July 31, 2017
Hyperlipidemia or High Cholesterol
July 31, 2017

What is Coronary Artery Disease?

Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients become damaged. Cholesterol-containing plaque in your arteries and inflammation are the usual causes. When plaque builds up, they narrow your coronary arteries, decreasing blood flow to your heart.

What are the Signs and Symptoms of Coronary Artery Disease?

Since coronary artery disease often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack. Significantly decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.

How is Coronary Artery Disease Diagnosed?

During your office visit, the doctor will ask questions about your medical history, do a physical exam and order routine blood tests. she may suggest one or more diagnostic tests as well, including:

1- Electrocardiogram (ECG) : An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that’s in progress.

2- Holter Monitor : Holter monitoring is a type of ambulatory ECG whan 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.

3- An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity.

Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.

  • Stress test : If your signs and symptoms occur most often during exercise, we may ask you to walk on a treadmill during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise.

Some stress tests are done using an echocardiogram. Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It’s similar to a routine exercise stress test but with images in addition to an ECG. A tracer is injected into your bloodstream, and special cameras can detect areas in your heart that receive less blood flow.

  • Cardiac catheterization or angiogram : We may recommend to inject a special dye into your coronary arteries in order to visualize your coronary circulation. This is known as an angiogram or cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images.
  • Heart scan : Computerized tomography (CT) can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

How is Coronary Artery Disease Treated ?

Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

Lifestyle changes :

The following healthy lifestyle changes are recommended:

  • Quit smoking.
  • Eat healthy foods.
  • Exercise regularly.
  • Lose excess weight.
  • Reduce stress.

Medications :

Dr. Sohail may recommend some of these medications for treatment of coronary artery disease:

1- Cholesterol-modifying medications : By decreasing the amount of cholesterol in the blood, specially low-density lipoprotein (LDL, or the “bad”) cholesterol. She can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.

2- The doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you’ve had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn’t appropriate, such as if you have a bleeding disorder or you’re already taking another blood thinner, so ask your doctor before starting to take aspirin.

3- Beta blockers : Sohail routinely recommends Beta blockers for treatment of coronary artery disease. These slow your heart rate and decrease your blood pressure, which decreases your heart’s demand for oxygen. If you’ve had a heart attack, beta blockers reduce the risk of future attacks.

4- Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating your coronary arteries and reducing your heart’s demand for blood.

5- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) : These medications decrease blood pressure and may help prevent progression of coronary artery disease. These help with cardiac remodeling or healing after a heart attack.

Procedures to improve blood flow:

Coronary artery stent

Sometimes more aggressive treatment is needed. Here are some options:

  • Angioplasty and stent placement :

We may recommend inserting a 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. Some stents slowly release medication to help keep the artery open.

  • 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.

Is there a role of Fish oil and Omega-3 fatty acids ?

Fish and fish oils are the most effective sources of omega-3 fatty acids. Fatty fish such as salmon, herring and light canned tuna contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish. Omega-3 fatty acids are a type of unsaturated fatty acid that’s thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease.

Other dietary sources of omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health isn’t as strong.

Are there any other supplements to help in coronary artery disease ?

Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. These include:

  • Alpha-linolenic acid (ALA)
  • Artichoke
  • Barley
  • Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
  • Blond psyllium
  • Cocoa
  • Coenzyme Q10
  • Garlic
  • Oat bran (found in oatmeal and whole oats)
  • Sitostanol (found in oral supplements and some margarines, such as Benecol)

Need to see a doctor? Make an appointment today. 714-916-0952.