- Tests your doctor may order to determine whether you have heart disease
- A Silent Threat to Women’s Hearts That Many Don’t Recognize
- Are You at Risk for This Quiet Killer?
- Heart Symptoms in Women vs. Men
- When to Have the Heart-Health Conversation?
- Heart Test Facts to Know
- Warning signs when an artery is blocked, and how to fix it
- Impacts of a complete blockage
- Updated Classification System Captures Many More People at Risk for Heart Attack – 01/11/2017
- Healthdirect 24hr 7 days a week hotline
- Heart attacks
- Heart failure
- Coronary Artery Disease Symptoms
- Blocked Heart Arteries: Symptoms, Prevention, Diagnosis and Treatment
- 7.Treatment and Surgery
- What is coronary microvascular disease (MVD)?
- Other names for coronary microvascular disease
- What causes coronary microvascular disease?
- Understand your risk for coronary microvascular disease
- What are the signs and symptoms of coronary microvascular disease?
- Diagnosis of Coronary Microvascular Disease
- Diagnostic Tests
- Duke Activity Status Index (DASI)
- Treatment of Coronary Microvascular Disease
- Prevention of Coronary Microvascular Disease
- Coronary Artery Disease
- Expert Diagnosis of Coronary Artery Disease
Tests your doctor may order to determine whether you have heart disease
Heart test can show reduced blood flow from artery blockage
A nuclear stress test shows areas of heart muscle that receive good blood flow at rest , but are starved of blood during exercise , due to insufficient blood flow.
What’s the right heart test for you?
There’s a good chance your first test will be noninvasive. This means it may be possible to obtain information without inserting needles or tubes into your body. “We usually start with the least complex and least expensive test, and go from there,” says Dr. Marcelo Di Carli, director of the cardiovascular imaging program at Brigham and Women’s.
A treadmill stress test is often the first test performed. You’ll walk at a brisk pace on a treadmill that’s slowly inclined to offer more resistance. This gets your heart pumping harder and faster. As you walk, an electrocardiograph measures your heart rate and the electrical activity in your heart, and your blood pressure is recorded periodically. A person who cannot walk on a treadmill will be given a drug to mimic the effects of exercise.
What you should ask your doctor about heart tests
When your doctor wants you to have heart tests, ask:
Why do I need this test?
Are there any alternatives?
How will the test results affect my treatment?
Does the test require any special preparations?
Do I need to stop taking any medications or food before the test?
The stress test may be combined with echocardiography, a nuclear perfusion study, or magnetic resonance imaging (MRI) to determine whether a flow-limiting blockage is present (see “Stress imaging studies explained” on page 7). These tests reveal how much of the heart muscle is affected by poor blood flow when challenged. An echocardiogram may also show an area of heart muscle that is impaired and not contracting normally after exercise. Nuclear studies and MRI can reveal which parts of the heart are receiving low blood flow, indicating an obstructed artery.
Since most older people have some degree of artery narrowing caused by coronary artery disease (atherosclerosis), the question is whether the narrowings interfere with blood supply to the heart muscle. If they do, attempts to reduce the narrowings through lifestyle changes or with bypass surgery or angioplasty and stenting may be needed. But that is not always the case.
“A person may have extensive coronary artery disease, but still have adequate blood supply to the heart muscle during exercise,” says Dr. Di Carli. “Neverthless, improving blood flow through their coronary arteries may prevent future problems.
When heart tests suggest heart disease
A “positive” stress test means that an artery may have one or more fatty plaques large enough to interfere with blood supply. A test is then needed to pinpoint their location,
The gold standard for this purpose is an angiogram taken during cardiac catheterization, an invasive test. A noninvasive alternative is an angiogram taken with an enhanced form of x-ray called computed tomography (CT). CT angiography is now used in many emergency departments to quickly rule out coronary artery disease in patients admitted with chest pain.
“A negative CT angiogram essentially excludes the presence of any significant disease and implies an extremely low risk of future heart attack,” says Dr. Blankstein.
Determining risk of heart attack
Cardiologists react with more concern when a large amount of the heart is in jeopardy. “Detecting a certain amount of heart muscle being starved of blood flow can help predict when revascularization is likely to improve symptoms and outcome,” Dr. Di Carli explains.
Even after a stress test and angiogram are performed, it is often not clear whether a blocked blood vessel is causing a problem. More testing might be needed.
However, some heart attack-causing plaques narrow an artery by only 30% to 40% and cause no symptoms until they suddenly rupture, causing a heart attack. Finding a way to identify lesions prone to rupture could save countless lives. Although many companies and investigators are trying to find ways to predict the most dangerous lesions, no one has yet shown that this will be able to prevent heart attacks.
