Coronary Artery Disease

Atherosclerosis is a kind of narrowing of the coronary arteries that reduces blood flow. The lining of the arteries accumulate cholesterol on the inner walls and create a pool of fatty cells. White blood cells come to protect the cell wall causing inflammation and weakening of the artery wall. If the artery wall bursts, this triggers the formation of blood clots causing a blockage.

Angina (Chest Pain)
Angina pectoris is the heart muscle’s way of warning you that it is not getting enough blood and oxygen. This can be triggered by such things as excitement, exertion, emotional distress, cold or extreme hot and humid weather, or eating a large meal. All of these activities make the heart work harder. Angina is most often caused by inadequate oxygen supply which is in turn caused by narrowing of the coronary arteries (atherosclerosis). In other words, there is an imbalance between the demand of the heart for blood and the available supply of blood.

When your heart is running short of oxygen, you may have any of the following symptoms:

  1. Pressure, pain, burning, tightness, fullness, or squeezing in the chest.
  2. Feelings of indigestion, pain or fullness in the upper abdomen.
  3. Heaviness, numbness, tingly sensations or aches and pains in any or all portions of the arms.
  4. Choking feeling, tightness or pain in the throat.
  5. Pain in the shoulders, neck, jaw, earlobes, or back.
  6. Difficulty catching your breath with any of the above symptoms.

You may experience discomfort in one or more areas, which may spread to other areas.

4 “E’s” of Angina

  • Exertion
  • Emotion
  • Eating
  • Extreme Temperatures

Although angina usually occurs with physical activity, you may have angina at rest or during the night.

An angina attack can lead to a heart attack if one of the coronary arteries is completely blocked off.

Heart Attack
As the coronary artery walls become narrowed with fatty material there is less room for the blood to flow and more chance of a blood clot forming, or sometimes a coronary artery can go into a severe spasm causing muscle damage. Therefore, either vessel narrowing, a blood clot or a spasm can be involved in a heart attack. The decrease in blood flow causes discomfort. When the blood supply to part of the heart muscle is stopped, that area is not able to do its job (squeeze) and permanent damage occurs. The term for this is myocardial infarction (MI) or heart attack.

In some cases, a medicine may be used that dissolves blood clots. This process is called thrombolysis and must be started within a few hours of the start of heart attack symptoms. If the blood clot can be dissolved, the blood flow in the artery will be restored. This may lessen the amount of heart muscle damage.

Heart catheterization (coronary angiogram) may be recommended to check the coronary artery system. This is a “moving picture x-ray” that shows the blood flow in the coronary arteries. You will receive additional information about this test if your doctor suggests it.

How We Diagnose A Heart Attack
The diagnosis of a heart attack is often suggested by a person’s symptoms. The common symptoms of a heart attack are:

  1.  Prolonged, heavy aching pain, pressure or tightness in the center of the chest.
  2.  This pain may spread to either arm, shoulder, neck, jaw, or back.
  3.  Sweating.
  4.  Nausea or vomiting.
  5.  Shortness of breath, dizziness, fainting.
  6.  Sometimes these symptoms lessen or go away, and then return.

Electrocardiograms (ECG) may show changes in the heart’s electrical activity. These changes may help confirm a heart attack diagnosis.

Blood tests are taken to look for certain proteins called enzymes. Injury to the heart may cause the enzyme level to increase in the blood.

Changes in heart function can be seen during an echocardiogram, which is another diagnostic test that can be done. It may take one to two days of observation and testing to make a diagnosis of a heart attack.

The healing process begins when white blood cells go to the damaged area of the heart. They help remove dead tissue and prepare for healing. Gradually, over a one to two month period, a scar forms in the damaged area. The heart isn’t able to grow new, healthy tissue so the damage of a heart attack is permanent. The healing process also involves expansion of smaller blood vessels around the damaged area. This is called collateral circulation. These vessels increase in size and number for several months to aid the healing process.

Treatments for Coronary Artery Disease
Coronary Artery Disease may be managed through a combination of lifestyle changes, such as increases in physical activity, diet modifications and medical treatment. Medical treatments of the blockage include medications, angioplasty, stent placement or coronary artery bypass graft surgery.

Medications
Medications may include aspirin therapy, beta-blockers, cholesterol lowering agents, nitroglycerin and possibly anticoagulants (blood thinners). The therapy your doctor recommends will depend on the condition and severity of your disease.

Percutaneous Transluminal Coronary Angioplasty
(PTCA)
Also referred to as balloon angioplasty, this procedure improves blood flow to your heart. A catheter with a balloon at its tip is put into your blocked artery. The balloon is then expanded to widen that blood vessel and the catheter is removed.

Stent Implantation
A stent is a small metal coil or mesh tube. After balloon angioplasty, a stent may be placed in the artery. This helps prevent the artery from narrowing again. Once in place, the artery will heal around the stent as it continues to support the vessel.

Some types of stents may be coated with a special drug that is designed to deliver a drug locally to reduce tissue formation within the coronary artery.

After stent placement, a medication called Plavix (Clopidogrel) will be prescribed for you. This medication reduces blood clot formation within the artery that has been stented. You will need to take this medication as prescribed by your physician. The length of treatment may range from 1-12 months.

After stent placement, you may not be able to undergo certain diagnostic tests for a period of time. This would include a MRI (Magnetic Resonance Imaging). Check with your physician prior to scheduling this type of test.

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