Coronary Artery Disease (CAD)

Many people with coronary artery disease have no symptoms since symptoms often do not occur until the blockage is 70% or greater.  However when they do occur, they can include:

• Chest pain or pressure, especially with exertion or activity.
• Pain in the neck, jaw, arms, shoulders, or upper back
• Shortness of breath
• Decreased exercise capacity
• Fainting

These warning symptoms should always be considered potentially serious and should be promptly reported to a doctor. We know that women often have different symptoms than men, often less pain and more shortness of breath.

Atherosclerosis is the cause of coronary artery disease, and the buildup of plaque progresses to varying degrees in many of the body's major arteries. 

Patients are at increased risk for developing coronary artery disease and stroke if they already have coronary heart disease or have a family history of heart disease or stroke.
Other factors that increase a person’s risk include:

• Smoking
• High cholesterol levels or lipid disorders - High levels of cholesterol in the blood can increase the risk of plaque buildup. 
• High blood pressure - Uncontrolled high blood pressure can result in hardening and thickening of the arteries, narrowing the channel through which blood can flow.
• Diabetes 
• Male gender
• Heart disease
• Advanced age
• Obesity and lack of exercise
• Alcohol and drug abuse

To diagnose carotid artery disease, the physician will first obtain a detailed description of the patient’s symptoms.
Blood pressure measurement in both arms is also an important part of evaluating carotid artery disease to detect possible narrowing in other branches of the blood vessels of the upper body.

Depending on the results of the patient’s history and findings from the physical exam, the physician may order the following tests:

• EKG
• Stress test (there are many different kinds)
• Echocardiogram – a sonogram to see the heart size and function.
• Calcium score (a CT scan to detect calcium build up in the heart arteries)
• Arteriogram – Also called angiogram, this test uses an injection of dye (contrast material) into an artery in combination with imaging techniques (x-ray, MRI or CT scan), resulting in detailed images that can show narrowing or blockages.

Medications

• Aspirin or other antiplatelet medicines can help prevent obstruction of the coronary arteries.
• Cholesterol-modifying medications such as statins, which helps lower the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol. 
• Beta-blockers are medications that reduce the work that the heart has to do and decrease stress on the heart.
• Nitrates cause enlargement of the coronary arteries so that blood can flow through them easier.

Coronary Interventions

Sometimes more aggressive treatment is needed to restore and improve blood flow to the heart. These option might include: 

• Angioplasty and Stenting - During this non-surgical procedure, a balloon attached to a small catheter is inflated within an artery to flatten the plaque against the artery wall, increasing the artery's diameter. In most cases, a stent, a metal-mesh tube, is expanded and left inside the artery to support the expansion and maintain blood flow.
• Bypass surgery- a surgical procedure where vessels from the chest wall or legs are used to create new routes for blood to go around blockages

Lifestyle Changes 

As with many cardiovascular conditions, lifestyle factors can contribute to coronary artery disease. The first step a patient should take is to modify any behavior that increases the risk for coronary artery disease. Some of these changes should include:

• Quitting smoking,
• Controlling high blood pressure,
• Lowering cholesterol,
• Exercising,
• Losing weight,
• Controlling diabetes, and 
• Reducing alcohol intake.