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JULES VUOTTO
By Dr. Dr. Shahzad Ahmed
Coronary artery disease (CAD) is the most common type of heart disease, affecting 18 million American adults. In CAD, the arteries that supply essential nutrients, such as oxygen to the heart become damaged. The primary cause of CAD is the buildup of fat and cholesterol in the blood, which adheres to the inner walls of blood vessels, resulting in their narrowing—a condition known as atherosclerosis. Over time, these narrowed arteries can become blocked, leading to chest pain or a heart attack.
Individuals with the following health conditions are at an increased risk of developing coronary artery disease:
- High blood pressure
- Diabetes mellitus
- High cholesterol
- Smoking
- Family history of CAD at a young age
- Unhealthy lifestyle factors, such as lack of exercise and poor eating habits
- Obesity
CAD typically takes decades to develop and may manifest as symptoms such as chest pain or a heart attack. The majority of patients may experience no symptoms at all. Signs and symptoms of CAD can vary widely; while some patients are asymptomatic, others may experience chest pain, chest pressure, heartburn, shortness of breath, dizziness, nausea, extreme sweating, and weakness. If you experience any of these symptoms, it is crucial to call 911 or go to the nearest emergency room for evaluation without delay.
Your doctor can diagnose CAD based on your signs and symptoms, medical history, blood tests, and imaging studies, such as chest X-rays, echocardiograms, and stress tests. An electrocardiogram (ECG) may also be performed to assess the electrical activity of the heart muscle and detect any damage. An echocardiogram evaluates the heart's structures and functions, while a stress test involves exercise on a treadmill or stationary bike (or medication) to assess for blocked arteries. A computed tomography (CT) angiography scan provides images of the heart's arteries, revealing any plaque buildup, even in the early stages before it hardens. A coronary angiogram, performed in a cardiac catheterization laboratory, involves threading a thin tube or catheter into an artery, usually in the wrist or leg, and guiding it to the heart. Dye is injected into the artery to evaluate it for blockages. This test is typically recommended when a non-invasive test is abnormal, when a patient's symptoms strongly suggest CAD, or after a heart attack.
Based on the results of these tests, your doctor may determine that you have severe blockage in one or more arteries. Severe blockage usually refers to greater than 70% narrowing, which could explain your symptoms of chest pain or shortness of breath. CAD is classified based on the severity of narrowing: mild (less than 49%), moderate (50-69%), or severe (greater than 70%).
The treatment for coronary artery disease depends on the severity of the blockages and the number of arteries involved. In many cases, CAD is treated with medications, including antiplatelets like aspirin, medications to decrease the workload on the heart (such as beta-blockers), and treatments to manage cholesterol and blood pressure. Adopting a healthy lifestyle, including a heart-healthy diet, regular exercise, and smoking cessation, is also essential.
In some cases, a procedure or surgery may be necessary to unblock arteries and improve blood flow:
Angioplasty: This procedure involves placing a stent to prop open the artery, typically through a small tube inserted into a blood vessel in the wrist (known as percutaneous coronary intervention).
Coronary Artery Bypass Grafting (CABG): This surgery reroutes blood around the blocked or narrowed areas using other arteries or veins from the body.
Your doctor may also refer you to a cardiac rehabilitation program, which typically lasts 12 weeks and includes a combination of supervised exercise, nutritional counseling, and stress management. This program can also assist you in quitting smoking. Cardiac rehabilitation is particularly beneficial for patients with angina, heart failure, or those who have recently undergone coronary procedures, such as stent placement or heart surgery.
About Dr. Shahzad Ahmed MD, FACC, FSCAI, RPVI
Dr. Ahmed holds board certifications in Interventional Cardiology, Cardiovascular Medicine, Echocardiography, Nuclear Cardiology, Vascular Ultrasound, and Internal Medicine. He received the esteemed Fellow of American College of Cardiology (FACC) award in 2019 and was honored as a Fellow of the Society of Cardiovascular Interventions in 2020 (FSCAI). Dr. Ahmed completed his training in internal medicine, cardiovascular, and interventional cardiology at Drexel University College of Medicine. His expertise and dedication have led to his appointment as Assistant Professor of Medicine at Drexel University College of Medicine.
BMC Cardiology Practice is located at Lower Bucks Hospital, 501 Bath Rd, Bristol, PA; 215- 785-5100.