USF-COM
Department
of Family Medicine
Patient Education Information on...
Index of
Patient Education Topics
What is coronary artery disease?
Coronary artery disease is the single greatesk killer in the United
States. It refers to a grouping of heart disorders caused by atherosclerotic
plaques in the coronary vessels. This is a fancy way of saying that
it is a group of heart diseases caused by clogging the blood vessels that
bring oxygenated blood to the heart with plaques of cholesterol and other
body materials. When these vessels become clogged, blood and oxygen
cannot reach your beating heart. Now your heart, being the good soldier
that it is, will continue to beat as best it can. In the meantime,
it will also let you know that it is not receiving enough blood and oxygen
to do its job properly. This disease, if untreated can lead to both
stroke and heart failure.
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How does my heart let me know that it is not
getting enough blood?
The heart lets you know that it isn’t getting enough blood through the
symptoms that you feel. These symptoms include substernal chest pain
(aka pain underneath your breastbone) that can (but not always) move to
your jaw, left arm and shoulder, and shortness of breath. The pain
is usually characterized as pressure (ie. it feels like an elephant is
standing on your chest). If you feel these symptoms, you may be suffering
from ANGINA PECTORIS. Angina pectoris is a type of coronary artery
disease that occurs when the blood vessels serving your heart are partially
blocked. It is often brought on by exercise, and can be relieved
with a drug called Nitroglycerin. If this pain continues for a while,
and it is not more or less relieved by the nitroglycerin, you may be having
a MYOCARDIAL INFARCTION, more commonly known as a heart attack. If
this is the case, it is IMPERATIVE that you or your companion(s) seek out
immediate medical assistance.
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How can I avoid coronary artery disease?
The risk of getting coronary artery disease can be minimized by reducing
the number of cardiac risk factors that you have. The risk factors
for CAD are:
-
Poorly controlled diabetes mellitus
-
Hypertension (high blood pressure)
-
Cigarette smoking
-
High levels of blood cholesterol, high levels of LDL (bad cholesterol),
low levels of HDL (good cholesterol)
-
Male gender, and post-menopausal females without hormone replacement therapy
-
Family history of early death due to cardiac disease (under the age of
fifty)
Other factors which may contribute to coronary artery disease are a non-active
lifestyle without any regular exercise, and stressful personality types.
The best way to avoid CAD is to avoid or reduce the previously
mentioned risk factors. Some of the risk factors, such as family
history, cannot be avoided in some people, but others can. Diabetics
can help reduce their risk by keeping good control of their blood sugars,
and hypertensives can keep their blood pressure under control as well.
Also, you can avoid eating foods high in fat and cholesterol. Most
importantly, you can QUIT SMOKING, OR NEVER START!!
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How do doctors diagnose CAD?
The first step in diagnosis is the history and physical. Doctors
need to sit down with you, listen to the problems at hand, and then examine
you personally. Next, the doctor can get an electrocardiogram (EKG)
to see what the electrical rhythm of your heart is like. In all honesty,
an EKG will never support or deny a diagnosis of CAD, but it can show whether
or not any parts of the heart have lacked enough oxygen for long periods
of time. Areas like that are termed ISCHEMIC. Next, doctors
may ask you to take a cardiac stress test. This test involves getting
on a treadmill and exercising, while the doctor and his staff take another
EKG. This test directly helps to show whether or not the coronary
vessels have any blockage. Doctors can also do blood tests, and look
for specific enzymes in order to detect heart damage.
Cardiologists, or heart doctors, can do specialized invasive tests to
look for coronary artery blockade. Coronary angiography is a procedure
where the doctor injects dye into the coronary vessels with a needle and
takes real-time X-rays. This procedure produces very accurate pictures
of the coronary vessels in action, and can show both the presence and degree
of arterial blockage. Another procedure that allows visualization
of the heart is echocardiography. This technique involves the use
of sound to generate an accurate picture of the heart, and is often used
to rule out other causes of cardiac disease.
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How do doctors treat CAD, and what are the treatment
risks/side effects?
While it is the single largest killer in the United States, it is important
to realize that CAD is a VERY TREATABLE DISEASE WITH A NUMBER OF EFFECTIVE
TREATMENT OPTIONS. Coronary artery disease can be treated either
medically, surgically, or both. Most patients are started on medical
therapy first. The goal of this therapy is to keep CAD from progressing
into a heart attack. There are numerous drugs available to accomplish
this goal.
The first such drug is known as a beta-blocker. Basically,
this drug prevents your heart from getting too excited and working too
hard. By doing this, it decreases the oxygen consumption rate of
the myocardium (ie heart muscle), which in turn decreases the chance of
a heart attack. The major side effects of this medication include
dizziness and fatigue (10% of patients), depression (5% of patients), headaches,
nightmares, insomnia, and bronchospasm in people with lung disease. While
these are significant side effects, they do not always occur. Also,
nitroglycerin can be used to reduce the symptoms of CAD, and can also be
useful in preventing heart attacks. It accomplishes this by dilating
the arteries serving the heart. The major side effect of this medication
is headaches, which can often be severe.
A third medication used by physicians for prevention of heart attacks
is aspirin. By taking one aspirin every day, patients with
coronary artery disease can reduce their chances of a FATAL heart attack
by 50% (Veteran’s Administration Cooperative Study).
A class of drugs known as calcium-channel blockers can also be
used to treat CAD. These medications also work by dilating the arteries
serving the heart. These drugs, however, are known to cause constipation,
swelling in the arms and legs, and headache.
Occasionally, some patients require surgery in order to reduce
the blockage caused by CAD. Surgical procedures include: 1) Angioplasty;
This is a procedure where the cardiologist blows up a specialized balloon
in your coronary arteries to widen them. The major side effects of
this treatment are perforation of body structures, and infection, 2) Coronary
Artery Bypass and Graft (CABG); Here, a cardiothoracic surgeon opens
up the patient’s chest, removes the clogged areas of the coronary arteries,
and replaces them with parts of a vein that is removed from the patient’s
leg. Again, the major complications include perforation and infection.
CABG procedures are generally the last theraputic option offered to patients.
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Web sites for Coronary Artery Disease