Coronary artery disease

Diagnosis and treatment

Tests to help diagnose or watch coronary artery disease include:

• Blood tests. Blood tests can check blood sugar and cholesterol levels. A high-sensitivity C-reactive protein (CRP) test checks for a protein linked to inflammation of the arteries.
• Electrocardiogram (ECG or EKG). This quick test checks the electrical activity of the heart. It shows how the heart is beating. Sticky patches called electrodes attach to the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which prints or displays the test results. The ECG signal patterns can show if you had or are having a heart attack.
• Echocardiogram. This test uses sound waves to show blood flow through the heart. Parts of the heart that move weakly may be caused by a lack of oxygen or a heart attack. This may be a sign of coronary artery disease or other conditions.
• Exercise stress test. If your symptoms usually occur during exercise, your healthcare professional may recommend this test. You walk on a treadmill or ride a stationary bike while your heart is checked. Because exercise makes the heart pump harder and faster than it does during most daily activities, an exercise stress test can show heart problems that might otherwise be missed. If you can't exercise, you may be given a medicine that affects the heart like exercise does. Sometimes an echocardiogram is done during an exercise stress test.
• Nuclear stress test. This test shows how blood moves to the heart at rest and during activity. It uses a small amount of radioactive material, called a tracer or radiotracer. The substance is given by IV. An imaging machine takes pictures of how the tracer moves through the heart arteries. This helps find areas of poor blood flow or heart damage.
• Heart CT scan. A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries. Sometimes dye is given by IV during this test. The dye helps create detailed pictures of the heart arteries. If dye is used, the test is called a CT coronary angiogram.
• Cardiac catheterization and angiogram. This test can see blockages in the heart arteries. A doctor places a long, thin flexible tube called a catheter in a blood vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video. Heart treatments may be done during this test.

Many medicines are available to treat coronary artery disease, including:

• Cholesterol medicine. Your healthcare professional might recommend this type of medicine to lower "bad" LDL cholesterol and reduce plaque buildup in the arteries. Such medicines include statins, niacin, fibrates and bile acid sequestrants.

• Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in some people.

  Daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Don't start taking a daily aspirin without talking to your healthcare team.

• Beta blockers. These medicines slow the heartbeat and lower blood pressure. If you've had a heart attack, beta blockers may reduce the risk of future heart attacks.
• Calcium channel blockers. One of these medicines may be suggested if you can't take beta blockers or beta blockers don't work for you. Calcium channel blockers can help reduce chest pain.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs). These medicines lower blood pressure. They may help keep coronary artery disease from getting worse.
• Nitroglycerin. This medicine widens the heart arteries. It can help control or reduce chest pain. Nitroglycerin is available as a pill, spray or patch.
• Ranolazine. This medicine may help people with long-term chest pain. It may be prescribed with or instead of a beta blocker.

Surgery may be done to fix a blocked artery and improve blood flow. Surgeries or procedures for coronary artery disease may include:

• Coronary angioplasty and stent placement. This treatment opens clogged blood vessels in the heart. A tiny balloon on a thin tube, called a catheter, is used to widen a clogged artery and improve blood flow. A small wire mesh tube called a stent may be placed to keep the artery open. Most stents are coated with medicine that helps keep the artery open. This treatment also is called percutaneous coronary intervention.
• Coronary artery bypass graft (CABG) surgery. This is a type of open-heart surgery. During CABG, a surgeon takes a vein or artery from somewhere else in the body. The surgeon uses the blood vessel to create a new path for blood to go around a blocked or narrowed heart artery. The surgery increases blood flow to the heart.

If you've had coronary artery bypass surgery, your healthcare professional may suggest cardiac rehabilitation. This is a program of education, counseling and exercise training that's designed to help improve your health after heart surgery.

Coronary artery stent

To place a coronary artery stent, a balloon on the tip of the catheter is inflated to widen the blocked artery (A). Then a metal mesh stent is placed (B). The stent helps hold the artery open so blood can flow through it (C).

Coronary artery bypass surgery

Coronary artery bypass surgery creates a new path for blood to flow to the heart. A healthy blood vessel from another part of the body is used to send blood around a blocked area of an artery. The blood vessel usually comes from an artery in the chest, called the internal mammary artery. Sometimes it's taken from a leg vein, called the saphenous vein.

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. For example, you may be told not to eat or drink for a few hours before a cholesterol test.
• Write down any symptoms you're having, including any that may seem unrelated to coronary artery disease.
• Write down your medical information, including other conditions you have and any family history of heart disease.
• Bring a list of medicines with you to your appointment. Include doses.
• Ask a family member or friend to go with you to the appointment, if possible. An extra person can help you remember details from the appointment..
• Write down questions to ask your healthcare team.

Questions to ask your healthcare professional at your first appointment include:

• What is causing my symptoms?
• What tests do I need?
• Should I see a specialist?
• Do I need to change my activity or diet while I wait for my next appointment?
• When should I call 911 or emergency medical help for my symptoms?

If you're sent to a cardiologist for coronary artery disease, you may want to ask these questions:

• What is my risk of long-term complications from coronary artery disease?
• What treatment do you recommend?
• If I need medicine, what are the possible side effects?
• Do I need surgery? Why or why not?
• What diet and lifestyle changes should I make?
• How often do I need follow-up visits?
• I have other health conditions. How can I best manage these conditions together?

Don't hesitate to ask additional questions.

A healthcare professional who sees you for coronary artery disease may ask:

• What are your symptoms?
• When did you begin having symptoms?
• Have the symptoms gotten worse over time?
• Do you have chest pain or difficulty breathing?
• If so, what does the chest pain feel like?
• Does exercise or activity make the symptoms worse?
• Does anyone in your family have a heart condition or high blood pressure?
• Have you been diagnosed with other health conditions?
• What medicines do you take?
• How much do you exercise in a typical week?
• What's your usual daily diet?
• Do you or did you smoke? How much? If you quit, when?
• Do you drink alcohol? How much?

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. These habits protect against coronary artery disease and its complications, including heart attack and stroke.