Coronary Artery Disease
Heart disease is the leading cause of death in the United States, and coronary artery disease is the most common type of heart disease.
Coronary artery disease occurs when cholesterol deposits called plaque build up on the walls of the arteries that supply blood to the heart. As these walls get thicker with deposits, the inside of the arteries become narrower.
Over time, less and less blood can flow through the arteries. Sometimes, they become completely blocked. This process, called atherosclerosis, can lead to heart attack, stroke, arrhythmia or heart failure.
Risk Factors of Coronary Artery Disease
Symptoms of Coronary Artery Disease
Testing for Coronary Artery Disease
Managing Coronary Artery Disease
Non-Invasive Procedures for Coronary Artery Disease
Coronary Artery Bypass Surgery
The risk of developing coronary artery disease increases after age 45 for men and age 55 for women. Family history is also a key risk factor.
Other risk factors – many of which you can control – include:
- Poor diet
- Being overweight
- Lack of regular exercise
- High LDL (bad cholesterol) levels
- Low HDL (good cholesterol) levels
- High triglyceride levels
- High blood pressure
Our specialized team at the Cardiac Wellness Clinic at Virginia Mason can work with you to address these risk factors to improve your health.
Angina is the most common symptom of coronary artery disease, and occurs when the heart muscle is not getting enough blood. Angina feels like discomfort, pressure, squeezing or pain in the chest. It can also cause pain in the jaw, neck, shoulders, arms or back.
If you have these symptoms during physical activity or while under stress, call for an appointment with your doctor. If you have these symptoms for no apparent reason, call 911 to get immediate medical attention. For some people, the first sign of coronary artery disease is a heart attack.
If you are at high risk for heart disease or already have symptoms, your cardiologist at Virginia Mason has several tests available to diagnose coronary artery disease, including:
- Heart calcium scan — uses a CT scanner to measure calcified plaque
- Exercise stress test — which involves walking with electrodes attached to your skin
- Stress echocardiogram —creates an ultrasound picture of your heart immediately before and after exercise
- Nuclear perfusion stress test — uses a radioactive isotope injected into a vein before and during exercise
- Carotid intima media thickness test — uses ultrasound to look for plaque
- Cardiac catheterization and angiography — uses a catheter inserted into an artery and maneuvered to the heart where contrast dye can show arteries that are narrowed or blocked
Some of these tests can be done in your cardiologist’s office. Others are done in the cardiac labs at Virginia Mason. Our interventional physicians are highly experienced and innovative. For example, they typically perform cardiac catheterization and angiography using an artery in the wrist (instead of the groin) to decrease the risk of complications and speed recovery time.
Treating coronary artery disease can involve lifestyle changes, medications or medical procedures. The type of treatment depends on how far the disease has progressed.
Lifestyle changes include:
- Following a heart-healthy diet
- Losing excess weight
- Managing stress
- Quitting smoking
- Getting enough exercise
Medications can include:
- Aspirin to reduce the risk of blood clots
- Enzyme inhibitors to lower blood pressure
- Beta blockers to slow the heart beat
- Calcium channel blockers to widen the arteries
- Cholesterol medications, such as statins, to help lower cholesterol
Procedures to restore blood flow to the heart include balloon angioplasty, coronary atherectomy and coronary artery bypass grafting.
Non-invasive procedures aimed at opening blocked or partially blocked arteries are done in the cardiac catheterization labs at Virginia Mason. Interventional cardiologists choose which procedure to use based on the size, location and characteristics of the blockage.
Balloon angioplasty involves using a thin catheter gently maneuvered to the blocked artery. The balloon is inflated within the blockage to restore blood flow. Percutaneous coronary intervention (PCI) is usually performed after the balloon is removed. PCI involves inserting a mesh coil called a stent into the artery to keep it open. A drug eluding stent – one coated with a slowly releasing drug – may be used to help prevent future blockages in the artery.
Coronary atherectomy involves shaving or cutting the blockage within the artery. As with balloon angioplasty, a thin catheter is maneuvered into the blocked artery. In addition to a balloon used to hold open the artery, a tiny drill is also inserted to shave off parts of the blockage. The shavings are sucked into the catheter and removed when the procedure is complete.
A minimally invasive procedure to reduce or remove a blockage may not be possible or appropriate if:
- The blockage cannot be easily fixed by angioplasty
- You have blockages in multiple vessels
- You have blockage in the main artery supplying blood to the heart
- Your heart muscle is weak
If one or more of these conditions are present, coronary artery bypass surgery has long been the solution for restoring blood flow to the heart muscle. In fact, coronary artery bypass surgery is the most common heart surgery performed in the U.S.
Bypass surgery involves using an artery or vein from the chest or leg to create a detour around the clogged artery. The new artery is grafted into place to restore blood flow to the heart.
If you have experienced angina or a heart attack, or had coronary angioplasty or heart surgery, your doctor may refer you to the Cardiac Rehabilitation Program at Virginia Mason.
Our rehab team includes physicians, nurses, exercise specialists and registered dietitians. We emphasize medical evaluation, exercise training, education and counseling. Our goal is to help you recover faster, return to a full and productive life, and reduce the risk of future heart problems.
For more information about cardiac rehabilitation at Virginia Mason, call (206) 625-7256.