Coronary Artery Disease

Coronary artery disease, also known as coronary heart disease, is the leading cause of death in the United States. Though there is no cure, it’s often manageable through lifestyle changes such as a more healthful diet, regular exercise and quitting smoking.

Symptoms

Chest pain or tightness is often the first sign of coronary artery disease. This discomfort, known as angina, can spread to the jaw, neck, back, arms and other parts of the body. Pain often intensifies with physical activity or an emotional event. Rest or medication (nitroglycerin) usually relieves the pain.

Some people also experience:

  • Shortness of breath.
  • Fatigue.
  • Heartburn.
  • Indigestion.
  • Nausea.
  • Sweating.

A normal heart and coronary arteries:

HVI Coronary Arteries

Causes

When plaque accumulates in the wall of coronary arteries that bring blood and oxygen to the heart, these small blood vessels begin to narrow. The plaque buildup, which includes cholesterol and other substances, can eventually block blood flow to the heart.

If the heart muscle gets inadequate amounts of oxygenated blood, you might begin to feel the first signs of coronary artery disease. Beyond angina, the disease might weaken the heart enough to cause more serious conditions such as heart failure (when the heart loses its ability to pump blood efficiently) or an irregular heartbeat, also known as arrhythmia.

Diagnosis/Treatment

Some risk factors, such as family health history, are irreversible. But lifestyle changes can prove lifesaving when a healthful diet and exercise are combined with stress management. Excess weight, poor diet, a sedentary lifestyle and smoking each increases the risk of coronary heart disease. Your doctor will want to establish a baseline, measuring blood pressure, sugar levels and cholesterol.

Several tests can help diagnose coronary heart disease:

Electrocardiogram: A device that measures the heart’s electrical activity, its rate and regularity.

Echocardiogram: An ultrasound test that uses a transducer to send out high-frequency sound waves toward the heart. The device, when moved over the chest and abdomen, turns the echoes of sound waves redirected from various parts of the heart into detailed images of organs, blood flow and tissues.

Stress Test: A measure of your heart rate as you walk on a treadmill that tells doctors if your heart works properly when required to pump more blood.

Chest X-ray: A picture of the chest area, including the heart and lungs, captured by X-rays.

Coronary angiogram: A type of X-ray that determines, by detecting dye injected with a cardiac catheterization – a procedure that uses a long tube called a catheter placed in an artery or vein to reach through blood vessels to your heart – if your arteries are narrowed or blocked.

Holter Monitor: A portable device worn for two days that records the heart’s electrical activity, including heartbeats. A patient who feels symptoms while wearing the device can press a button that records heart rhythms at that time.

Lifestyle Changes

Start with a diet your heart will like. The National Heart, Lung and Blood Institute, part of the National Institutes of Health, says your doctor will likely recommend a diet that includes:

  • Fat-free or low-fat dairy products, such as fat-free milk.
  • Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week.
  • Fruits, such as apples, bananas, oranges, pears, and prunes.
  • Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans.
  • Vegetables, such as broccoli, cabbage, and carrots.
  • Whole grains, such as oatmeal, brown rice, and corn tortillas.

What to avoid:

  • A lot of red meat
  • Palm and coconut oils
  • Sugary foods and beverages
  • What makes your cholesterol levels rise:
  • Saturated Fat: Red meat is a primary source.
  • Trans fat, or trans fatty acids: Foods with hydrogenated oils and fats.

Check the labels on baked goods, crackers, stick margarine and other foods.

Your goal: Limit saturated fat to no more than 6 percent of your daily calories. A 2,000-calories-a-day diet should cap saturated fat at 13 grams.

Treatment

Aside from lifestyle changes, your doctor might prescribe medications for coronary heart disease or high (LDL) cholesterol or, if that fails, surgery.

Medications: Lipid-lowering statins are the only effective drugs against coronary artery disease. Regular use of aspirin, often the low-dosage baby type, can help lower the risks of both angina and a heart attack.

Medications are also available to lower your blood pressure and prevent blood clots that can lead to a heart attack or stroke. Calcium-channel blockers, which widen coronary arteries, lower blood pressure by increasing the blood supply to the heart. Beta blockers and ACE (angiotensin-converting enzyme) inhibitors also lower blood pressure.

Nitroglycerin, another drug that widens coronary arteries, is often prescribed to control chest pain.

Should you take statins?

Many physicians are reluctant to prescribe statins because of side effects that can include liver problems, muscle aches, memory loss and diabetes. But Dr. Paul Thompson, chief of cardiology and co-physician-in-chief of the Hartford HealthCare Heart & Vascular Institute, says such fears should not discourage anyone from taking statins.

Dr. Thompson, in an article in the Journal of the American Medical Association, cautioned that patients who take 80 percent of their statin dose have a 45 percent greater chance of dying than patients who take the prescribed dosage faithfully.

"Yet thousands of patients avoid these life-saving medications," he wrote, "because of the presence of, or concern about, possible statin-associated adverse effects."

Procedures

The Hartford Hospital Cardiac Catheterization Laboratory’s coronary angioplasty program is the largest in New England for treating coronary arteries that have been blocked completely for extended periods.

These chronic total occlusions, or CTO, typically did not respond to angioplasty.

Technological improvements, however, now make it possible to open blockages more efficiently at lower risk. Hartford Hospital’s doctors, led by program directors Dr. Jeffrey Hirst and Dr. Daniel Fram, have performed more than 200 procedures, called chronic total occlusion percutaneous coronary intervention, with close to 90 percent success. (National data shows a success rate between 40 percent and 50 percent.)

Dr. Daniel Fram explains the procedure that avoids open-heart surgery for patients with a blocked coronary artery:

Angioplasty, developed in 1977, remains an essential method to treat coronary artery disease when medications fail. It is not major surgery. Doctors use the technique to open blocked arteries, even replace them, by placing a catheter in the narrowed artery, inserting a deflated balloon and then inflating it. Once inflated, the balloon compacts fatty acids against artery walls. If needed, doctors can ensure the artery remains open by placing a stent, or mesh tubing, in the artery

 Other procedures:

Coronary thrombectomy: Used when a coronary blockage includes a blood clot, or thrombus. Thrombectomy catheters, equipped with a suction feature, remove the clot before a balloon angioplasty and stenting.

Coronary atherectomy: For blockages so hardened that neither a balloon nor a stent can expand fully during an angioplasty procedure. The drilling motion of devices like the rotational atherectomy catheter – this one has a diamond tip – breaks through extraordinarily dense plaque.

Hartford Hospital also uses newer technology, the Diamondback catheter, that features a brass burr embedded with diamond dust to cut through plaque buildup in an orbital motion.

Cutting balloon: The cutting theme continues with this device, which uses thin razor blades to slice through plaque and give your narrowed artery some needed elasticity to accommodate a stent.

A closer look at angioplasty: