According to the Centers for Disease Control and Prevention, coronary artery disease is the most common form of heart disease in the US. Coronary artery disease occurs when the blood vessels that carry blood to the heart narrow or become blocked due to the hardening of the blood vessels and buildup of plaque, or possibly from a blood clot. The process can start as early as the 20s or 30s and progresses as we age.
In this episode of San Diego Health, host Susan Taylor and Curtiss Stinis, MD, an interventional cardiologist at Scripps Clinic John R. Anderson V Medical Pavilion in La Jolla, discuss who’s at risk for coronary artery disease, the symptoms, and how lifestyle changes, such as quitting smoking and controlling diabetes, may help prevent blocked arteries. Your physician can test for heart problems and many treatment options are available.
The heart is the engine of the body and pumps blood through the body, but it also has its own blood supply and those arteries are right on the outside surface of the heart.
Arteries can become blocked typically from buildup of fatty deposits and calcium and occasionally from blood clots.
Atherosclerosis is the fancy term for hardening of the arteries, which is a very common term. A normal artery is nice and clean. But patients that develop atherosclerosis, or hardening of the arteries, develop plaque underneath a very thin wall inside the artery called the intima, and those fatty deposits start to narrow the inside of the artery restricting the flow of blood.
There are a lot of factors that are involved. There are genetic factors and then there are lifestyle decisions, such as smoking, diabetes and other risk factors.
Unfortunately we think it starts at a relatively young age. There have been studies over the years of younger individuals who have passed away and they’ve done autopsies and found that even very early, plaques can form in your twenties and then thirties. The process can start very early in life and then progress as we get older.
Typically, patients who have developed blocked arteries in the heart will have symptoms when they try to exert themselves or exercise, such as shortness of breath, chest pressure, or chest pain or chest tightness.
Occasionally, if the arteries are severely blocked, the heart muscle will suffer and become weakened and patients will have fatigue, maybe some swelling in the legs or feet, and even fluid buildup in the lungs, and develop a condition called congestive heart failure.
Certainly anyone that has chest pressure, shortness of breath, any of the symptoms I mentioned, should definitely seek medical attention. Your doctor can do some simple tests to determine whether there’s a cardiac or heart problem involved versus something else.
If it’s a chronic condition, it’s probably best to make an appointment with your primary care doctor or a specialist to discuss those symptoms. Certainly if it’s a sudden onset or an acute presentation, it’s best to go to the ER or the urgent care. You don’t want to ignore these types of symptoms.
There are lots of different ways that it can be diagnosed. Typically, we start with basic testing like an electrocardiogram or EKG for short. Stress testing is a common method that we use to determine if there is a lack of blood flow to the heart muscle.
In patients where there is very high suspicion, there are other advanced imaging studies, such as CAT scans and angiograms, to look at the actual arteries to determine whether they’re blocked up or not.
If you have a family history, if anyone in your family has had heart disease or stroke, or other circulation problems, certainly that increases the risk. People who smoke cigarettes or use tobacco products, use drugs, or who have diabetes, they are definitely at risk. Patients with high blood pressure, high cholesterol or overweight, are also at risk for developing blockage of the arteries.
That’s a good question, a somewhat controversial question. There are some studies that suggest that certain medications and certain diet and lifestyle changes may help to slowly make some reversal, but complete reversal is probably not possible once there is significant blockage that’s built up.
Patients who have mild blockage can be treated conservatively with diet and exercise and lifestyle changes. Patients who already have very significant blockage, we typically need to do something physically to restore blood flow to the heart and that involves things, such as stents or bypass surgery.
Stents are small little metal tubes that have flexibility. They can be placed into the artery and push that blockage to the side and prop open the artery, so that you have a normal size space for blood. It’s a very common procedure that’s done.
Most patients come in electively, meaning they have symptoms for a long time and nothing that’s an emergency. Typically those procedures are done as an outpatient basis. Patients come in, have a procedure done and go home the same day. Patients who are sicker, maybe they’ve had a heart attack or something more acute happen to them, they may stay in the hospital for several days.
That’s the million dollar question, right? The answer is, we’re not totally sure about that. But we do believe that if we make some lifestyle changes, stop smoking, get your blood pressure under control, get your cholesterol under control, eat right, exercise, if we do those things starting at an early age, we certainly give ourselves the best opportunity to avoid developing these problems.
Once these problems exist, they are a little bit harder to control, but we have ways of controlling them. But preventing it in the first place is challenging because again, genetic factors probably play a large role here. So, knowing if you’re at risk and identifying signs and symptoms early on is very important.
Unfortunately, yes. The process that creates the plaque is a biochemical process that we don’t fully understand. When we fix the blockage, we’re fixing the physical blockage. The underlying condition that created the blockage still exists unfortunately. We can control those things to some degree with medications, diet and exercise, but there’s always a chance that blockage can reform in the future. So anyone that’s had blockage problems is at risk unfortunately for future blockage problems.
It is a really common condition. It affects many, many people. Unfortunately in this day and age, we do have a larger percentage of our population that have diabetes and obesity and other factors that put them at risk for heart disease.
It’s very important to see your doctor regularly, make sure that you’re being screened for those risk factors, and make sure that you take good care of yourself and make good decisions.
Lightly edited for clarity