Coronary Artery Disease

Coronary artery disease (CAD), also known as coronary heart disease, ischemic heart disease or coronary microvascular disease, is the most common form of heart disease in the United States and is the number one killer of men and women in this country.

If you have symptoms like chest pain and shortness of breath, you should seek medical attention. Early diagnosis is important for diagnosing and managing coronary artery disease.

What is Coronary Artery Disease?

CAD refers to the narrowing of coronary arteries which restricts the flow of blood to the heart muscle. Affected arteries can be partially narrowed or completely blocked, depending on the severity of the disease.

Coronary artery disease usually results from atherosclerosis, which is the buildup of fat and cholesterol inside the arteries (plaque). Without the proper amount of blood flow, the heart cannot function effectively which can lead to symptoms like chest pain and shortness of breath. With severe narrowing/blockage, a heart attack will occur.

There are three types of coronary artery disease. It is possible to have more than one type at the same time.

Obstructive coronary artery disease

An obstructive condition occurs when the coronary arteries have greater than 50 percent blockage. Left untreated, obstructive CAD could lead to complete blockage.

Non-obstructive coronary artery disease

This type of CAD is less severe than obstructive coronary artery disease. With the non-obstructive type of CAD, the arteries are narrowed by a thickening of plaque, but they are less than 50 percent blocked.

Coronary microvascular disease

This type of CAD affects the small blood vessels in the heart muscle, rather than the large arteries. Plaque develops in the tiny blood vessels in the same way it does in the arteries.

Coronary artery disease develops slowly, over many years. The disease develops when fatty deposits, called plaque, build up in the coronary arteries which supply oxygen-rich blood to the heart. This accumulation of plaque thickens and narrows the arteries, decreasing or blocking the flow of blood to the heart. The process of plaque building up in the arteries is called atherosclerosis.

If you have any of the following risk factors, you are at a greater risk of developing coronary artery disease:

• Family history of heart disease
• High blood pressure
• High cholesterol
• Diabetes
• Sedentary lifestyle
• Obesity
• Smoking
• Stress

Unfortunately, sometimes the first sign of coronary artery disease is a heart attack.

The disease develops over time, and many people do not experience symptoms until after age 50. Reduced blood flow to the heart can cause chest pain or pressure, which is called angina and is the most common symptom. Angina does not always feel like acute pain. It is sometimes described as chest heaviness, fullness or achiness. It can also be felt in the shoulders, arms or back.

In addition to angina, you may experience the following as symptoms of coronary artery disease, especially with exertion:

• Shortness of breath
• Rapid or irregular heartbeat
• Dizziness
• Nausea
• Extreme weakness or fatigue
• Sweating or clammy feeling

If your physician suspects coronary artery disease, they may perform a physical exam, order blood work, and recommend additional tests to make a diagnosis. Coronary artery disease may be suspected due to symptoms, risk factors or a combination of both.

The skilled practitioners at Memorial Hermann utilize cutting-edge technology to perform these tests to diagnose a wide range of conditions:

• Angiogram (cardiac catheterization)
• Cardiac calcium scoring
• Cardiac CT
• Cardiac MRI
• Electrocardiogram (ECG or EKG)
  • Resting ECG
  • Stress ECG
• Echocardiogram
  • Transthoracic echocardiogram (TTE)
  • Transesophageal echocardiogram (TEE)
  • Dobutamine echocardiogram
  • Stress echocardiogram
• Nuclear Medicine scan
• PET scan

Your treatment plan will be created to address your specific needs and the severity of your disease.

Lifestyle Changes

Making healthy choices can have a significant impact on your heart health. You can greatly reduce your risk of a heart attack and of developing more severe heart disease by taking these steps:

• Eat a healthy diet with lean protein and plenty of fruits and vegetables
• Increase your physical activity and stay active every day. Aim for at least 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous aerobic activity (or a combination of both) each week.
• Maintain a healthy weight
• Stop using tobacco, including smoking, chewing and dipping.

Medication

Your physician may recommend taking medications help control risk factors for coronary artery disease. These could include medications to treat and control cholesterol level or blood pressure, diabetes, or to regulate your heartbeat.

Procedures

Minimally invasive procedures like percutaneous coronary intervention (angioplasty), with or without stent placement, or atherectomy can open narrowed or clogged arteries caused by atherosclerosis.

Surgery

If you are taking medications and controlling your risk factors, but your coronary artery disease is extensive, you may need surgery. Bypass surgery is not a therapy option to substitute for sticking with a healthy lifestyle and taking prescribed medications. Coronary artery bypass surgery (open heart surgery) takes a blood vessel from elsewhere in your body and uses it to bypass the blocked part of the coronary artery. This reroutes blood flow around the diseased portion of the artery so it can reach the heart muscle.

Memorial Hermann-affiliated heart and vascular specialists are committed to using a multidisciplinary approach to provide exceptional care. Our highly skilled practitioners utilize leading-edge technology to diagnose and treat cardiovascular concerns.

To learn more about coronary artery disease or to evaluate your risk factors, visit Find a Doctor to schedule an appointment with an affiliated Memorial Hermann Heart and Vascular physician.