Coronary Artery Disease

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Coronary artery disease represents narrowing of the major blood vessels that supply blood, oxygen, and nutrients to your heart muscle. The narrowing is generally caused by atherosclerotic plaques that restrict blood flow to your heart. Prolonged deprivation of oxygen and nutrients to your heart can lead to permanent damage to the heart muscle and heart failure. Coronary artery disease usually develops over the course of several decades and may go undiagnosed for a long period of time.

At Yale Cardiac Surgery, we have extensive experience in treating patients with coronary artery disease. Our world-renowned surgeons can help you better understand and offer you the most advanced surgical treatments, including off-pump and minimally invasive robot-assisted coronary artery bypass grafting. We also specialize in all-arterial coronary revascularization.

Causes

Coronary artery disease usually results from the buildup of plaque, or cholesterol-containing deposits, on arteries that bring blood, oxygen, and other nutrients to your heart muscle. This plaque builds up and restricts the delivery of these vital elements to your heart.

Coronary artery disease is associated with several risk factors, including:
  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Radiation therapy to the chest
  • Injury to the inner wall of the artery

Symptoms

Coronary artery disease is a serious condition that may go unnoticed for some time. If you are experiencing any of the following symptoms, please call your doctor. It is also important to understand that having one or more of the following symptoms does not mean that you have coronary artery disease.

  • Chest pain (angina): Angina can be triggered by physical and emotional stress. You might compare the tightness or pressure to someone standing on your chest. In women, this type of chest pain may also include fleeting pain in the abdomen, back, or arm.
  • Shortness of breath: When blood flow is restricted, the heart cannot pump enough blood to meet the body’s needs, leading to shortness of breath and extreme fatigue.
  • Heart attack: A heart attack may occur when a coronary artery becomes completely blocked, completely shutting off blood to the heart muscle it supplies. Classic signs of a heart attack include crushing pressure in the chest and pain down the left shoulder or arm.

Risk Factors

A risk factor is anything that increases your change of getting a particular disease. However, having a risk factor does not mean that you will definitely develop the condition. Risk factors for coronary artery disease include one or more of the following:

  • Age: As age increases, the risk of developing coronary artery disease also increases.
  • Sex: Men are at greater risk than women for developing coronary artery disease. The risk for women increases after menopause. 
  • Family history: A family history of heart disease, including coronary artery disease is a risk factor. The risk of developing coronary artery disease is higher if a close relative developed the disease at an early age. Men are at an increased risk if their father or a brother was diagnosed before the age of 55. Women are at an increased risk if their mother or a sister was diagnosed before the age of 65. 
  • Smoking: The incidence of heart attack is higher in men and women who are smokers. Nicotine and carbon monoxide constrict blood vessels and causes damage to the inner lining, increasing the risk of coronary artery disease. 
  • High blood pressure: High blood pressure, or hypertension, is a recognized risk factor for coronary artery disease.
  • High blood cholesterol: High blood cholesterol, or hypercholesterolemia, can increase the risk of plaque buildup in the coronary arteries.
  • Diabetes: Diabetes is a very strong coronary risk factor.

Diagnostic Tests

Most everyone being referred for coronary artery bypass surgery will undergo a routine history and physical examination, along with basic blood tests. Additional tests may include:

Chest X-Ray: A plain chest X-ray is almost always obtained as a screening test to confirm that there are no significant chest masses, fluid collections, pneumonias, or major anatomic malformations in the chest.

Electrocardiogram (ECG): An ECG detects electrical patterns that run through your heart and is particularly useful in identifying an ongoing heart attack or one that occurred in the distant past. It is also an important tool to identify any rhythm disturbances as well.

Echocardiogram: An echocardiogram is a non-invasive test that uses ultrasonic sound waves to display moving images of the heart. It usually provides an excellent assessment of heart pumping function and heart valve competence. For patients with coronary artery disease, it can provide clues as to which areas of heart muscle are suffering from a lack of blood flow.

Stress test: Stress tests are generally used to determine deficiencies in coronary blood flow during cardiac exertion. There are several types of stress tests in which the heart is stimulated by actual exercise (i.e., walking on a treadmill) or with medicines and then imaged with echocardiography or radioactive imaging techniques. These tests are usually performed in the presence of a cardiologist to interpret them and to make sure that the patient is not over-stressed.

Cardiac catheterization (coronary angiogram): A cardiac catheterization, or coronary angiogram, is performed by threading a thin catheter into the heart via an artery in your leg or arm and injecting dye directly into the coronary arteries. These studies map out the coronary anatomy and detect narrowing within the arteries.

Computerized tomography (CT) scan: Coronary CT angiography is a relatively new imaging technique that, like cardiac catheterization, displays the coronary anatomy and identifies narrowing or blockages in the coronary arteries. Its potential advantage over the older, more traditional coronary angiogram is that it’s non-invasiveness, as a catheter does not need to be threaded into the heart.

Magnetic resonance angiogram (MRI): MRI studies are not usually obtained prior to coronary artery bypass surgery, but are most often useful for determining the functional potential, or “viability,” of heart muscle. It is also quite accurate in measuring overall heart function, assessing aortic diseases, and characterizing rare cardiac tumors.

Treatment

The two most common treatments for coronary artery disease are coronary angioplasty and stent placement, and coronary artery bypass grafting.

Coronary angioplasty and stent placement: This procedure is generally performed by interventional cardiologists. This procedure begins with placement of a special catheter into the heart via an arm or leg artery. A wire specially fitted with a balloon is guided through this catheter into the diseased coronary artery. The balloon is inflated at the point of vessel narrowing, plastering the atherosclerotic plaque against the side of the vessel wall, thereby opening up the vessel and improving blood flow through it. This allows enough room for to the cardiologist to place a metal stent in the artery that will help keep it open.

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Coronary artery bypass grafting: Coronary artery bypass grafting is a commonly performed cardiac operation whereby arteries taken from within the chest wall or arm and veins taken from the leg are used to detour blood flow around and past coronary artery blockages to deliver more blood to the heart muscle. This can be performed either with or without the heart-lung bypass machine. 

We understand that the thought of undergoing heart surgery can feel overwhelming. Our surgeons will review your surgical plan, in detail, so that you will know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their innovative treatment strategies.