Spotlight on Coronary Artery Disease: What It Is and How It’s Treated
For the past few months, 73-year-old Paula has been experiencing mild pain in her chest. She’s had bouts of heartburn for much of her adult life, so she assumes this is the cause of her pain. She usually takes over-the-counter heartburn medications to relieve her symptoms, but they haven’t been helping lately. The pain comes and goes, and she also feels nauseous and short of breath sometimes.
Paula doesn’t think too much of it, at first, but she becomes alarmed when a friend says her father experienced similar symptoms shortly before his heart attack. Paula decides to see her doctor right away, who refers her to a top cardiologist in her area.
Paula’s heart doctor performs a coronary angiogram, which uses a special dye and x-rays to reveal blockages or narrowing inside the arteries. The results of the angiogram show that Paula has three severely blocked arteries (three-vessel disease), and her doctor schedules emergency bypass surgery (coronary artery bypass grafting, or CABG) for the next day.
Unfortunately, Paula’s experience is not all that uncommon. Nearly 400,000 coronary artery bypass procedures are performed in the U.S. alone each year.1 Severe cases, like Paula’s, are sometimes treated on an emergency basis.
It’s hard to know what’s happening inside the heart, and many people don’t realize there’s a problem until they start experiencing symptoms. Despite the way heart attacks are so often depicted in movies and television—usually with an older man suddenly clutching his chest and dropping to the floor—the symptoms of coronary artery disease and heart attack are often more subtle, and they affect both men and women.
Even though we can’t directly observe our heart function or see inside its vessels, there are still proactive measures we can take to help prevent heart problems. This is especially important for those who are at increased risk of heart disease. Ahead, we’ll look at risk factors, as well as prevention measures and current treatments for coronary artery disease (CAD).
What Is Coronary Artery Disease?
Coronary artery disease is the most common form of heart disease in the U.S. It affects both men and women and occurs when a fatty substance called plaque builds up in the artery walls of the heart, reducing blood flow. Plaque build-up in the arteries is called atherosclerosis.
As plaque continues to accumulate and harden in the arteries, the vessels become narrowed. This restricted blood flow can make it difficult for the heart to get enough blood and oxygen. A person with CAD may eventually begin to experience chest pain (angina) or have a heart attack. CAD can weaken the heart muscle, over time, and it can also lead to atrial fibrillation (irregular heart rhythm).
Signs and Symptoms of CAD
Some people with CAD have no signs or symptoms—this is called silent CAD. Those who do may experience any of the following:
- Angina, chest pain or discomfort that occurs when your heart can’t get enough blood; angina sometimes feels like pressure or tightness in the chest—many describe it as feeling as if someone is sitting on their chest; or it may feel like indigestion, or pain or pressure in the shoulders, back, neck, or jaw. Angina tends to get worse with physical activity.
- Shortness of breath, which occurs when CAD causes heart failure; shortness of breath is caused by fluid buildup in the lungs.
- Arrhythmia, which is an irregular heartbeat.
- Heart attack, which can occur when an artery becomes completely blocked; heart attack symptoms include crushing pressure in the chest, pain down the arm or in the shoulder, and possible shortness of breath; women are more likely to experience jaw pain before a heart attack.
Risk Factors for Coronary Artery Disease
There are two kinds of risk factors for CAD: those you can control and those you can’t. Risk factors you can control include:
- High blood pressure (can be prevented with good lifestyle choices or controlled with medication)
- High cholesterol (can be prevented with good lifestyle choices or controlled with medication)
- Diabetes and prediabetes (while type 1 diabetes is hereditary, type 2 diabetes and prediabetes can be prevented with healthy lifestyle choices or managed with medications)
- Lack of physical activity
- Poor diet
- Excessive alcohol consumption (which can raise blood pressure and contribute to high triglyceride levels, obesity, and other problems; moderate drinking—no more than 2 drinks per day for men and no more than 1 drink per day for women—may have a protective effect on cardiovascular health; however, non-drinkers should not start drinking, as the risks generally outweigh the benefits).2
Risk factors you can’t control include:
- Family history of CAD
- Age: Older people are at increased risk; most people who die of CAD are 65+.2
- Gender: Men are at greater risk of heart attack, and they have heart attacks earlier in life than women.2
Just because some risk factors are beyond your control does not mean that developing CAD or having a heart attack is inevitable. Keeping blood pressure and cholesterol levels under control, being physically active, eating a healthy whole foods diet, managing stress, and avoiding or quitting smoking can help prevent CAD, even if you’re at increased risk for the disease because of gender, age, or family history.
