Coronary heart disease (CHD) is the single most common cause of death globally; many people with coronary heart disease have no symptoms. For those who do, the most common symptoms usually happen with exercise. They can include:
- Pain, pressure, or discomfort in the center of the chest.
- Pain, tingling, or discomfort in other parts of the upper body – This might include the arms, back, neck, jaw, or stomach.
- Feeling short of breath.
The first symptom of coronary heart disease can be a heart attack. That’s why it is so important to know how to spot a heart attack.
Angina is chest pain or discomfort, it happens when your artery becomes narrowed.
Heart attack happens when an artery becomes blocked with plaque or a clot. When blood cannot flow to the heart, damage or death to the heart muscle may occur. This is a life-threatening situation.
With angina and a heart attack you may feel:
- tightening, pressure, squeezing or aching in your chest or arms
- a feeling of indigestion
- a feeling of fullness
- a sharp, burning or cramping pain
- aching, weakness or numbness that begins in or spreads to your neck, jaw, throat, teeth, back, shoulder or arms
- discomfort in your neck or upper back, particularly between your shoulder blades
- trouble breathing
- nausea (upset stomach) or vomiting (throwing up)
- cold sweats
- generalized weakness or severe fatigue (tiredness)
If these symptoms last more than 10 minutes or they keep coming and going, call for an ambulance immediately.
Development of atherosclerosis
Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery. The damage may be caused by various factors, including:
- High blood pressure
- High cholesterol
- Diabetes or insulin resistance
- Sedentary lifestyle
The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing in the first place. Leading a healthy lifestyle can help keep your arteries strong and clear of plaque. To improve your heart health, you can:
- Quit smoking
- Control conditions such as high blood pressure, high cholesterol and diabetes
- Get moving.
- Eat a low-fat, low-salt diet that’s rich in fruits, vegetables and whole grains
- Maintain a healthy weight
- Reduce and manage stress
In addition to healthy lifestyle changes, remember the importance of regular medical checkups. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.
There are several diagnostic tools that include:
- Electrocardiogram (ECG). An electrocardiogram records electrical signals and can often reveal evidence of a previous heart attack or one that’s in progress.
In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
- An echocardiogram uses sound waves to produce images of your heart.
- Cardiac catheterization and angiogram. To view blood flow through your heart, your doctor may inject a special dye into your coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart.
This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.
- Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries.
Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.
Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:
- Quit smoking.
- Eat healthy foods.
- Exercise regularly.
- Lose excess weight.
- Reduce stress.
Sometimes more aggressive treatment is needed. Here are some options:
Diagnostic coronary angiography:
Before the test starts, you will be given a mild sedative to help you relax.
An area of your body (the arm or groin) is cleaned and numbed with a local numbing medicine (anesthetic). The cardiologist passes a thin hollow tube, called a catheter, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter.
Once the catheter is in place, dye (contrast material) is injected into the catheter. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow.
The procedure most often lasts 30 to 60 minutes.
Balloon angioplasty and stent placement
Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls.
A stent is often left in the artery to help keep the artery open. Most stents slowly release medication to help keep the arteries open.
Chronic total occlusion PCI
A chronic total occlusion is defined as the complete obstruction of a coronary artery;these blockages are a result of severe build-up of fatty deposits or plaque within the arteries (atherosclerosis) and are one of the complications from coronary artery disease.
When a blockage occurs, new blood vessels known as collateral blood vessels are formed around the blockage to help with blood flow. Using advanced guide wires, our physicians insert a catheter into these collateral vessels, entering the blocked artery from multiple sides. Using a technique called balloon angioplasty; a small un-inflated balloon is placed at the tip of the catheter and inflated while in the artery. This approach, along with stents, is used to create a wider opening in the arteries to restore blood flow.
This is a procedure which attempts to “bore out” a narrowing in a coronary artery which might not otherwise respond to stenting.
The test involves the insertion of a long thin catheter into an artery in the groin or wrist under local anesthetic. The catheter is moved up the inside of the artery until it reaches the heart. When the catheter is in place, a small amount of dye will be injected into it. X-rays will be taken as the dye travels through the coronary arteries. A specially-designed burr is used to grind away the blockage.
Intravascular Ultrasound (or IVUS) allows us to see a coronary artery from the inside-out. This unique point-of-view picture yields information that goes beyond what is possible with routine imaging methods, such as coronary angiography.
The resulted cross-section view can aid in stent sizing, and in confirmation that the stent has been placed optimally.
Fractional Flow Reserve, or FFR, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of a coronary catheterization. The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages.
Optical coherence tomography (OCT) is a novel invasive imaging technique that produces high resolution intracoronary images. Its general principle of operation is similar to IVUS; however OCT uses infrared light, not ultrasound.
Coronary artery bypass surgery
A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it is most often reserved for cases of multiple narrowed coronary arteries.
MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG.