Coronary artery disease is the most common form of heart disease in the United States. Most people know that the heart pumps blood through the body, but what exactly are the coronary arteries, and how do they become diseased?
In this video, San Diego Health host Susan Taylor talks with Curtiss Stinis, MD, an interventional cardiologist at Scripps Clinic John R. Anderson V Medical Pavilion in La Jolla, about how coronary artery disease develops and what can be done to treat it.
The heart not only supplies blood to the rest of the body, it has its own blood supply as well. Coronary arteries, the blood vessels that carry blood to the heart, are found on the heart’s outer surface. When a person has coronary artery disease, deposits of cholesterol, fat and calcium called plaque build up in the walls of the arteries. Eventually, this buildup narrows the opening in the arteries, which restricts the flow of blood to the heart. In severe cases, the arteries become completely blocked. Coronary artery disease is also known as hardening of the arteries or atherosclerosis.
Your risk of coronary heart disease may be higher than average if you have a family history of heart disease, stroke or other circulation problems, but lifestyle also plays a role. Factors including tobacco use, being overweight, having diabetes, and having high blood pressure or high cholesterol also raise the risk.
Moreover, coronary artery disease can begin at a relatively young age. Studies suggest that plaque can begin forming in the arteries as early as your 20s or 30s.
Typically, patients who develop blocked arteries in the heart will have symptoms like shortness of breath, chest pressure or chest pain when they exercise or exert themselves. Occasionally, if the arteries are severely blocked the heart muscle will weaken and patients may have fatigue and swelling in the legs or feet. Fluid also may build up in the lungs, creating a condition called congestive heart failure.
“Anyone who has chest pressure, shortness of breath or any of these symptoms should definitely seek medical attention,” says Dr. Stinis. “Your doctor can do some simple tests to determine whether there is a heart problem involved versus something else.”
In most cases, your doctor will start with basic tests such as an electrocardiogram (EKG) to check the heart’s rhythm. A stress test, which usually involves running on a treadmill, is commonly performed to determine if there's a lack of blood flow to the heart muscle. Advanced imaging studies like CAT scans and angiograms look at the actual arteries to determine whether they're blocked.
While chronic shortness of breath can be a symptom of coronary artery disease, shortness of breath that comes on suddenly or is severe should be checked out immediately at an emergency department or urgent care.
Treatments for coronary artery disease depend on the severity of blockages in the arteries, along with the patient’s health profile and medical history. Patients who have only mild blockage often can be treated conservatively with changes in diet, exercise and lifestyle; for example, eating a more heart-healthy diet or starting an exercise program.
If significant blockages affect one or more arteries, treatment may be needed to open the artery and restore blood flow to the heart.
One common treatment involves stenting the artery. Stents are tiny flexible metal tubes that are placed into the artery to push the blockage aside and prop open the artery. The stent is placed using a long, flexible tube called a catheter. Typically, an incision is made in the leg or groin, and the catheter is inserted into a blood vessel and guided to the heart. The stent is placed through the catheter to the artery, and the catheter is removed. Many patients go home the same day, although patients who have had a heart attack or have other complications may stay in the hospital for several days.
“That’s the million-dollar question,” says Dr. Stinis. “Genetic factors probably play a large role, but we do believe that if we make some lifestyle changes, stop smoking, get blood pressure and cholesterol under control starting at an early age, we certainly give ourselves the best opportunity to avoid developing these problems. And if you have symptoms, get them checked out early.”