Coronary Artery Disease

Coronary artery disease, or CAD, is currently the most common type of heart disease. It is the leading cause of death in the United States, currently affecting over 18 million adults and accounting for 2 out of every 10 deaths.

What is Coronary Artery Disease?

Coronary artery disease occurs when the coronary arteries become weakened or diseased with plaque buildup. As the plaque accumulates in the arteries, they can become narrowed and stiff, thus blocking healthy blood flow to the heart. Narrowed blood vessels are caused by atherosclerosis, a term for excessive plaque buildup within the walls of the blood vessels. Plaque is an unhealthy combination of fat, cholesterol, cellular waste, calcium, and proteins that cause blood clotting. Overtime, this plaque can harden, creating a blockage that hinders blood from traveling to the heart.

What are Coronary Arteries?

The coronary arteries supply blood to the heart to keep it pumping. The four main coronary arteries reside directly on top of the heart muscle. The small branches extend, diving into the heart muscle to provide it with blood. If any of these four coronary arteries are weakened or diseased with plaque buildup, CAD may ensue. 

The Signs & Symptoms of Coronary Artery Disease

The signs and symptoms of coronary artery disease can be extremely mild, or potentially life-threatening. For example, some patients may experience painful symptoms gradually, and others might not notice anything is wrong until they have a heart attack. This can make CAD difficult to diagnose and regulate. It is important to closely monitor the condition of your arteries. If a blood clot forms in one of the damaged coronary arteries and travels to the carotid arteries, it can lead to a stroke. Familiarizing yourself with common symptoms might help you to recognize the disease in its early stages.

Heart Attack
Angina (chest pain/discomfort)
Pain or Discomfort in the Arms, Neck, Back, or Jaw
Dizziness/Lightheadedness
Weakness
Cold Sweats
Indigestion or Heartburn

A heart attack is a dangerous side effect that can occur as a result of coronary artery disease. A heart attack is medical emergency and circulatory issue during which a blood clot blocks or significantly reduces blood flow to the heart. The coronary arteries give the heart oxygenated blood it needs to survive. The blockages that develop because of coronary artery disease make it impossible for the coronary arteries to do their job. A gradual process known as atherosclerosis (plaque accumulation in the arteries) narrows the arteries and makes them stiff. The plaque that builds up in the coronary arteries can eventually break apart. When this happens, blood clots form around these pieces of plaque, forming the arterial blockage that ultimately leads to a heart attack.   

Risk Factors Associated with Coronary Artery Disease

Coronary artery disease is one of the most common types of heart disease. Habitual lifestyle changes, such as a healthy diet and exercise, can help to combat this condition. However, some of these factors are inevitable, meaning patients should prioritize monitoring their CAD closely.

  • Smoking
  • Obesity
  • Sedentary Lifestyle
  • Diabetes
  • Insulin Resistance
  • High Blood Pressure
  • High Cholesterol
  • Old Age 
  • Family History of Atherosclerosis, Coronary Artery Disease, or Carotid Artery Disease

How is Coronary Artery Disease Diagnosed?

Diagnosing coronary artery disease as early as possible is extremely important. However, this can be difficult as some patients may not even know they have coronary artery disease until they have a heart attack. Regardless of symptom severity, treating coronary artery disease is crucial when maintaining heart health. Your doctor can diagnose coronary artery disease utilizing an array of tests and diagnostic methods

A Cardiac Catherization is a minimally invasive procedure that is done to see how well your heart is working. During this procedure, you can find out if you have coronary artery disease, aortic valve disease, and other types of heart conditions. Also known as cardiac or heart “cath,” during a cardiac catherization- a cardiothoracic surgeon uses a catheter and contrast dye to monitor and assess how blood is flowing through your arteries.

A Chest X-Ray is a diagnostic test that takes pictures of your heart. It helps your doctor to determine if there is any plaque accumulation in your coronary arteries, which is an indication of coronary artery disease. It also helps the doctor to assess any damage that has been done to your heart as a result of your diseased coronary arteries.

An Electrocardiogram (ECG or EKG) is another type of diagnostic test that can record the heart’s electrical activity. Using electrodes that are placed on your skin, an EKG can also detect abnormal heart rhythms and muscle stress.

An Echocardiogram (echo) is an ultrasound of the heart. The electronic sensors record soundwaves that produce a moving picture of both the heart and coronary arteries.

An Exercise Electrocardiogram (ECG or EKG) can be done to assess the heart’s response to stress. During the test, you will be asked to do some form of mildly strenuous exercise, such as walking on a treadmill or riding a stationary bike. While you are doing these exercises, an EKG will be recorded to compare how your heart is impacted by the varying levels of stress put on it.

