CORONARY-ARTERY DISEASE

General Information

DEFINITION--Hardening and narrowing of the coronary arteries, which provide the blood supply to the heart. There are three main coronary arteries. When any or all become narrowed, they can no longer provide adequate oxygen for heart cells.

BODY PARTS INVOLVED--Blood vessels to the heart.

SEX OR AGE MOST AFFECTED--Adults of both sexes over age 40. Coronary-artery disease is uncommon in premenopausal women.

SIGNS & SYMPTOMS

Early stages:

• No symptoms (often).

Later stages:

• Angina pectoris (burning, squeezing, heaviness or tightness in the chest that may extend to the left arm, neck, jaw or shoulder blade).
• Heart attack.

CAUSES--Often unknown, except for association with risks listed below. In addition to narrowing due to hardening of arteries, blood clots frequently form and block arteries.

RISK INCREASES WITH

• Smoking.
• Family history of coronary disease, diabetes, high blood pressure or atherosclerosis.
• Poor nutrition; too much fat in the diet.
• Previous heart attack or stroke.
• Lack of exercise; obesity; hypertension.
• Hostile or impatient personality type.
• Elevated cholesterol and/or low level of HDL (high-density lipoprotein).

HOW TO PREVENT

• Don't smoke.
• Eat a low-fat, low-salt, high-fiber diet.
• Exercise regularly; attain ideal body weight.
• One aspirin a day (consult your doctor).
• See How to Cope with Stress in Appendix.
• If you have diabetes or hypertension, adhere strictly to the treatment schedule, including diet.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Diagnostic tests may include electrocardiogram, echocardiogram, exercise-tolerance test, thallium stress test, blood studies to measure total fat, cholesterol and lipoproteins, x-rays of the chest and coronary angiogram.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to bypass coronary arteries (severe cases).
• Balloon angioplasty (treatment for obstructed arteries). A small uninflated balloon is passed up the artery to the obstruction and then expanded to release the obstruction.
• Although these procedures may decrease or eliminate symptoms for a while, they do not control the underlying disease.
• Heart transplant (sometimes) for end-stage coronary artery disease.

POSSIBLE COMPLICATIONS--Life-threatening myocardial infarction (death of heart-muscle cells from inadequate blood flow).

PROBABLE OUTCOME--This condition is currently considered incurable. However, symptoms can usually be relieved or controlled. Treatment can prolong life and improve its quality. Evidence now suggests that aggressive treatment can reverse atherosclerosis to some degree. Scientific research into causes and treatment continues, so there is hope for treatment and cure.

How To Treat

GENERAL MEASURES--

• Reduce as many risk factors as possible.
• Stop smoking.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Nitroglycerin, anticoagulants, calcium channel-blockers, ACE inhibitors or beta-adrenergic blockers for angina pectoris and blood-vessel spasms.
• Vasodilator drugs to increase the blood supply to the heart muscle. Injection of a blood clot dissolving medication (sometimes).

ACTIVITY--Engage in a program of moderate, daily physical exercise.

DIET--

• Low-fat diet (see Low-Fat Diet in Appendix).
• If you are overweight, begin a moderate reducing diet and stick to it.

Call Your Doctor If

• You develop deep chest discomfort (aching or pressure) with radiation to the jaw, left arm or back. Call immediately; may be an emergency!
• You sweat and feel short of breath.
• After exertion, you develop chest, neck or jaw pain that goes away with rest.
• Symptoms worsen or don't improve.
• New or unexplained symptoms develop.