Coronary Artery Disease (CAD)

Most people with coronary artery disease have no symptoms until the blockage is 70% or greater, and CAD's symptoms are typically worse with exertion.  They can include:

• Chest pain, usually described as pressure or tightness
• Similar pressure or tightness can be felt in the neck, jaw, arms, shoulders, or upper back
• Shortness of breath
• Decreased exercise capacity
• Fainting
• Women often have different symptoms than men, often less pain and more shortness of breath.

These warning symptoms should always be considered potentially serious and should be promptly evaluated, as emergency care may be needed. 

Atherosclerosis is the cause of coronary artery disease, and it is due to both cholesterol and inflammation. It is caused by plaque that gradually builds up in arteries over time, causing arteries to narrow and reduce blood flow. The buildup of plaque progresses to varying degrees in many of the body's major arteries. Plaque is composed of a variety of substances including cholesterol, calcium, and inflamed cells. When plaque ruptures, it releases these substances into the bloodstream, which leads to the formation of a blood clot inside the artery which can result in a heart attack. 

Factors that increase a person’s risk include:

• Smoking
• Hyperlipidemia or lipid disorders- high levels of cholesterol in the blood can increase the risk of plaque buildup. 
• High blood pressure (hypertension) - Uncontrolled high blood pressure can result in hardening and thickening of the arteries
• Diabetes 
• Family history of CAD, especially in the 1st degree relatives under the age of 65
• Male gender
• Advanced age
• Obesity and lack of exercise
• Alcohol and drug abuse

In addition to taking a detailed medical history, listening to the patient describe symptoms, and conducting a physical exam, the healthcare provider may also recommend. 

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

• EKG
• Stress testing to evaluate blood flow to the heart at rest and under stress. There are many different kinds (ETT, stress echocardiogram, exercise MPI study, Lexiscan MPI study, Cardiac PET-CT)     
• Echocardiogram – a painless, non-invasive study that uses ultrasound waves to evaluate heart structure and function in real time. 
• Calcium score (a CT scan to detect calcium build up in the heart arteries)
• Coronary CTA- contrast material is injected in an IV, then a CT is performed, resulted in more detailed images that can help measure degree of narrowing or blockages
• Cardiac catheterization

Medications

• Aspirin or other antiplatelet medicines can help prevent obstruction of the coronary arteries.
• Cholesterol medication to help lower the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol. 
• Beta-blockers reduce blood pressure and the heart rate to decrease the work that the heart has to do and decrease stress on the heart.
• Nitrates relax 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. This may 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- an "open heart surgery" 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.

People with CAD do not need to take antibiotics for the dentist, regardless of prior stenting or bypass procedures.