What heart tests show blockage?
Echocardiogram. Before and after a person walks on a treadmill, a small device is placed against the chest. It emits ultrasound waves, which bounce off the heart and produce a moving image of the beating heart and its valves.
Nuclear perfusion studies. At rest and after exercise, a radioactive substance is injected into the veins and travels to the heart. This substance enables images taken with a camera to show areas of abnormal blood flow to the heart muscle caused by narrowings or blockages in the arteries, as well as scarred areas from prior heart attack.
Magnetic resonance imaging (MRI). The person lies inside an MRI machine. Images are taken at rest and after a medicine is given to increase blood flow to the heart. The images can show areas of scarring and how well different parts of the heart contract.
Echocardiogram and other heart tests
What it can show
Why it is ordered
Treadmill stress test
Heart rate, blood pressure, symptoms, and changes in the electrical activity of the heart that occur during or after exercise
Chest pain or other symptom of coronary artery disease
Pumping function and heart valve function
Heart failure, damage after a heart attack, heart valve problems
Nuclear stress test
Abnormal blood flow to the heart muscle from narrowing or blockages in the coronary arteries, prior heart attacks
Symptoms that suggest heart disease
Cardiac computed tomography (CT) angiography
Presence of plaque as well as severity of narrowing of the heart’s arteries
Symptoms that suggest heart disease
Cardiac magnetic resonance imaging (MRI) stress test
Heart muscle dysfunction, tumors, other rare disorders
Symptoms that suggest heart disease, underlying cause of heart muscle disease (cardiomyopathy), evaluation after heart attack
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A Silent Threat to Women’s Hearts That Many Don’t Recognize
Are You at Risk for This Quiet Killer?
If you are a woman with silent coronary artery disease (CAD), you may not realize that the arteries leading to your heart can get partially blocked by plaque buildup. But this situation can cause a heart attack as heart tissue dies and is starved of a nutrient-rich blood supply.
“Women do not understand it’s the No. 1 killer,” says Battaglino about heart disease. “Give them the tools to find out about the risk. Women will share their stories.”
Battaglino was inspired to get involved in patient advocacy for women because she was impressed by Violet Bowen-Hugh, MD, a champion for women’s health who began the nonprofit national women’s health resource center that’s now called HealthyWomen. “In 1988, a female ob-gyn from West Virginia founded our organization. She believed all women need to be educated, regardless of their socio-economic background, to make educated decisions about their own health,” Battaglino says.
Now, Battaglino hopes that more women will join the conversation about heart disease online and become their own advocates in the doctor’s office.
“Write a blog post. Go on social media. Share what you learned with friends and family,” she urges. “If we don’t take care of ourselves, we won’t be there to take care of those we love.”
Heart Symptoms in Women vs. Men
Women can all too easily overlook the more subtle symptoms of a heart condition like atherosclerosis — including arm or back pain. Often, the condition remains undiagnosed until after a heart attack or heart failure from arterial blockage, notes the National Heart, Lung, and Blood Institute.
“Symptoms present (show up) so differently in women than in men,” explains Battaglino. In women, coronary artery disease may mimic other common, less deadly ailments. Whereas a man is more likely to feel the typical effects of angina — sharp chest pain — women need to be looking out for other possible symptoms, she says.
Women’s symptoms of coronary artery disease can include:
- Feeling tightness in your jaw
- Upper back pain
- Upper arm pain
- Upper abdominal pain
- Throat pain
- Stomach pain
- Sudden weakness or fatigue
You, or a woman you love, could easily mistake the pain of coronary artery disease for a pulled muscle. Gut pains might seem like simple indigestion. Even sudden-onset fatigue is too often explained away by women who don’t realize it could be heart related.
“Many women are often tired, and so could easily dismiss that. But it could be a sign of coronary artery disease,” says Battaglino.
When to Have the Heart-Health Conversation?
You don’t have to wait until a cardiologist diagnoses you with heart disease — at your annual well-woman checkup, you can become your own patient advocate. Take advantage of the opportunity to find out more about how your heart is working.
“It’s so important to have the conversation about heart health when you visit the ob-gyn or your primary care provider,” says Battaglino. “If they tell you your blood pressure is a little high, for example, ask, what does that mean?” This way, you can understand what your heart is telling you in the results of routine, but vital, heart-health tests like blood pressure.
RELATED: 10-Step Do-It-Yourself Heart Makeover
When you get to the few precious minutes you have with your doctor, tell them about any symptoms that could point to heart disease. “You want to bring up anything that’s bothering you, like indigestion, pain in the upper arm, back, or neck, or tightness in the jaw. Remember, women present (show symptoms) differently than men,” Battaglino says.
