Coronary Artery Disease

To work properly, the heart must always have oxygen from the blood that flows through its chambers. Oxygen-rich blood is pumped into the heart muscle through the coronary arteries.

As a person ages, fatty deposits and scar tissue form plaque that clings to the inside of the arteries. This makes them narrower and lets less blood flow through. Without enough oxygen, the heart muscle becomes strained. This is especially so when a person is emotionally stressed or involved in physical activity.

In addition, blood clots sometimes form. They can become attached to the plaque deposits. This blocks the arteries bringing oxygen to the heart even more.

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Symptoms

Coronary artery disease can cause angina, heart attacks or sudden death.

Signs of disease include:

  • An indigestion-like sensation of heaviness, squeezing or burning in the chest or any portion of the upper left side of the body
  • Irregular or fast heartbeat
  • Difficulty breathing
  • Dizziness or nausea

Causes and Risk Factors

Coronary artery disease occurs in all races but is most frequent among whites.

Risk factors include smoking, a high-fat diet and an inactive lifestyle.

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Diagnosis

The following are commonly used to diagnose coronary artery disease:

  • A physical exam and extensive medical history
  • Electrocardiogram (EKG) at rest. The patient may be asked to wear a portable monitor for a day so that heart function can be tested during his or her normal routine.
  • Radionuclide imaging or stress test. Sometimes it is necessary to record an EKG during exercise (on a treadmill or bicycle). A radioisotope is injected during stress testing. This allows a special camera to take pictures showing the pattern of blood flow to parts of the heart.
  • Coronary angiogram and cardiac catheterization. In this test, a catheter is threaded to the opening of the coronary arteries from the groin. The catheter injects dye into the coronary arteries, allowing video that shows any blockages.
  • Electronic beam computed tomography (CT) scan
  • Cardiac magnetic resonance imaging (MRI)
  • Coronary calcium scan
  • Computed tomography (CT) angiography
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Treatments

Treatment of coronary artery disease starts with managing risk factors such as reducing cholesterol, controlling blood pressure, managing diabetes when present, achieving ideal weight, getting more exercise and quitting smoking.

The following may also be used:

Drug therapy, which can reduce or get rid of the risk of angina and heart attack.

Coronary artery bypass surgery. Veins taken from another part of the body are used to reroute blood around a blocked area.

Angioplasty. A long wire is threaded from the groin to the blocked area of the heart. A balloon attached to a catherter at the tip of the wire is inflated to clear and widen the clogged artery. In some cases, a stent (metal or plastic tube) is placed in the artery to make sure it stays open.

Brachytherapy. By applying radiation to the affected artery, arteries are prevented from narrowing again, which can happen even after a stent (a tube-like device) has been put in to help keep the artery open.