Coronary Artery Disease

What is coronary artery disease?
Coronary artery disease is a condition that puts you at risk for heart attack and other forms of heart disease. In people who have coronary artery disease, the arteries that supply blood to the heart get clogged with fatty deposits. Other names for this disease are “coronary heart disease” or just “heart disease.”

What are the symptoms of coronary artery disease?
Many people with coronary artery 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

What are the symptoms of a heart attack?
The first symptom of coronary artery disease can be a heart attack. That’s why it is so important to know how to spot a heart attack.

The symptoms of a heart attack can include:

  • Pain, pressure, or discomfort in the center of the chest
  • Pain, tingling, or discomfort in other parts of the upper body, including the arms, back, neck, jaw, or stomach
  • Shortness of breath
  • Nausea, vomiting, burping, or heartburn
  • Sweating or having cold, clammy skin
  • A racing or uneven heartbeat
  • Feeling dizzy or lightheaded

If these symptoms last more than 10 minutes or they keep coming and going, call for an ambulance (in the US and Canada, dial 9-1-1) right away. Do not try to get to the hospital on your own.

As mentioned above, some people with coronary artery disease have chest pain even when they are not having a heart attack. This is most likely to happen when they are walking, going up stairs, or moving around. But if you have chest pain that is new or different than pain you have had before, you should see a doctor right away.

Is there a test for coronary artery disease?
Yes. If your doctor or nurse thinks you might have coronary artery disease, he or she might order blood tests and one or more of these tests:

  • An electrocardiogram (“ECG”) – This test measures the electrical activity in your heart.
  • A stress test – During a stress test, which is also called an exercise test, you might be asked to run or walk on a treadmill while you also have an ECG. Physical activity increases the heart’s need for blood. This test helps doctors see if the heart is getting enough blood. If you cannot walk or run, your doctor might do this test by giving you a medicine to make your heart pump faster.
  • An echocardiogram – This test uses sound waves to create an image of your heart as it beats.
  • Cardiac catheterization (also called “cardiac cath”) – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. Next, the doctor puts a dye that shows up on X-ray into the tube. This part of the test is called “coronary angiography.” It can show whether any of the arteries in your heart are clogged.

How is coronary artery disease treated?
The main treatments for coronary artery disease are:

Lifestyle changes – Here are some things you can do to reduce your risk of heart attack and death:

  • Quit smoking, if you smoke.
  • Eat lots of fruits, vegetables, and foods with a lot of fiber. Avoid foods that have a lot of sugar.
  • Walk or do some form of physical activity on most days of the week.
  • Lose weight, if you are overweight.

Medicines – The medicines to treat heart disease are very important. Some medicines lower your risk of heart attacks and can help you live longer. But you must take them every day, as directed. Medicines your doctor might prescribe include:

  • Medicines called statins, which lower cholesterol
  • Medicines to lower blood pressure
  • Aspirin or other medicines that help prevent blood clots
  • Medicines to treat diabetes

People who have chest pain caused by coronary artery disease (called “angina”) can also get medicines to relive their pain. These medicines might include “nitrates,” “beta blockers,” and others.

Some people with coronary artery disease can also have:

  • A stent procedure – During this procedure, the doctor puts a thin plastic tube into the blocked artery, and uses a tiny balloon to open the blockage. Then the doctor leaves a tiny mesh tube called a “stent” inside the artery to hold it open.
  • Bypass surgery (also known as “coronary artery bypass grafting” or CABG) – During bypass surgery, the doctor removes a piece of blood vessel from another part of the body. Then he or she reattaches the blood vessel above and below the area that is clogged. This re-routes blood around the clog and allows it to get to the part of the heart that was not getting blood.

If your doctor recommends stenting or bypass surgery, ask these questions:

  • What are the benefits of this procedure for me? Will the procedure help me live longer? Will it reduce my chance of having a heart attack? Will I feel better if I have this procedure?
  • What are the risks of the procedure?
  • What happens if I don’t have this procedure?

Peripheral Artery Disease

What is Peripheral Artery Disease?
Peripheral artery disease (PAD) is a condition that can cause leg pain that gets worse with activity. Muscle pain that gets worse with activity and better with rest is called “claudication.” PAD affects the blood vessels (called arteries) that bring blood to the legs. PAD can also cause wounds to heal more slowly than usual.

Normally, blood flows easily through arteries to all parts of the body. But sometimes, fatty clumps called “plaques” build up inside the walls of arteries (figure 1). Plaques can cause arteries to become narrow or blocked. This prevents blood from flowing normally. When muscles do not get enough blood, symptoms can occur.

Some people have a greater chance of getting PAD, such as those who:

  • Smoke
  • Have diabetes
  • Have high cholesterol
  • Have high blood pressure

What are the symptoms of PAD?

PAD often causes pain in the back of the lower leg. The pain usually gets worse with walking or other exercise, and gets better with rest. PAD can also cause pain in the buttocks, thighs, or sometimes in the feet. People who have leg pain can have other symptoms, too, such as:

  • Trouble walking up stairs
  • Trouble getting an erection (in men) or trouble with sexual arousal (in women)

Symptoms of claudication can be mild or severe, depending on:

  • Which arteries are affected
  • How narrow the arteries are
  • How much activity a person does

Is there a test for PAD?
Yes. Your doctor or nurse can do different tests to find out if you have PAD, and to check how severe it is. He or she might:

  • Take the blood pressure in your arm and lower leg (just above the ankle) at rest and right after exercise, and compare them
  • Take the blood pressure in other places in your leg (like the thigh)
  • Order a blood vessel imaging test such as an ultrasound, which can show pictures of your leg arteries

How can I help treat my PAD?
To help treat your PAD and prevent it from getting worse, you can:

  • Stop smoking
  • Get your diabetes, high blood pressure, and high cholesterol under control (if you have these conditions)
  • Walking – Doctors recommend that most people with PAD walk every day. Ask your doctor or nurse how best to begin a walking program.

What other treatments might I have?
Along with a walking program and getting medical conditions under control, some people are also treated with medicines. The medicines used to treat PAD can reduce symptoms, increase blood flow to the legs, and help people walk farther without pain. Most doctors ask their patients to try a medicine called cilostazol (brand name: Pletal). But people who have certain heart problems cannot take cilostazol and must take a different medicine.

If you still have severe symptoms after trying medicines, your doctor will talk with you about the possibility of having surgery or a procedure to increase blood flow to your legs and feet. Your treatment options might include:

  • Angioplasty or stenting – During angioplasty or stenting, the doctor sends a thin tube with a balloon at the end of it to the part of the artery that is blocked. Then the doctor inflates the balloon to open the blockage. Often the doctor props open the artery using a tiny mesh tube called a stent, which stays in the body.
  • Bypass surgery – During bypass surgery, the doctor removes a piece of blood vessel (vein) from another part of the body. Then he or she reattaches that piece of blood vessel (called a vein graft) above and below the area that is clogged. This re-routes blood around the clog, and allows it to get to the part of the leg that was not getting enough blood. Sometimes instead of taking a graft from another part of the body, the doctor can use a man-made graft.

What should I know about the different procedures?
Angioplasty and stenting work best for treating blocked areas that are short. Surgery works better long-term for treating blocked areas that are long. People who have the fewest long-term problems after bypass surgery include those who are younger than 70, do not have diabetes, and do not have PAD below the knee.

Your doctor might recommend a procedure for you, depending on your symptoms, age, and medical problems. But many people can choose which procedure to have. If your doctor offers you a choice, ask:

  • What are the benefits of each procedure for me?
  • What are the downsides of each procedure for me?
  • What happens if I do not have any procedure?