Coronary artery disease (CAD) is the most common form of heart disease, affecting more than 18 million people in the U.S. If you or a family member has recently been diagnosed with CAD, you may be wondering what comes next.
“While there is no cure for CAD, there is a full range of safe and effective treatments to stop its progression. With regular checkups, risk factor modifications and healthy lifestyle habits after treatment, you can enjoy an active lifestyle for years to come,” says Raed Alnajjar, M.D., a cardiothoracic surgeon at Henry Ford Health.
What Is CAD?
Coronary artery disease occurs when a sticky substance called plaque builds up in the coronary arteries that carry blood to the heart. Plaque is made of cholesterol, calcium and other materials. As it builds up over time, plaque creates blockages that can slow or stop the flow of blood, oxygen and nutrients to the heart. This process is called atherosclerosis (hardening of the arteries).
Many patients are first diagnosed with CAD after having symptoms like shortness of breath, chest pain (angina) or fatigue. In some cases, a patient is diagnosed with CAD after seeking emergency medical care for a heart attack, when blood flow to the heart is blocked. In other cases, a patient might have no symptoms (called a silent heart attack) or come late when he/she have symptoms of heart failure due to long-standing CAD.
What Factors Determine My Best Treatment Option?
Your doctor will discuss your treatment options based on many factors, including:
- Your physical exam
- Your medical history and family history of heart disease
- Diagnostic test results showing the number, size and location of blockages
To help his patients better understand CAD, Dr. Alnajjar likens the severity of the blockages to parts of the landscape.
“For those with mild CAD, blockages are like rolling hills on a prairie, forcing blood to take a meandering path through the artery. In moderate CAD, blockages are like a dam in a river, slowing blood flow to the heart. In more advanced stages of CAD, blockages have steep, high peaks that can completely block blood flow,” he says.
Here he explains the treatment options available for each stage of the disease.
For people with mild CAD, medications are the best option to prevent plaque buildup. The most common medications used to treat CAD are statins. These medications help prevent low-density lipoproteins (LDL), sometimes called “bad” cholesterol, from building up in the arteries.
Other medications used to control plaque buildup include beta blockers and calcium channel blockers. Your doctor may also recommend a daily aspirin to reduce your risk for a heart attack or stroke.
Medications are a vital component of treatment for patients with moderate or more severe CAD. Most patients affected by CAD continue taking these medications throughout their lives. Additionally, medical management also includes making sure that your blood pressure and blood sugar are under control if you are diabetic or have hypertension.
Angioplasty And Stents
If initial tests suggest moderate CAD, your doctor may recommend a diagnostic test called cardiac angiogram (also known as cardiac catheterization). Your cardiologist inserts a thin, flexible tube called a catheter into an artery in your groin or wrist. Using an x-ray, your doctor carefully guides the catheter to your heart. Dye is injected through the catheter. The dye illuminates blood flow through your coronary arteries on the x-ray, helping your doctor identify blockages (where they are, how many you have, how severe they are).
If one or two blockages are detected, your cardiologist may perform an angioplasty to treat the obstructions. In this procedure, a catheter with a deflated balloon-shaped device at the end is inserted into the affected arteries.
Once the device reaches the blocked area, your doctor inflates the balloon, pushing the plaque out of the way and improving blood flow. Your doctor may also insert a stent, a coil made of mesh, to keep the artery open.
The angioplasty procedure takes up to two hours, depending upon the number of blockages treated. After the procedure, you’ll stay overnight in the hospital. Most people return to normal activities about a week after the procedure.
Coronary Artery Bypass Surgery
If you have a higher number of blockages that are difficult to access through angioplasty, your doctor may recommend coronary artery bypass surgery. This procedure is an open-heart surgery, which involves an incision in your chest to repair your heart by rerouting the blood flow around the blockages by using conduits (arteries and veins that are harvested from a patient chest wall, forearm and legs).
Bypass surgery takes three to four hours, depending on the number, location and severity of the blockages. Your surgeon uses veins or arteries from other parts of your body to bypass the blockages and reroute the blood flow to the heart.
You’ll stay in the hospital for about a week after bypass surgery. During that time, physical and occupational therapists help you regain your strength. You’ll learn how to move through daily tasks while your chest bone (sternum) heals.
Once home, you’ll need to avoid lifting anything over ten pounds for up to eight weeks. Over time, you can increase your physical activity. Most patients fully recover within two to three months after surgery.
Keys To Recovery And Heart Health Moving Forward
After treatment, you’ll see a significant improvement in coronary artery disease symptoms. Your next step is to take time for recovery and maintain your heart health going forward. Dr. Warner recommends these strategies:
- Take all prescribed medications: Continue taking statins or other medications to reduce the risk for future blockages. Keep diabetes and high blood pressure (hypertension) under control with medications and diet.
- Complete cardiac rehabilitation: If you have an angioplasty or bypass surgery, your cardiac rehabilitation will begin in the hospital. Your doctor will recommend a cardiac rehabilitation program for you once you return home. The goal of these programs is to restore your physical and emotional health through education and exercise.
- Schedule regular doctor visits: You should have ongoing care from a primary care physician and cardiologist. With periodic testing, your care team can monitor your heart function and identify and treat new blockages.
- Adopt a healthy lifestyle: Make changes in your lifestyle to improve your heart health. Eat a heart healthy diet, avoiding foods high in sodium and saturated fat . Get moving with regular exercise and stop smoking. Manage stress and get adequate sleep.
“Together, these steps will help you live an active lifestyle for years after CAD treatment,” says Dr. Alnajjar.
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Dr. Raed Alnajjar is a cardiothoracic surgeon who sees patients at Henry Ford Hospital, Henry Ford Macomb Hospital, Henry Ford Macomb Medical Pavilion and Henry Ford Medical Center - Bloomfield Township.