure. Then the doctor will examine your eyes, arms, legs, and skin for signs of heart function.

In addition, the doctor may want you to have certain tests performed to help diagnose and evaluate the extent of your coronary heart disease, the effect it has had on the function of your heart, and how to best treat the disease. These tests may include:

  • blood tests to check the levels of fat, cholesterol, sugar, and proteins in the blood; abnormal levels may indicate you are at risk for coronary artery disease
    chest x-ray to see if the heart is enlarged or if the lungs have extra blood flow or extra fluid, a sign of heart failure
  • echocardiogram (ultrasound), which uses sound waves to create a moving image of the heart, allowing doctors to assess overall function of the heart and to see any problems with blood flow, injuries caused by poor blood flow, or heart muscle that isn’t contracting properly
  • electrocardiogram (EKG or ECG), which records the heart’s electrical activity and checks for irregular heart rhythms (arrhythmias); the test can show signs of damage due to coronary heart disease or signs of a current or previous heart attack
  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast; the doctor will look for signs of coronary artery disease, such as  shortness of breath or chest pain, abnormal changes to your heart rate, or electrical activity that may indicate coronary artery disease
  • tilt table test, which is used to help find the cause of fainting spells; the test involves lying still on a table that is tilted at different angle while machine monitor your blood pressure, oxygen level, and electrical impulses in your heart
  • cardiac catheterization, during which a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, upper thigh, then threaded into the heart where it can measure pressures in the heart chamber to gauge its pumping ability; the procedure is typically performed in a hospital while you’re awake and with minimal pain
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart and blood vessels; this procedure is often done with cardiac catheterization

While your doctor may detect signs of coronary heart disease, a cardiologist—a doctor who specializes in the diagnosis and treatment of heart problems—will diagnose your condition.

How is coronary heart disease treated?

Treating coronary artery disease is important for reducing your risk of heart attack and stroke. This can be achieved through lifestyle changes, medications, and/or surgical procedures.

Lifestyle changes

Making certain lifestyle changes can help prevent or treat coronary artery disease. For some people, these changes may be the only treatment they need. The goal here is to reduce your risk factors, which can be achieved through:

  • eating a healthy diet aimed at reducing high cholesterol and blood pressure levels
  • quitting smoking
  • being physically active
  • maintaining a healthy weight
  • reducing stress

Medications

If lifestyle changes alone can’t control your heart disease, your doctor may prescribe medications to treat certain risk factors based on your personal needs, other health conditions you may have, and your specific heart condition. Goals of these treatments may include:

  • lowering your risk of having a heart attack or dying suddenly
  • reducing your heart’s workload
  • relieving your disease symptoms
  • lowering your cholesterol and blood pressure
  • preventing blood clots
  • preventing/delaying the need for a procedure or surgery

Medications commonly used to treat the signs and symptoms of coronary artery disease include:

  • antiarrhythmics to treat and prevent irregular heartbeats
  • ACE inhibitors to reduce the risk of heart attack and death due to coronary disease in people who have shown evidence of coronary artery disease
  • beta-blockers to slow down the heart rate and reduce blood pressure, which then reduces the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death
  • blood thinners (aspirin, anti-coagulants) to lower the risk of blood clots in the heart or blood vessels
  • calcium channel blockers to relax blood vessels and increase the supply of blood and oxygen to the heart and to reduce the heart's workload
  • digoxin to increase the strength of heartbeats
  • diuretics to remove excess fluids and sodium in the body
  • vasodilators (nitrates) to relax or widen blood vessels to allow more blood flow to the heart and reduce strain on the heart

Surgery

When a procedure or surgery is required to treat coronary artery disease, the most common ones include:

  • angioplasty (or percutaneous coronary intervention), which is a nonsurgical procedure that uses a thin, flexible tube (catheter) with a balloon on the end that is threaded through a blood vessel or a narrowed or blocked artery; once there, the balloon is inflated to compress the plaque against the wall of the artery to restore blood flow. During the procedure, a small mesh tube called a stent may be inserted to keep the artery open.
  • coronary artery bypass graft (CABG) is a type of surgery during which arteries or veins from other areas of the body are used to create a pathway around a blocked artery to improve blood flow to the heart and help avoid a heart attack.

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing any symptoms that may be related to coronary artery disease, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your coronary artery disease-related condition.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there’s no need to travel to another institution to have it done. Since 2006, Temple cardiovascular surgeons have been performing cardiac surgery procedures at Jeanes Hospital.
Our surgeons are supported by a full-time team of cardiac anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed at Jeanes for the diagnosis and treatment of coronary artery disease include:

  • Diagnostic coronary angiography
  • Coronary intravascular ultrasound
  • Tilt table testing
  • Complex coronary interventions
  • Heart catheterization for pressure/flow monitoring
  • Minimally invasive heart value repair and replacement
  • Balloon angioplasty
  • Coronary stenting
  • Aortic and valve repairs
  • Coronary artery bypass (CABG)
  • Surgical treatment of cardiac arrhythmia
  • Full on-site back-up capability for open heart surgery

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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