Coronary Disease
What Is Coronary Artery Disease?
Coronary artery disease (CAD) occurs when the blood vessels that bring blood to the heart - the coronary arteries - thicken and narrow. When this occurs, the oxygen-rich blood supplied to the heart slows down or completely stops. This can cause chest pains (known as angina) as well as a heart attack.
Coronary artery disease is the leading cause of death in the United States, and people with diabetes face an even greater risk of CAD. Over time, it can weaken the heart muscle and lead to heart failure or irregular heart rhythms (called arrhythmias) which can sometimes be quite serious.
What Is Angina?
When your heart doesn't get the blood it needs, you feel chest pain called angina. The pain, which can be sharp and fleeting, often occurs under the breastbone and may feel like pressure or a squeezing-type pain. For some people, it feels like heartburn. For others, it feels like pain in the back, arm, or even the abdomen. Rest or nitroglycerin can often relieve the symptoms, which usually last only a minute or two.
The most common type of angina, called stable angina, can stem from emotional situations or exercise. With stable angina, you'll probably learn to predict when it might occur, even after just a few episodes.
In some people with diabetes, episodes of low - or high - blood sugar may bring on angina.
What Is a Heart Attack?
Sometimes enough plaque builds up in a coronary artery that a blood clot develops. The clot can quickly cut off all, or most, of the heart's blood supply, resulting in a heart attack.
Warning signs of a heart attack may include:
- Severe chest pain that lasts several minutes (as opposed to the one- to two-minute angina pain). However, this pain might stop and start and might feel like fullness, squeezing, or pressure — even heartburn.
- Shortness of breath. This may accompany chest discomfort, or it may occur before the pain begins.
- Feeling of discomfort in the upper body, including arms, back, stomach, neck, and/or jaw.
- Nausea and vomiting.
- Dizziness or light-headedness.
- Breaking out in a cold sweat.
If you suspect you're having a heart attack, call emergency help immediately. Early treatment can minimize the damage to your heart and prolong your life.
What Causes Coronary Artery Disease?
Most often, coronary artery disease results from the build-up of fatty material and plaque, also called atherosclerosis.
Risk factors that you can somewhat control include:
- Diabetes (type 2)
- High LDL (bad) cholesterol level
- Low HDL (good) cholesterol level (high HDL decreases the risk)
- Smoking
- High blood pressure
- Lack of exercise
- Obesity
- High homocysteine levels in the blood
Risk factors that you cannot control include:
- Family history of CAD (especially before age 50)
- Ethnicity (African American or Asian Indian)
- Gender (male)
- Diabetes (Type 1)
- Age (65+ years old)
- Post-menopause or experiencing menopause
- Inflammation in the artery caused by infection
How Do You Know If You Have Coronary Artery Disease?
Many people don't know they have coronary artery disease until chest pain hits. In fact, for people with diabetes, ischemia (or cramping of the heart) and heart attacks can occur without any warning signs.
Because coronary artery disease often lacks warning signs, prevention plays a critical role.
How Can You Prevent Coronary Artery Disease?
You can help minimize the amount of plaque that builds up in your arteries by making a few lifestyle changes.
- Keep your blood sugar, blood pressure, and cholesterol levels as close to normal as possible.
- Don't smoke.
- Lose weight.
- Develop - and follow - and exercise plan. (Talk with your doctor first.)
- Eat a heart-healthy diet low in salt and saturated fat.
Also, if your doctor has prescribed medication, make sure you take it as directed.
How Can You Treat Coronary Artery Disease?
A number of therapies exist to treat coronary artery disease, including drug therapy, percutaneous intervention, and surgery.
Drug Therapy
To manage your coronary artery disease, your doctor might prescribe a variety of drugs designed to make your heart work better and keep your cholesterol and blood pressure down.
These medications may include:
- ACE inhibitors that can help reduce how much blood flows from the heart, thus reducing blood pressure, such as Accupril®, Capoten®, Monopril®, Zestril®, and others.
- Beta-blockers to decrease your heart rate and reduce how much oxygen your heart uses, such as Coreg®, Lopressor®, Toprol-XL®, and many others.
- Blood thinning drugs (antithrombin drugs) or antiplatet drugs like aspirin to reduce the risk of blood clots.
- Calcium-channel blockers that can increase blood flow to the heart and control high blood pressure, such as verapamil, diltiazem, and nifedipine.
- Statins, which can help lower cholesterol, such as Lipitor®, Crestor®, Ranexa®, and others.
- Nitrates such as nitroglycerin to improve blood supply to the heart.
A note about cholesterol lowering drugs: Some statins have recently made headlines because of serious adverse affects, even death. However, the American College of Cardiology and the American Heart Association maintain that, for most people, the drugs remain safe and effective. If you have concerns, talk with your prescriber.
Current studies are looking into drugs that might even reverse the damage caused by coronary artery disease.
Percutaneous Coronary Interventions (PCIs)
PCIs refer to a group of minimally invasive surgical techniques where doctors can reach the heart via a major blood vessel rather than cutting open the chest.
PCIs include:
- Ablative laser-assisted angioplasty: a laser dissolves and removes the plaque that blocks the artery.
- Angioplasty: a balloon-tipped hollow tube threads through a blood vessel to the heart; doctors then inflate the balloon, causing the artery to expand.
- Stents: tube-shaped devices get placed into an artery to help keep it open (may or may not be used with angioplasty).
- Atherectomy: a rotating cutting blade threads through the artery and then cuts away the plaque.
- Brachytherapy: implants a particular type of radioactive material into the artery to dissolve the plaque (primarily used if a stent-related problem develops).
- Thrombectomy: inserts a thrombolytic device into a blood vessel via a catheter to break up a clot.
Surgery
You might need surgery to treat a heart attack or other results of coronary artery disease. The procedures include coronary artery bypass surgery and minimally invasive heart surgery.
In coronary artery bypass surgery, also known as CABG (pronounced "cabbage"), doctors make a six- to eight-inch incision in the chest. Then they use a blood vessel from one part of the body (usually from the leg or chest) to bypass a blockage in a coronary artery. This is called a graft. The vessel chosen to graft depends on the location of the blockage and how many blockages need repair.
If a doctor creates two bypasses, it's called double bypass surgery, three bypasses would be a triple bypass surgery, and so on.
The doctor creates a bypass by attaching the graft to the affected artery above and below the blocked area. This allows blood to flow around the blockage and get to the heart. This can improve heart function, relieve angina, and may prevent a heart attack.
During the procedure, doctors might place you on a heart-lung machine that takes over the heart function, allows the beating of your heart to be stopped, and lets the surgeon work on an area that is still.
Instead of traditional CABG, you might need minimally invasive heart surgery. In this case, doctors make a two- to four-inch incision, often between the ribs. The type of surgery implemented depends on the location of the blockage.
|
Thursday
November 20, 2008
Tip of the Day
Regular exercise increases the number of insulin receptor sites on cells, making the body more sensitive to insulin.
|