Treatment for Coronary Artery Disease (CAD) -- 718.780.7830

What is Coronary Artery Disease?

Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become hardened and narrowed. The arteries harden and narrow due to buildup of a material called plaque on their inner walls. The buildup of plaque is known as “atherosclerosis”. As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them. Eventually, blood flow to the heart muscle is reduced, and, because blood carries much-needed oxygen, the heart muscle is not able to receive the amount of oxygen it needs. Reduced or cutoff blood flow and oxygen supply to the heart muscle can lead to:

• Angina: Angina is chest pain or discomfort that occurs when the heart does not get enough blood.
• Heart Attack: A heart attack happens when a blood clot develops at the site of plaque in a coronary artery and suddenly cuts off most or all blood supply to that part of the heart muscle. Cells in the heart muscle begin to die if they do not receive enough oxygen-rich blood. This can cause permanent damage to the heart muscle.

Over time, CAD can weaken the heart muscle and contribute to:

• Heart Failure:  In heart failure, the heart can’t pump blood effectively to the rest of the body. Heart failure does not mean that the heart has stopped or is about to stop. Instead, it means that the heart is failing to pump blood the way that it should.
• Arrhythmias: (abnormal heart beats). Arrhythmias are changes in the normal beating rhythm of the heart. Some can be quite serious.

CAD is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

How Is CAD Diagnosed?

There is no single test to diagnose coronary artery disease (CAD). Your NYM doctor will ask about your medical history and your family’s medical history, assess your risk factors, and do a physical exam and several tests.

Based on the results of these procedures, your doctor may order one or more of the following tests:

• EKG (electrocardiogram): This test measures the rate and regularity of your heartbeat.
• Echocardiogram: This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow.
• There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart.
• Stress Test: Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed.
• During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.
• If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done.
• During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle.
• Your doctor also may order newer tests along with stress testing if more information is needed about how well your heart works. One new test is magnetic resonance imaging (MRI). Cardiac MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged.
• Chest x ray: A chest x ray takes a picture of the organs and structures inside the chest. These include the heart, lungs, and blood vessels.
• Cardiac catheterization: A thin, flexible tube is passed through an artery in the groin or arm to reach the coronary arteries. The tube allows your doctor to examine the inside of your arteries to see if there is any blockage. Your doctor also can determine the pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x ray.
• Coronary angiography:  This test is usually performed along with cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. The doctor can see the flow of blood through the heart and the location of blockages.
• Nuclear heart scan: This test provides your doctor with moving pictures of the blood passing through your heart's chambers and arteries and shows the level of blood flood to the heart muscle. A small amount of a radioactive tracer is injected into your bloodstream through a vein, usually in your arm. A special camera is placed in front of your chest to show where the tracer lights up in healthy heart muscle and where it doesn't light up (in heart muscle that has been damaged or has a blocked artery).
• There are different types of nuclear heart scans. Most scans have two phases—taking pictures of the heart at rest and while it is beating faster (called a stress test), although sometimes only a rest scan is done. Many heart problems show up more clearly when your heart is stressed than when it is at rest. By comparing the nuclear heart scan of your heart at rest to your heart at "stress," your doctor can determine if your heart is functioning normally or not.

How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines, and special procedures. These include:

• Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy weight
• Quit smoking
• Exercise, as directed by your doctor
• Lose weight, if you are overweight or obese
• Reduce stress
• If prescribed, take medications ordered by your doctor

If medicines and lifestyle changes have not improved your symptoms or your symptoms get worse, you may need to see a NYM doctor about two special procedures: 

• Percutaneous Coronary Procedures: Angioplasty and Stenting. Angioplasty opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a device called a stent is placed in the artery to keep the artery propped open after the procedure.
• Coronary artery bypass surgery: In this procedure arteries or veins from other areas in your body are used to bypass your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

Some people may need to have angioplasty or bypass surgery on an emergency basis during a heart attack to limit damage to the heart.

For more information, call 718.780.7830.