Coronary Artery Disease

What is coronary artery disease?

• Coronary artery disease is also called CAD. It is when the arteries in your heart narrow or become blocked. CAD may cause angina (chest pain), a heart attack, or congestive heart failure. CAD is one of the leading causes of death in the United States.
  
  

What are the causes of coronary artery disease?

• CAD is caused by cholesterol (fatty deposits) and cells that cause inflammation. These collect inside your artery (blood vessels) walls and cause plaque to form. Oxygen cannot get to your heart muscle when your arteries get narrow or blocked. When a part of your heart muscle does not get oxygen, you may have chest discomfort or pain. The discomfort or pain causes you to slow down or stop. When the blood begins flowing through the artery again, the discomfort and pain go away.
  
  
• Risk factors for developing CAD include smoking, high blood pressure, high cholesterol, and diabetes. Eating unhealthy foods, being overweight, not exercising, and having a family history of heart disease may also increase your risk.

What are the signs and symptoms of coronary artery disease?

You may not have any symptoms of CAD until the blocked artery gets too narrow. The most common symptom of CAD is chest pain, also called angina pectoris. This is caused by your heart not getting enough blood flow to deliver oxygen to the heart muscle. The pain is usually caused by a blockage or spasm of the heart arteries. You could have a heart attack if the angina is not treated. Sometimes the first symptom of CAD is a heart attack. You may have stable or unstable angina.

• Stable angina:
  
  
  • The most common symptom of stable angina is chest pain. The pain may start below the breast bone. It may feel crushing, tight, or heavy. It may move to the neck, jaw, shoulders, back, or inner arms. You may have pain under the breast bone that feels like indigestion (burning). The pain often starts slowly and may only last a few minutes.
    
    
  • Stable angina may be triggered by cold air or getting upset. Physical activity like walking or shoveling snow may also cause pain. Angina may feel different to each person. Rest or medicine usually makes stable angina go away.
  
  
• Unstable angina: Unstable angina is chest pain that begins to occur more often, or occurs with less activity than it had in the past. Unstable angina starts while you are resting or exercising. After resting you may still have pain. Unstable angina is a warning sign that a heart attack may occur.

How is coronary artery disease diagnosed?

You may need to go into the hospital for tests and treatment. Caregivers may do tests to see if you have plaque build-up blocking the arteries in your heart. Tests may include:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Exercise stress test: This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing.
  
  
• Exercise stress test with imaging: A stress test may be combined with an echocardiogram (ECHO) or nuclear isotope imaging.
  
  
• Stress test with medicine: If you cannot walk or exercise, you may be given medicine that causes your heart to work harder. You will be connected to the stress test machine. The medicine stresses the heart and is combined with the echocardiogram or nuclear isotope imaging.

How is coronary artery disease treated?

You may need to take heart medicine, lose weight, make diet changes, and begin exercising. If these changes do not help or if the stress tests show the arteries in your heart are badly blocked, you may need a procedure to look at the coronary arteries. A procedure called cardiac catheterization (heart cath) with angioplasty and stent may be done to open the artery.

• Cardiac catheterization: This is a procedure done to find the cause of and treat a heart condition. A thin, bendable tube inserted into an arm, neck, or groin vein is moved into your heart. Your caregiver may use an x-ray to guide the tube to the right place. Dye (contrast) may be put into your vein so the pictures show up better on a monitor. If blocked arteries are found, the treatments include:
  
  
  • Angioplasty: A percutaneous coronary angioplasty (PTCA) or angioplasty may be done to open an artery blocked by plaque. Plaque is fatty material inside your arteries. A special tube with a balloon on the end is threaded into the blocked artery. Once the tube is in the artery, the balloon is filled with contrast dye. As the balloon fills, it presses the plaque against the artery wall. Pressing the plaque against the artery wall opens the artery so blood can flow through it more easily.
    
    
  • Coronary intravascular stent placement: Coronary intravascular stent placement is also called coronary artery stenting. It is often done with percutaneous transluminal coronary angioplasty or PTCA. The stent is a small mesh wire that is inserted into an artery to keep it open so blood can flow through it. When the stent is expanded by the balloon, it attaches to the artery wall and keeps the artery open.
  
  
• Cardiac rehabilitation: Cardiac rehabilitation includes information about cardiac disease, medicines, and lifestyle changes that may be necessary. It also includes exercise programs which may be done in a rehabilitation center or at home. **(Is the new language only for DC/AC, or for GI as well?)**
  
  
• Coronary artery bypass surgery: Coronary artery bypass surgery (CABG) is open heart surgery. A CABG is usually done because one or more of the arteries on your heart are blocked.

What medicines are used to treat coronary artery disease?

Your medicines may include the following:

• ACE inhibitors: ACE Inhibitors are medicines that keep your blood vessels relaxed and open. This helps keep oxygen-rich blood flowing into your heart. These medicines may be used to treat high blood pressure.
  
  
• Anti-platelet medicines: Anti-platelet medicines, such as aspirin, keep platelets from sticking to a damaged part of your artery. Platelets are a part of your blood that come together to heal injury. They may cause a blockage in your artery and keep blood from going to your heart.
  
  
• Beta blockers: Beta blockers keep your heart pumping strongly and regularly. This helps to keep the heart from having to work so hard to get oxygen.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Blood thinners: This medicine keeps clots from forming in the blood. Clots may cause heart attacks, strokes, or death.
  
  
• Cholesterol lowering medicines: These medicines help lower high blood cholesterol levels.
  
  
• Clot busters: This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.
  
  
• Hypoglycemic medicine: This medicine may be given to decrease the amount of sugar in your blood. Hypoglycemic medicine helps your body move the sugar to your cells, where it is needed for energy.
  
  
• Nitroglycerin: Nitroglycerin relaxes the arteries of your heart so the heart gets more oxygen. Nitroglycerin may help to relieve your chest pain.

What life style changes should I make?

• If you smoke, you should quit. Ask your caregiver for help stopping smoking.
  
  
• Exercise when your caregiver says it is OK. Ask your caregiver about what kind of exercise you should do and how to get started.
  
  
• Eat foods that are low in fat and salt. You should also eat high fiber (roughage) and high nutrient foods, such as fruit, vegetables, and whole grains. Instead of fatty meats, eat more fish, chicken (without skin), and soy products. Avoid eating too much junk food, foods that are fried or cooked in butter, and highly salted food. Talk to your caregiver about taking vitamins or over-the-counter medicines.
  
  
• If you are overweight, talk to your caregiver about how to lose weight.
  
  
• You will receive medicine if you have high blood pressure. Do not miss any doses of your medicine. Talk to your caregiver if you think you are having side effects from your medicines.
  
  
• You will also need to take medicine if you have diabetes. Do not miss any doses of your medicine.
  
  
• If you abuse alcohol (drink too much or too often) stop drinking. Binge drinking (drinking a lot at one time) or regularly drinking three or more drinks daily can damage the heart and blood vessels. Stop drinking if you have an alcohol problem. Ask your caregiver if it would be safe for you to drink alcohol.
  
  
• Join a support group, or see a therapist or counselor to get help for personal problems or for help managing stress.

Where can I find support and more information?

You may feel scared, confused, and anxious because of your CAD. You may blame yourself and think you have done something wrong. These feelings are normal. Talk about them with your caregiver or with someone close to you. Contact the following for more information about CAD and heart disease:

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

• American College of Cardiology
  Heart House
  2400 North Street Northwest
  Washington , DC 20037
  Phone: 1- 202 - 375-6000
  Web Address: http://www.acc.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Coronary Artery Disease