Coronary Artery Disease

By Dr. Shahzad Ahmed MD, FACC, FSCAI, RPVI

Coronary artery disease (CAD) is the most common type of heart disease affecting 18 million American adults. With coronary artery disease, your arteries that supply essential nutrients like oxygen to the heart, become damaged. The main reason for CAD is build up of fat and cholesterol in blood that sticks to the inner walls of blood vessels resulting in narrowing of these vessels, called atherosclerosis. Over time, these arteries get narrowed and blocked, resulting in chest pain or heart attack.

Individuals with following heath conditions are at increased risk of CAD

  • High blood pressure
  • Diabetes Mellites
  • High Cholesterol
  • Smoking
  • Family history of CAD at young age
  • Unhealthy lifestyle, like lack of exercise and poor eating habits
  • Obesity

CAD usually takes decades to develop and manifest into chest pain or heart attack. The signs and symptoms of CAD varies. Some patients have no symptoms, while others have chest pain, chest pressure, heartburn, shortness of breath, dizziness, nausea, extreme sweating, and weakness. If you have any of these symptoms, call 911 or go to the nearest emergency room for evaluation. You should not delay your care due to Covid-19 concerns.

“Due to fears of contracting COVID-19 or taking up space in hospitals, patients experiencing a heart attack or stroke are delaying their essential care, causing a new public health crisis,” said Martha Gulati, MD, FACC, editor-in-chief of CardioSmart.org.

Your doctor can diagnose CAD based on your signs and symptoms, medical history, blood tests and imaging like chest X-ray, echocardiogram (EKG), and stress test. An EKG reviews the electrical activity of the heart muscle and can detect heart damage and assess heart structures and functions. A stress test involves exercise on a treadmill or stationary bike (or medicine) to evaluate blocked heart arteries. A computed tomography (CT) angiography scan of the heart shows pictures of the heart's arteries and whether there is a buildup of plaque, even in the early stages, before the plaque hardens. Coronary angiogram is done in the cardiac catheterization laboratory. It involves threading a thin tube or catheter into an artery, usually in the wrist or leg, and into the heart. Dye is injected into the artery to evaluate it for any blockages. This test usually is recommended when a non-invasive one is abnormal, a patient's symptoms strongly suggest CAD, or after a heart attack.

Based on the tests, your doctor might say that you have severe blockage in one of the arteries.  Severe blockage usually means greater than 70% narrowing.  This might explain your chest pain or shortness of breath.  CAD is graded as mild (less than 49%), moderate (50 to 69%) or severe (greater than 70% narrowing).

The treatment for CAD depends on severity of the blockages and the number of arteries involved.  Most of the time, CAD is treated with medicine, which include antiplatelets like aspirin, medicine to decrease the workload of the heart, like beta-blockers, and management of cholesterol and blood pressure.  You should also adopt a healthy lifestyle including heart healthy diet, regular exercise and no smoking.

You may need a procedure or surgery to unblock arteries and to improve blood flow. These may include:

  • Angioplasty: Placing a stent to keep the artery open, typically through a small tube placed in a blood vessel in the wrist (percutaneous coronary intervention).
  • Open-heart surgery, or coronary artery bypass (CABG) surgery, to re-route blood around the blocked or narrowed area by using other arteries or veins in the body.

Your doctor may refer you for cardiac rehabilitation, which is a 12-week program that includes a mix of supervised exercise, nutritional counseling, and stress management.  This program can also help you quit smoking.  Cardiac rehabilitation is best for patient with angina, heart failure or those who have had a recent coronary procedure, like stent or bypass surgery.

Dr. Shahzad Ahmed MD, FACC, FSCAI, RPVI is an Interventional Cardiologist and Director Cardiology at Lower Bucks Hospital. He is Board Certified in Interventional Cardiology, Cardiovascular Medicine, Echocardiography, Nuclear Cardiology, Vascular Ultrasound and Internal Medicine. He was Awarded Prestigious award of Fellow of American College of Cardiology (FACC) in 2019 and Fellow of Society of Cardiovascular Interventions in 2020 (FSCAI). He completed internal medicine, cardiovascular and interventional cardiology training at Drexel University College of Medicine. He was appointed Assistant Professor of Medicine at Drexel University College of medicine. Under his leadership Lower Bucks Hospital has started many new programs including same-day discharge after percutaneous coronary intervention, Venous and Pulmonary Thrombectomy, Carotid stenting and implementing the radial first approach (Cardiac Cath through arteries of hand).

Dr. Ahmed is currently accepting new patients at BMC Cardiology Practice,501 Bath Road in Bristol. For more information or to schedule an appointment, please call 215-785-5100 or visit www.lowerbuckshosp.com/find-a-provider/shahzad-ahmed-md.