Last updated: December 27, 2020
Although there are a number of different types of heart disease, we will limit our discussion today to Coronary Artery Disease. So you’ve been diagnosed with Coronary Artery Disease. You experienced angina, you failed on your stress test and now your doctor is telling you he thinks you may have Coronary Artery Disease and you need to have a cardiac catheterization. What does this all mean?
Your coronary arteries are the blood vessels that deliver oxygenated blood to your heart muscles, specifically the myocardium. Atherosclerosis happens when there is an accumulation of fatty materials in the lining of the arteries, thus restricting the blood flow to the organs of the body like the heart. Multiple factors have been considered to contribute to the development of atherosclerosis which includes diet, genetics, smoking, and lifestyle. Due to the accumulation of fatty substances in the lining of the artery, these blood vessels become narrow, decreasing the blood flow to the heart. In order to compensate for this change in the system, the arteries would normally dilate. This is the body's mechanism to counteract the inadequate blood supply to the heart.
With constant dilation in cases where factors contributing to atherosclerosis is not corrected, the blood vessels weaken and are unable to dilate further to provide adequate supply, resulting in chest pains known as Angina Pectoris or Stable Angina. Oftentimes, chest pain is relieved by resting to ease the workload of the heart or with the aid of medications like Nitroglycerin which relax the coronary arteries and other blood vessels in the body.
Coronary artery diseases are known to be one of the main causes of a heart attack. When your coronary artery ruptures, blood clot formation occurs in the affected area, impeding blood flow to the heart and resulting in ischemia with eventual progression to myocardial infarction. Corrective procedures, called coronary artery bypass grafts, have been developed to create alternate blood flow to the heart.
A small tube or catheter is inserted either through the blood vessel in your groin, neck, or through the arm. It is guided by x-ray and placed through a large coronary artery in your heart. A contrast agent (sometimes referred to as dye) is injected down the tube, and x-ray pictures of each of your coronary arteries are taken, allowing your physician to see the blood vessels and any blockages that may be present.
This is known as coronary angiography. In addition, a catheter will be placed into your left ventricle (the pumping chamber of your heart) and the chamber will be filled with contrast. This enables your physician to evaluate the pumping ability of the heart to contract, take blood samples to determine the oxygen content of the four chambers, and check for further defects in the valves of the heart.
You will be sedated during the procedure. You may feel a burning sensation and pressure, as the area where the tube is going to be placed is numbed. There are no nerve endings in your blood vessels so you will not feel anything as the catheter is manipulated or as the contrast is being injected. You may feel a warm, flushed feeling as your ventricle is filled with contrast.
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Aside from diagnostic purposes, cardiac catheterization may be useful for corrective procedures like coronary angioplasty wherein a deflated balloon is attached to the tubing and is threaded to the coronary artery that is affected. This balloon will be inflated to aid in the increase of blood flow to the heart. If your coronary disease is diffuse and very advanced, open-heart surgery may be necessary. This would be the exception, not the rule, and is beyond the scope of this article.
If your blockage is not serious enough to require stent placement (generally less than 70%) the catheter will be removed and a device will be placed to stop any bleeding. If you have not had a stent placed, you will be discharged the same day. Although it is possible to be discharged the same day, most often, if you have a stent placed, you will be required to spend one night in the hospital.
In addition to the surgical procedures, pharmacotherapy is also part of the medical management of Coronary Heart Disease. Pharmacotherapy refers to the administration of drugs depending on the state of the disease condition and the symptoms associated. The following are some of the medications that are commonly used in the treatment of coronary artery disease.
Aspirin — inflammation plays an important part in coronary artery disease, aspirin can inhibit this inflammation. In addition, aspirin can prevent the formation of blood clots and therefore reduce the risk of a heart attack. Some patients, especially those with disease condition that is hematologic in nature, and the elderly, cannot take aspirin because they are at a higher risk for bleeding.
Plavix — is a medication commonly given to patients who have had stents placed in their coronary arteries. It prevents blood clots from forming at the site of the stent.
Beta blockers — can be used to decrease the amount of work that the heart must do, by blocking the effects of adrenaline (the hormone responsible for the fight-or-flight response of the body). It can also be used to manage high blood pressure. Most patients who have been diagnosed with coronary artery disease will be placed on a Beta Blocker.
ACE inhibitors — are used to relax blood vessels and limit the amount of water retained by the kidneys. It is used in both coronary artery disease and in the treatment of hypertension.
Nitrates — are usually given to patients with coronary artery disease in the form of nitroglycerin pills or spray. It is used on an "as needed" basis, which means that if you have chest pain caused by the inadequate flow of oxygenated blood to the heart, it will dilate (make the blood vessel bigger) the vessel and increase the amount of blood flow.
Statin — it is given to most patients with coronary artery disease to limit the build-up of cholesterol in the blood vessels. Patients who have coronary artery disease can benefit from statin medications even if they have normal cholesterol levels.
Dietary Changes — if you are just a little overweight or morbidly obese, weight loss is an important component of your treatment for heart disease. Obesity increases your risk of heart disease as well as your risk for other diseases that affect the heart, such as diabetes and hypertension.
Low fat, low salt, and a balanced diet are highly recommended. Try to steer clear of saturated fats. Your diet should consist of lean proteins, fruits, and vegetables. Carbohydrates should be eaten in limited amounts. A well rounded healthy diet can prevent the worsening of your coronary artery disease. You must also reduce the consumption of alcoholic beverages or avoid them altogether
Smoke cessation — This is one of the best things you can do to reduce the risk of coronary artery disease. Reducing nicotine consumption will increase the amount of available oxygen in the heart and arteries as well as avoiding the risk of lung cancer.
Exercise — when exercise is combined with a healthy diet, weight loss results. In addition, exercise helps to keep your heart healthy. Remember, your heart is a muscle. Thirty minutes of aerobic exercise a day will go a long way in keeping your heart healthy and your coronary artery disease from getting worse.
Smoking — NO, NO, NO! There is little else that can be said about smoking. It is a huge risk factor in the development of coronary artery disease and chronic obstructive pulmonary disease (lung disease) and is guaranteed to worsen the coronary artery disease that you already have.
Stress Management — Managing stress can contribute to an overall healthy lifestyle. Stress management options will differ based on your preferences. For some patients, Yoga, meditation, or massage can be helpful in maintaining a low-level stress environment.
9 Ways to Reduce Stress for Caregivers — Healthy habits, strong connections and resources are important for the well-being of caregivers.