What is Coronary Artery Disease?

Coronary artery disease (CAD), also known as ischemic heart disease, is a condition in which fatty plaque deposits narrow artery walls leading to the heart and reduce blood flow. When a clogged artery completely blocks blood flow, a heart attack occurs. Coronary artery disease is a result of coronary heart disease. More than 16 million Americans have coronary artery disease – the number one killer of people in the U.S.

Baptist Health is an accredited American Association Mission Lifeline Receiving Center, meaning patients being treated for coronary heart disease will benefit from the most advanced, superior care in the diagnosis, management and treatment of heart attacks. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost excellent care to those who trust us with their health.

Symptoms

Coronary artery disease (CAD) symptoms can include mild to severe chest pain (angina) or no pain at all. That’s why regular checkups are important. Ischemic heart disease symptoms can include:

• Pain in the chest or upper body that may last for hours or days 
• Pain in the left shoulder or between the shoulder blades
• Shortness of breath
• Weakness
• A cold sweat
• Tiredness
• Dizziness or lightheadedness
• Nausea

Causes

The causes of coronary artery disease causes include:

• Diabetes
• High blood pressure
• High cholesterol
• Obesity
• Stress
• Tobacco use

Risk Factors

Risk factors that can contribute to coronary artery disease include:

Age: Men over 50 with a family history of heart disease and women after menopause ends are particularly at risk for coronary artery disease.

Family history: People with a family history of heart disease are more likely to develop coronary heart disease.

Heart attack: A previous heart attack raises the risk of developing coronary artery disease.

Prevention

While risk factors like heredity cannot be controlled, there are ways you can help to prevent ischemic heart disease:

Practice good heart health: Watch what you eat, exercise and avoid smoking.

Take your medications as prescribed: If you have high blood pressure, high cholesterol or diabetes, be certain to take your prescribed medications as directed.

Regular check-ups with your provider: Regular check-ins with your provider can help you manage risk factors and causes of coronary artery disease.

Reduce stress: It's important to find healthy ways to manage and reduce your stress. If you need help managing your stress, a stress management program can help.

Diagnosis

We use advanced technology to diagnose, treat and carefully monitor coronary artery disease (CAD). 

• Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions such as coronary heart disease.
• Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages.
• Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
• Holter monitor: This portable EKG device continuously records the heart’s rhythms and is worn for 24 to 48 hours during normal activity.
• Radionuclide imaging (thallium stress test): This non-invasive procedure can identify if there is severe heart damage. A radioactive isotope is injected into a vein and a special camera or scanner records how it travels through the heart. Any heart damage can be plotted, locating the damaged area of the heart. This procedure can be done with an electrocardiogram, during both rest and exercise.
• Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.
• Echocardiogram (echo): An echo is a noninvasive procedure used to diagnose and monitor heart disease through ultrasound. There are 4 different types of echocardiograms and your doctor will recommend the best type for your condition.
• CT scan (CAT scan): CT scans allow your physician to create cross-sectional images across your body and can help physicians diagnose and monitor conditions, locate blood clots and more. Oral or IV contrast may be necessary for a CT scan.
• Angiogram: This procedure uses a dye to provide your doctor with pictures of your blood vessels to help pinpoint blockages in your arteries. An angiogram can help your doctor detect conditions before a major medical issue such a heart attack or stroke.

Treatment and Recovery

Treatment of coronary artery disease focuses on reducing symptoms and treating the underlying causes of the disease. An individualized treatment plan can include medications, lifestyle changes, medical procedures or surgery. Depending on age and how severe the condition is, treatment can include:

Lifestyle Changes

A few lifestyle changes can help with quality of life and improve coronary artery disease symptoms. Your physician can tailor a heart-healthy diet and daily exercise program for you to follow to reduce your risk of a heart attack.

Medication

Medications can be prescribed to improve cardiac function; treat symptoms like heart rate, high blood pressure and diabetes; and prevent complications of coronary artery disease. Medications can include:

• ACE inhibitors, calcium-channel blockers, beta blockers or diuretics to lower blood pressure.
• Aspirin to prevent blood clots.
• tPA or tenecteplase to dissolve blood clots.
• Statins to control or lower cholesterol and decrease the risk of stroke or another heart attack.

Surgery

Surgical treatment depends upon the severity of your coronary artery disease. Procedures can include:

• Angioplasty and stenting: During this procedure, a small balloon is inserted to widen narrowed or blocked blood vessels of the heart and improve blood flow. A vascular surgeon sometimes inserts a stent, a tiny metal mesh tube, to support artery walls and keep blood vessels wide open.
• Atherectomy: This procedure, similar to angioplasty, removes plaque that blocks arteries in order to improve blood flow to the heart. During this procedure, a thin tube (catheter) is inserted into a vein or artery via a small incision in the arm, neck or groin. The catheter is carefully threaded into the blocked artery. The tip of the catheter removes the plaque and collects it. When the catheter is removed, the plaque comes with it.
• Coronary artery bypass grafting (CABG): This surgery creates a bypass around the narrowed coronary arteries by grafting arteries or veins taken from other parts of the body to improve blood flow, stop chest pain and prevent a heart attack. 
• Laser angioplasty: A laser dissolves a blood clot that is blocking the blood flow of an artery.
• Percutaneous coronary intervention (PCI): This procedure, commonly known as coronary angioplasty, can open a blocked artery, improve blood flow and diminish chest pain. A stent, which is a small mesh tube, can be inserted to keep the artery open.

Recovery After Surgery

Depending upon your condition, you may have your procedure for coronary artery disease as an outpatient, or you could stay in the hospital for up to five days. It may be a few weeks or months until you feel able to fully resume your normal activities. Your physician will provide complete information about your recovery time and when you can become fully active again.

Follow-up Care After Surgery

Before leaving the hospital, your doctor will discuss your follow-up plan, which will probably include checkups at one month, six months, 12 months and annually thereafter. To reduce the risk of ischemic heart disease complications, it is important that you follow the health plan created for you after your procedure, which can include:

• Eat a diet low in fat, cholesterol and salt
• Get exercise daily
• Stop smoking
• Reduce stress
• Take any prescribed high blood pressure or diabetes medications as directed

Prognosis

The prognosis for coronary artery disease (ischemic heart disease) depends upon how early the condition and underlying causes are diagnosed and treated. A good prognosis can be expected when the heart has not been severely damaged and when the patient maintains a healthy lifestyle, takes prescribed medications as directed and seeks regular follow-up care.

Complications

Coronary artery disease complications can include: 

• Heart attack or stroke: If you have coronary artery disease, you may be at higher risk for developing a blood clot that may lead to a heart attack or stroke.
• Other heart problems: Coronary artery disease can lead to other heart problems, including abnormal heart rhythm and heart failure.
• Frequent hospitalizations: People with coronary artery disease are in the hospital more often.