Surgical Associates of Texas, P.A. - Diseases & Conditions

Coronary Artery Disease

Also known as Coronary Heart Disease (CHD), Coronary Arteryt Disease (CAD) is the most common form of heart disease. The National Institute of Health estimates that some 7 million Americans suffer from it. Each year more than 500,000 men and women in the US die of heart attacks caused by CAD.

What is Coronary Artery Disease?

The Main Coronary Arteries and their Branches Surround the Heart to feed the Muscle with Fresh Oxygenated Blood The coronary arteries, illustrated at right, surround the heart to  supply the heart muscle with the fresh blood nourishment it needs to do its work of pumping blood throughout the rest of the body. Just like other organs, the heart needs a constant supply of oxygenated blood to feed itself. Coronary Artery Disease is an occlusion (obstruction) of the coronary (heart) arteries resulting from atherosclerosis (arteriosclerosis). When the body goes into more strenuous activity, the heart has to work harder to supply the body's demands for fresh, oxygen-rich blood. When this happens, the heart's own need for oxygen rich blood rises, and the constrictions in coronary arteries prevent it from receiving the necessary amount. This insufficient supply of blood to the heart muscle results in oxygen deprivation, a condition called myocardial (heart) ischemia.

The image below left is an arteriogram showing occlusion of the right coronary artery.The illustration at right below shows a heart with diseased Left Anterior Descending (LAD) and Right Coronary Arteries (RCA). Stenosis is the diseased arterial tissue. A buildup of stenosis results in occlusion, or blockage, of an artery.

Arteriogram showing Occlusion of the Right Coronary Artery       Heart with Coronary Artery Disease

Symptoms of Coronary Artery Disease

An ischemic heart reacts by giving off a sensation of pain. We call this pain angina, or, more technically, angina pectoris. When the blockage of an artery is complete, for example, when an occluded artery is blocked by a thrombus (blood clot), the result is a heart attack. The heart tissue supplied by that coronary artery begins to die, and some of the heart muscle may be permanently damaged, or, in very severe cases, may result in death of the patient.

The earliest symptoms of CAD may be angina, shortness of breath, or both. Angina may be experienced as a heaviness, tightness, pain, burning, pressure, or squeezing of the chest usually behind the sternum (breastbone), but sometimes also in the arms, neck, or jaws. Typically, angina is brought on by intensified physical activity, emotional stress, eating, or cold temperatures.

Some people have no symptoms at all, some have mild, intermittent chest pain; and some have more pronounced and steady pain. Still others have CAD that is severe enough to make normal everyday activities difficult. Some people have heart attacks without ever having any of these symptoms. It is important to know that there is a wide range of symptoms and severity of CAD.

Because CAD and its symptoms vary so much from one person to another, diagnosis and treatment of CAD will also vary, depending on the individual case. If you suffer from angina you should consult your doctor about your condition. You must also be aware that angina-like pain that does not stop when your physical activity stops, or within just a few minutes after, may be the sign of an impending heart attack, or worse, of a heart attack in progress. You should seek prompt medical attention in that event.

Coronary Artery Disease and Heart Attacks

The inner lining of a healthy artery is very smooth and allows blood to flow freely. As plaque buildup progresses, it will accumulate calcium deposits, and this makes the artery stiff and hard. It also roughens the inner surface of the plaque, causing turbulence in blood flow in the area of the plaque. With time, the lining of fibrous tissue over the plaque may be eroded by this turbulent flow, and the inner core of the plaque is exposed to the blood stream. When this fatty core is exposed to blood a thrombus (blood clot) may form. This may cause the blood vessel to suddenly become totally blocked, a condition known as thrombosis. When this happens in a coronary artery, there is a sudden decrease in blood flow to heart muscle which causes a heart attack or myocardial infarction.

Risk factors for Coronary Artery Disease

Risk factors are conditions that increase the probability of developing heart disease. Some can be changed and some cannot.

Coronary Artery Disease Major Factors - Uncontrollable

Gender - pre menopause females have a lesser risk of heart attack than males. Post menopause females have about equal risk as males
Heredity - family history of CAD
Age - risk increases with age for both males and females

Coronary Artery Disease Contributing Factors - Controllable

High blood pressure
High blood cholesterol and triglycerides
Cigarette smoke
- Smokers have 2 to 4 times the risk of sudden death from a heart attack than non-smokers. Chronic exposure to second-hand smoke increases the risk of CAD.
Physical inactivity
- A diet high in fats and carbohydrates increases the risk of CAD

Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.

Treatment Options for Coronary Artery Disease

There are three approaches for treating Coronary Artery Disease:

  • Medication
  • Interventional Cardiology
  • Cardiovascular Surgery

It is important to note that none of these approaches provides a cure. In other words, although the symptoms are eliminated or alleviated, the disease and its causes are still present after treatment and require that the patient modify his or her lifestyle to properly prevent the disease from progressing and the symptoms from recurring.

Cardiovascular Surgery

When the number and location of stenosis injuries present a significant risk for the patient, surgery is the preferred method of treatment. All variations of coronary artery bypass surgery involve bypassing the blockage in the coronary arteries with a blood vessel taken from another part of the patient's body. The standard procedure is called Coronary Artery Bypass Grafting (CABG) surgery, or simply coronary artery bypass surgery. Since the first operation done in the 1960's, many different improvements and variation in techniques have been developed, including a new technique called Minimally Invasive Coronary Artery Bypass (MIDCAB), or "limited access coronary artery bypass" that is available for patients with one or two blocked coronary arteries. In contrast with conventional CABG, which is an open-heart surgery, this procedure is done through a smaller incision over the heart to access the coronary arteries.

If you have been advised to consider heart bypass surgery, we encourage you to contact us for CABG or limited access coronary artery bypass evaluation. The doctors at Surgical Associates of Texas will evaluate your case to determine the best approach for you.

TransMyocardial Laser Revascularization

TransMyocardial Laser Revascularization (TMLR) is one of the latest approaches in treating CHD. TMLR makes use of a laser to create blood perfusion channels in the heart muscle to supplement the function of the coronary arteries. If you have been advised that neither heart bypass surgery nor interventional cardiology are options for your condition, we encourage you to contact us for a TMLR evaluation.

Surgical Associates of Texas, P.A., the surgical team at the Texas Heart Institute, have more experience than any other cardiovascular surgical group in the world, having performed approximately 100,000 open heart surgeries of all types and degrees of complexity and over 800 heart transplants. Many of our patients have had successful operations and recovery when previously led to believe no further treatment options were possible.

If you are interested in learning more about any of these procedures, please visit our pages on Surgical Options for CAD or on the individual procedures for a more detailed illustrated description.

More on Surgical Options for CAD  |  CABG | MIDCAB | TMLR  

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Last revised April 2005