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Coronary Artery Disease (CAD)
(Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)

Definition:
Coronary artery disease (CAD) is blockage of the arteries that feed the heart muscle. If the blockage is complete, areas of the heart muscle may be damaged and/or die from lack of oxygen. This can lead to a heart attack, otherwise known as a myocardial infarction.

Coronary artery disease is the most common form of heart disease and is the leading cause of death in the United States and worldwide.

Causes:
Causes include:
  • Thickening of the walls of the arteries feeding the heart muscle
  • Accumulation of fatty plaques within the coronary arteries
  • Sudden spasm of a coronary artery
  • Narrowing of the coronary arteries
  • Inflammation within the coronary arteries
  • Development of a blood clot within the coronary arteries that blocks blood flow
    • Clot formation at the site of a narrowed artery (rather than progressive arterial narrowing to the point of blockage) is the precipitating cause of CAD events.
  • There has also been debate about the role of infection ( by Chlamydia pneumoniae) in causing CAD. But trials of antibiotics targeting this infection showed no evidence of an effect on CAD.
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

Major Risk Factors:

  • Sex: Male (men have a greater risk of heart attack than women)
  • Age: 45 and older for men; 55 and older for women
  • Heredity: strong family history of heart disease
  • Obesity and being overweight
  • Smoking
  • High blood pressure
  • Sedentary lifestyle
  • High blood cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
  • Diabetes

Other Risk Factors:

  • Stress
  • Excessive alcohol use
  • Metabolic syndrome: combination of high blood pressure, abdominal obesity, and insulin resistance
Symptoms:
CAD may progress without any noticeable symptoms.

Symptoms include:
  • Angina–intermittent chest pain that often has a squeezing or pressure-like quality, that may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes, and is often relieved with rest. Angina can be triggered by:
    • Exercise or exertion
    • Emotional stress
    • Cold weather
    • A large meal

If angina is unrelieved by rest or nitroglycerin, is severe, begins at rest (with no activity), or lasts more than 15 minutes, these are warning signs of unstable angina or a heart attack. Accompanying symptoms may include:

  • Shortness of breath
  • Sweating
  • Nausea
  • Weakness

Immediate medical attention is needed for unstable angina.

Diagnosis:
If you go to the emergency room with chest pain, some tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done more electively to determine the severity and extent of your disease and to create a treatment plan.

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

Blood Tests–to look for certain substances in the blood; helps the doctor determine if you are having angina or an acute heart attack

Electrocardiogram (ECG, EKG)–records the heart's activity by measuring electrical currents through the heart muscle; can reveal evidence of past heart attacks, acute heart attacks, and heart rhythm problems

Echocardiogram–uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart; gives information about the structure and function of the heart

Exercise Stress Test–records the heart's electrical activity during increased physical activity

Thallium Stress Test–thallium is used to scan the myocardium, the muscle layer of the heart

Nuclear Scanning–radioactive material is injected into a vein and observed as it is absorbed by the heart muscle

Electron-beam CT Scan–a type of x-ray that uses a computer to make pictures of the inside of the heart

Coronary Angiography–x-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities in the arteries

Treatment:
Treatment may include:

Nitrate Medications
Nitroglycerin is usually given during an acute attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. There are also longer-lasting types that can be used to prevent angina before you participate in an activity known to cause it. These may be given as pills or applied as patches or ointments.

Blood-thinning Medications
A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily. Warfarin (Coumadin), ticlopidine (Ticlid), and clopidogrel (Plavix) are also used for some patients. Beta-blockers, Calcium-channel Blockers, and ACE-inhibitors

These may help prevent angina and, in some cases, lower the risk of heart attack.

Cholesterol-lowering Medications

May prevent the progression of coronary artery disease, and may even improve existing coronary artery disease.

Evidence shows that lowering cholesterol has a positive effect on prevention of CAD events.

Surgery
Patients with severe blockages in their coronary arteries may benefit from:
  • Coronary bypass graft
  • Atherectomy
  • Coronary angioplasty with or without stenting
Prevention:
To reduce your risk of getting coronary artery disease:
  • Maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, quit.
  • Eat a healthful diet, low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Treat your high blood pressure and/or diabetes.
  • Treat high cholesterol or triglycerides.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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