A Cardiac MRI uses a combination of magnets, radiofrequency energy, and a computer to take detailed pictures of your heart. These pictures will allow your physician to get a closer look at how your coronary arteries are functioning. During a cardiac MRI, patients lie in a giant tube while magnets rotate around the body

Treating Coronary Artery Disease

If you have been diagnosed with coronary artery disease, executing a treatment plan is crucial. If left untreated, coronary artery disease can cause heart attack, stroke, and even death. Whether they recommend lifestyle changes, medication, or a surgical procedure- following the treatment plan formulated by your doctor can reduce your risk of complication and significantly improve your quality of life.

Certain habitual changes can be implemented at home that will combat the effects of coronary artery disease.

  • Quit Smoking: All nicotine products constrict the blood vessels. If you currently smoke and have coronary artery disease, quitting will help to strengthen your blood vessels.
  • Blood Glucose Maintenance: High blood sugar not only damages the arteries, but can also raise cholesterol levels, both of which can worsen coronary artery disease. Blood glucose can be controlled through low-sugar diets and regular exercise. If you are diabetic, insulin medication may be needed to keep blood sugar levels under control.
  • Blood Pressure Maintenance: Blood pressure levels that are consistently high can also damage arteries. Inflamed arteries increase one’s risk of developing coronary artery disease. To reduce the risk of hypertension, most people should aim to keep their blood pressure levels at or below 140/90.
  • Cholesterol Maintenance: Your body needs some cholesterol to digest food, build cells, and make hormones. However, if cholesterol levels are too high, it can damage the heart. Eating a healthy diet of lean meat, fruits, vegetables, and grains can help to keep cholesterol levels in check.

The following medications may be used to treat certain kinds of heart disease.

  • Antiplatelets: This type of medication makes the platelets in the blood less likely to bind together and cause blood clots. A few examples of antiplatelet medications may include Acetylsalicylic Acid (Aspirin), Clopidogrel (Plavix), Prasugrel (Effient), and Ticagrelor (Brilinta)
  • Cholesterol Maintenance Medication: Medications that lower cholesterol levels are also known as statins. Statins have been proven to help decrease the thickness of plaque around the arterial wall and increase the opening of the artery.
  • Blood Pressure Maintenance Medication: Blood pressure medicine works to keep levels under control by relaxing blood vessels, decreasing the force at which your heart beats, and blocking nerve activity that can cause blood vessels to restrict.
  • Nitroglycerin: These tablets can be taken to combat chest pain, or “angina,” in patients with coronary artery disease. This medication relaxes and widens the blood vessels that have been damaged and narrowed due to coronary artery disease. After the Nitroglycerin takes effect, blood can flow more easily through the coronary arteries again.

Sometimes, lifestyle changes and medication cannot effectively treat coronary artery disease on their own. In these cases, a doctor may recommend either a minimally invasive or surgical procedure to restore the diseased coronary arteries.

  • Coronary Artery Bypass Grafting: Also known as CABG, coronary artery bypass grafting is a surgical procedure used to treat severe coronary artery disease. During this procedure, a cardiothoracic surgeon will take a blood vessel from another part of the body, usually the legs or wrist, to attach to the coronary artery, creating a new blood vessel for blood to flow through. The new blood vessel will “bypass” the blocked coronary artery. Coronary artery bypass grafting improves blood flow to the heart by rerouting oxygenated blood around arterial blockages.
  • Stenting: Years of plaque buildup can cause damage to the walls of the artery. Stents are wiry, mesh tubes that can be placed within the artery. They act as an internal support system for the damaged walls. This will prevent the arteries from closing after the plaque is removed. Stents can also be coated with medicines to help prevent future plaque buildup.
  • Angioplasty: During this procedure, a small catheter is inserted into the artery to restore blood flow. Once in the artery, a small balloon is inflated at the tip of the catheter. The balloon pushes the plaque against the artery wall. The pressure created by the balloon widens the narrowed arteries, allowing for optimal blood flow throughout the once diseased artery.
  • Atherectomy: This is a minimally invasive procedure that uses a catheter (a small, thin tube) to gently remove plaque stuck in your arteries. While under local anesthesia, a small incision is made so the catheter can be easily inserted. During the procedure, the catheter gently removes the plaque out from the small chamber at its tip. After the plaque is collected, optimal blood flow returns to the arteries.

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Why Monterey Bay Vascular?

At Monterey Bay Vascular, we provide individualized arterial treatment options that help in minimizing pain, curing sores, and prevent limb amputation. Our main goal is to stop the disease progression and improve your quality of life. Our patient care does not stop after you walk out of our facility. We schedule follow-up appointments that help us to evaluate your results and recovery. Our team will also provide you with answers to your concerns or questions after every appointment, diagnostic test, and medical procedure. We strive to offer all our patients the best possible results so you can get back to doing the things you love as quickly as possible.