Coronary Artery Disease

Coronary Artery Disease (CAD) develops when the arteries that supply blood to your heart become narrowed or blocked by a build-up of fatty deposits called plaque. As a result, it gets harder for the arteries to supply blood to the heart.

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Coronary Artery Disease Symptoms

Symptoms of CAD may include:

  • Chest pain (angina)
  • Shortness of breath
  • Heaviness in the chest
  • Pain in the jaw or down the arms
  • Heartburn
  • Nausea
  • Vomiting
  • Heavy sweating

Coronary Artery Disease (CAD) develops when the arteries that supply blood to your heart become narrowed or blocked by a build-up of fatty deposits called plaque. As a result, it gets harder for the arteries to supply blood to the heart.

Risk Factors for Coronary Artery Disease

There are several risk factors for CAD. Certain risk factors are beyond your control, including:

  • Age
  • Family history of heart disease

However, majority of risk factors can be controlled. When addressed successfully, these factors can reduce the risk of further heart disease:

  • Smoking decreases the amount of oxygen delivered to the heart, and increases the risk of developing deadly blood clots.
  • Obesity or excess body fat, particularly around the waist, can be a cause of increased blood pressure and high blood cholesterol.
  • Lack of physical activity or an inactive lifestyle may contribute to CAD.
  • High blood pressure places a strain on the heart and directly damages blood vessels, making it easier
  • for plaque to form. Diabetes causes excess sugar to build up in blood vessels and damages nerves.
  • High cholesterol in the blood can lead to atherosclerosis, or the build-up of thick, fatty plaque that clogs arteries.

Diagnosing Coronary Artery Disease

If your doctor suspects that you have CAD, you’ll likely be asked to take a physical exam to check your heart and see how well it is working. Some of the tests used to diagnose CAD include:

1. Electrocardiogram (ECG)
Records your heart’s electrical activity to identify an abnormal heartbeat or damage to the heart muscle.

2. Stress test
Evaluates your heart rate and rhythm while you are exercising.

3. Echocardiogram
Measures the chambers and heart function using sound waves and check your valves and major blood vessels.

4. Coronary Angiography
Coronary angiography is a procedure to visualize the coronary arteries. The coronary arteries are the blood vessels that supply blood to the heart muscles. On ordinary chest X-ray films, the heart appears as a silhouette and the coronary arteries cannot be seen.

To see the coronary arteries, a special dye or contrast medium is injected through a small tube (catheter) inserted via a large artery in the groin or the wrist. The catheter is then advanced to the heart and positioned at the openings of the coronary arteries before the injection is performed.

After the catheter placement and filming, which normally takes about 15 to 30 minutes, the catheters will be removed.

Upon removal, the doctor will discuss his findings with you. If necessary and you are agreeable, he may proceed directly to coronary angioplasty.

Treatment Options for Coronary Artery Disease

Treatment of CAD usually begins with lifestyle changes and/or medications that help the heart work more efficiently and improve blood flow to the heart muscle.

If these initial treatments are unable to control the symptoms of CAD, an interventional procedure may be required. The same is true if the narrowing of the artery is so great that the lack of blood flow is starving the heart muscle of oxygen.

Interventional procedures that are “minimally invasive” include balloon angioplasty, coronary artery stenting, and a Bioresorbable Vascular Scaffold (BVS). Depending on your medical history or the condition of your blocked artery, coronary bypass surgery may be preferred. This uses a healthy blood vessel taken from the chest, leg, or arm to redirect the flow of blood around a section of the blocked artery within the heart.

Balloon Angioplasty – a small balloon is inflated within the narrowed portion of a blocked artery, pushing plaque against the artery walls and improving blood flow to the heart.

Bare Metal Stent – a metallic mesh tube that is delivered on an angioplasty balloon to the narrowed portion of an artery to permanently support the artery walls and improve blood flow.

Drug-eluting Stent – a metallic coronary artery stent, permanently implanted in an artery, which has been coated with medication to prevent an overgrowth of the artery lining that can occur as a reaction to stent implantation.

Bioresorbable Vascular Scaffold (BVS) – the latest advance in CAD therapy, a non-metallic mesh tube that is delivered on an angioplasty balloon to treat a narrowed artery, similar to a stent, but slowly dissolves once the blocked artery can function naturally again and stay open on its own.

Managing CAD after an Interventional Procedure

Once a CAD care plan has been established by your doctor, its success depends on your willingness to see it through.

If you smoke, create a plan to stop. There are support groups you can contact to help encourage you, as well as medications to make stopping easier.

Try to lose weight, even if it’s only a few kilograms. Remember that even a 2.5 to 5 kg weight loss can significantly reduce your risk of heart disease.

Make moderate exercise a part of your daily routine. Regular physical activity is a great way to burn fat. It also releases natural chemicals such as endorphins and vasodilators that help to maintain healthy blood vessels.

Monitor your blood pressure, cholesterol, and blood sugar. In addition to having your blood pressure, cholesterol, and blood sugar checked regularly, be sure to limit your sodium intake, eat healthy foods, exercise regularly, maintain a healthy weight, and take all medications prescribed by your doctor.

Visit your doctor regularly. After being diagnosed with CAD, it’s important to have regular check-ups with your doctor.

Don’t try to become a new person overnight. Instead, select an area or two to work on and go from there. By setting achievable goals, you may be surprised at the level of success you’ll reach.

Make changes gradually. If you want to lose weight, work steadily towards a realistic goal – every kilogram you lose is a step in the right direction. If you want to reduce sugar in your diet, eliminate desserts a few days a week, but not every day. Small changes over time increase the chance of making a permanent change.

Enlist the support of friends or family members. If your goal is to take more walks or join a gym, ask a friend to accompany you. You’ll be much more likely to stick with an activity when it’s social and fun.

Download Coronary Angiography and Angioplasty: A Patient’s Guide to Pre-and-Post Procedure (English)

Download Coronary Angiography and Angioplasty: A Patient’s Guide to Pre-and-Post Procedure (Chinese)

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