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Heart Facts: Coronary Artery Disease

Causes
The heart is a muscle that pumps blood throughout the body. To function properly, the heart must receive oxygen. Oxygen is supplied to the heart by coronary arteries that wrap around the surface of the heart.

CAD is caused by the build-up of fatty substances, such as cholesterol, along the inner lining of the coronary arteries. These fatty deposits are sometimes called plaques or lesions. Known as atherosclerosis, the build-up of these lesions narrows the artery and may eventually block the flow of blood. Because the coronary arteries supply oxygen-rich blood to the heart itself, untreated CAD can have very serious consequences including heart attack (myocardial infarction) or even death.

Symptoms
CAD is a disease that progresses very slowly, often without symptoms. Unless you are tested for the disease, your first sign that something is wrong and may be an episode of angina, or even a heart attack. The symptoms of angina are pressure, tightness, or pain in your chest, arm, back, neck, or jaw; heartburn; nausea; vomiting; profuse sweating; or shortness of breath. Angina may be a single symptom or a combination of these symptoms.

Risk Factors for CAD
You are at greater risk for CAD if you:

. are male
. have high blood pressure or diabetes
. smoke cigarettes
. are overweight
. have a close relative with the disease
. are inactive

Diagnosis
If you have an increased risk of CAD or certain symptoms of the disease, your doctor may recommend a stress test, or exercise electrocardiogram (ECG). The stress test measures changes in the electrical activity of your heart as you perform controlled exercise. This test can show if there has been damage to your heart.

If the results of the stress test indicate a need for further testing, your doctor may arrange for you to have a coronary angiogram, also called cardiac catheterization. The coronary angiogram is the most useful test for diagnosing CAD because it allows the doctor to see exactly where the coronary arteries are narrowed or blocked.
v Before the angiogram begins, you will receive a local anesthetic or pain medicine. The doctor then inserts an introducer sheath into an artery in your groin or an incision in your arm. Then the doctor inserts a long tube, called a guiding catheter, into the artery and advances it to the blocked artery. By injecting a contrast dye that can be seen on an x-ray screen, the doctor can observe the arteries in your heart. You may be asked to take a deep breath and hold it while the doctor is taking the angiogram. Any narrowing or blockage that exists can then be identified. In some cases, the doctor performs an angioplasty, or balloon procedure, immediately following the angiogram in order to open the coronary artery for blood flow.

Treatment
Most patients with CAD receive medication to help prevent heart attack, and doctors usually recommend controlled exercise and a low-fat diet. Medication may also be prescribed to help lower cholesterol levels in the blood. However, there are no drugs available that will eliminate an existing coronary blockage (lesion).

Until several years ago, the only treatment for a coronary lesion was bypass surgery. Today, a non-surgical treatment known as angioplasty is commonly used. The full medical term for this procedure is Percutaneous Transluminal Coronary Angioplasty, or PTCA. During angioplasty, a small balloon is placed inside the artery at the lesion site. When the balloon is carefully inflated, the fatty deposits are compressed, enlarging the arterial opening and restoring blood flow.

In certain cases, surgery is still necessary. Your doctor will advise you on the best course of treatment for you.



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