Coronary Artery Disease Treatment
Lifestyle changes are usually the first line of treatment to alleviate symptoms and slow the progression of CAD. Many people with mild to moderate heart failure are able to live normal lives with lifestyle changes alone, which include:
- Quitting smoking
- Losing or maintaining (a healthy) weight
- Avoiding or limiting caffeine and alcohol
- Eating a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins
- Being physically active
- Managing/reducing stress
- Monitoring blood pressure
- Sleeping enough
- Monitoring cholesterol levels
Some people may need medications to help control CAD symptoms or contributing factors (such as high blood pressure). Medications can include blood thinners (for patients with atrial fibrillation), diuretics (to rid the body of excess water and sodium), cholesterol-lowering drugs (called statins), beta-blockers (which reduce the heart’s demand for oxygen by slowing heart rate), and others. Your cardiologist/cardiovascular surgeon will help you understand which, if any, medications may be necessary to help manage your symptoms.
Those with more advanced cases of CAD may require surgical interventions, some of which involve the implantation of a medical device. These procedures are explored below.
Percutaneous coronary intervention (PCI): Commonly called an angioplasty, this procedure involves inserting a thin, flexible tube on which a balloon is attached through a blood vessel into the narrowed or blocked artery. Once at the site of the blockage, the balloon is inflated, which compresses the plaque against the wall of the artery, restoring blood flow. The cardiovascular surgeon may also place a wire mesh device called a stent in the artery to help prevent future blockages.
Coronary artery bypass grafting (CABG): Known by most people simply as “heart bypass surgery,” CABG is a surgical procedure in which arteries or veins are taken from another part of the body and used to bypass a narrowed/blocked artery in the heart. The procedure can improve blood flow, relieve CAD symptoms, and help prevent a heart attack.
Implantable cardioverter-defibrillator (ICD): ICDs are devices that are surgically implanted in the chest to correct an irregular heartbeat (arrhythmias).
Valvuloplasty: A surgical procedure to open a stiff stenotic heart valve (pulmonary, tricuspid, mitral, or aortic); through a blood vessel in the groin, the surgeon threads a catheter into the heart, and then inflates a balloon to push open the valve.
Transcatheter aortic valve replacement (TAVR): A procedure to repair a damaged aortic valve without removing the old valve; the new valve is wedged in to replace the old valve. TAVR has several benefits, including reduced risk of dying, reduced risk of stroke, lower risk of bleeding during surgery, and faster recovery rate; this procedure is most appropriate for older patients who are sick or frail.
Heart valve replacement: A procedure to replace a defective or diseased heart valve with a new one made from human or animal tissue, plastic, or metal.
Left ventricular assist device (LVAD) implantation: This procedure involves implanting a battery-operated device that acts as a mechanical pump to help the heart pump blood out to the body.
Cardiac resynchronization therapy (CRT): This procedure involves implanting a small pacemaker in the chest, usually just below the collarbone. Wires on the device monitor the activity of the heart and emit electrical impulses to correct an arrhythmia. CRT therapy is most appropriate for patients with moderate to severe symptoms, and who have a particular type of irregular heartbeat.
You Only Have One Heart—Take Good Care of It
The heart is an amazing organ, working day and night to pump oxygen-rich blood around our bodies. The heart of someone who lives to be 80 years old will beat nearly 3.4 billion times! Even those who are at increased risk can take the proactive measures outlined earlier to help prevent or delay the onset of coronary artery disease.
The highly skilled, compassionate cardiologists at Cardiac & Vascular Consultants can help you understand your risk for coronary artery disease and develop a targeted plan of care tailored to your specific needs. Our board-certified heart doctors rank among the top 1% of cardiologists in Central Florida. Please call us at 352-633-1966 to schedule an appointment.