Coronary Artery Disease

Coronary artery disease develops slowly, usually over a period of decades. Plaque, which is composed of fat, cholesterol, calcium and other substances, builds up on the artery walls over time. Coronary artery disease can be hereditary, or it can develop over time from a poor diet and lack of exercise. Eventually the flow of blood becomes severely restricted, causing shortness of breath and chest pain. When the artery becomes completely blocked, a heart attack can occur.

Symptoms can include: chest pain or pressure (angina), which feels as if someone is standing on your chest, shortness of breath or a heart attack. Symptoms of a heart attack typically include a crushing pressure on your chest, pain in your shoulder or arm and in women, nausea and back or jaw pain. However, a heart attack may occur without any symptoms at all in cases of coronary artery disease, especially when it is associated with diabetes.

Stenting

Stenting is often used in patients with coronary artery disease. Coronary angioplasty will reopen arteries that are narrowed or blocked by plaque so blood can continue to flow freely. A catheter is used to locate the narrowed passage or blockage. Once found, a small balloon is expanded to push the artery open. A wire mesh tube (a stent) is inserted into the coronary artery to keep it open. The stent can either be plain or contain a time-released drug that keeps the artery from becoming closed or blocked again.

Surgery

Surgical options depend on the patient’s health, symptoms and the results from diagnostic tests.

Catheter Assisted Procedures

Radiation Brachytherapy: If the stent procedure fails to keep the artery open, radiation brachytherapy may be used to discourage the region from redeveloping new blockages. The area is revisited using a catheter and a small, exacting dose of radiation is applied to the area to prohibit new blockages from reforming.

Atherectomy: A catheter is used to remove plaque from the walls of the artery. Once the catheter is inserted, various devices such as a rotating shaver or laser catheter shave and scrape the plaque off. A stent may also be used once the walls are cleaned.

Coronary Artery Bypass Surgery

Bypass surgery allows the surgeon to redirect the flow of blood around the blockage. A short piece of blood vessel is harvested from another part of the body and placed onto the affected artery beyond the blockage. Each blocked artery is bypassed individually, resulting in the familiar terms “triple bypass” or “quadruple bypass”, which signify the number of bypasses done during surgery.

Medical Management

Coronary artery disease is often treated with medications, either alone or in concert with other treatments. These can include:

Medications that lower your cholesterol, such as statins, niacin, fibrates and bile acid sequestrants, are used to decrease the formation of LDL forms of cholesterol, which contribute to plaque formation on the artery walls.

ACE inhibitors work much like beta-blockers, lowering blood pressure and making it easier for the heart to pump blood. They have also been shown to have benefits for patients recovering from a heart attack. ACE inhibitors include ramipril, lisinopril, enalapril and captopril.

Aspirin, or Plavix, which thins the blood and is an anti-coagulant as well, helps reduce the tendency of your blood to clot.

Beta-blockers help relax the heart and slow it down, decreasing blood pressure and lowering the heart’s demand for oxygen. Prescriptions include metoprolol, atenolol and propanolol.

Calcium channel blockers help reduce high blood pressure and increase the flow of blood to the heart muscle by opening the arteries.

Nitroglycerin (prescribed in tablet, spray or patch form) helps relieve chest pains by opening the blood vessels and improving blood flow to the heart. Nitrates can serve the same purpose, and are longer lasting.

Vitamins B-6, B-12 and folic acid can decrease the levels of homosysteine in the blood. Homosysteine which has been associated with an acceleration in the clogging of the arteries. Depending on the situation, your physician may also suggest Omega-3 fatty acids.