She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but also for family members who may be getting ready for their annual primary care visit.
Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”
The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.
A few places to find heart health info you can use are:
- AHA’s Go Red for Women
- Women Heart
- Fight the LadyKiller
- Spread the Word
While you’re with your healthcare provider, be sure to talk about how you might be able to cut your risk for heart disease. Important factors include a healthy diet, regular exercise, and curtailing any exposure to smoke — be it cigarettes, e-cigarettes, or secondhand smoke.
While you’re there, remember to check that you’re current with all your vaccines. If you’re a smoker, you may want to get the pneumonia vaccine, Battaglino points out. And if you’re not sure whether or not you were vaccinated against measles — which has reappeared in the United States — ask your doctor about getting your MMR vaccine. If you have a heart condition, you may be at greater risk for infection and complications, which can be severe.
Battaglino says about her patients, “They can have blood drawn and have titers taken to find out if they need a booster or not.”
Heart Test Facts to Know
If your visit to primary care turns up a possible heart condition, be proactive and ask for a cardiac referral.
“You’d go to primary care, then you’d see a cardiologist, and based on that you’d see about tests. Understand the testing that’s available to you,” says Battaglino.
Getting the right tests just might put you on the path to avoiding a potentially fatal heart attack. Heart tests have different benefits and health risks. Here are some of the heart tests that might come up, what they identify, and, for some, their radiation exposure risks:
CAD Blood Test This sensitive genetic test may be considered to identify which genes are active. (The test is manufactured by CardioDx.)
Exercise Stress Test An ECG (electrocardiogram), with or without imaging of the heart with an echocardiogram, is done while you walk on a treadmill or pedal a stationary bicycle. This test can identify blood flow limiting coronary artery disease.
CT Coronary Calcium Scan Also called the Agatston score, this heart scan shows areas where plaque has built up inside your blood vessels even before symptoms appear. It exposes you to radiation of about 3 millisieverts (mSv, a measure of radiation dose).
CT Coronary Angiogram Another heart scan, this is one that identifies narrowing of individual coronary arteries. But note that it exposes you to significantly more radiation than a calcium scan — 12 mSv.
Nuclear Stress Test This combines an ECG, small amounts of intravenous radioactive dye, and heart scans that include radiation exposure of about 10 to 24 mSv. For comparison, a mammogram exposes you to about 0.4 mSv, and a dental exam to 0.005 mSv. This test can identify regions of the heart that have diminished blood flow during exercise or drug-induced stress.
Don’t be afraid to ask questions if you don’t know what the tests involve. According to Andrew Einstein, MD, PhD, associate professor of medicine at Columbia University Medical Center in New Your City, two questions you should always ask about your heart test are:
1. Is there a good clinical reason I’m getting this test?
2. Do you modify the test for each specific patient?
The answer to the first question should, of course, be yes. And Dr. Einstein points out that it’s important that some tests be adjusted to suit the person, because a woman may need lower radiation doses based on her weight, the size of her heart, or her age.
The best practice is to minimize your exposure to radiation, because you may be scheduled for several X-ray screening tests in a year by different doctors. Both your referring physician and the doctor who actually does the tests should discuss the risks of radiation exposure with you, according to the AHA.
Warning signs when an artery is blocked, and how to fix it
Imagine driving through a tunnel.
On Monday, you encounter a pile of rubble. There is a narrow gap, big enough to drive through.
On Tuesday, you’re driving through the tunnel and find a giant boulder blocking the entire tunnel. No gaps whatsoever.
Now translate those examples to your health. The tunnels are the arteries that carry blood to your heart. The rubble and boulders are blockages that can lead to problems – shown through symptoms.
Blocked tunnels aren’t good for traffic flow, and blocked arteries aren’t good for your heart.
In cardiology, the boulder is called a Chronic Total Occlusion (CTO). It means the artery is completely blocked. This occurs in 15 percent to 20 percent of patients who have heart disease. Sometimes there has been a complete blockage for many months or even years. However, only about 3 percent to 5 percent of these patients undergo a stent or bypass procedure, so there’s a real need to help these untreated patients.
Failure to diagnose and treat a CTO can lead to symptoms and impact your quality of life.
Impacts of a complete blockage
Artery blockages are not created equal. Treatment of an artery that is 97 percent blocked is much easier than treating one that has been 100 percent blocked for a long time. The symptoms – chest pain, tightness and shortness of breath – can be similar, though.
Sometimes, when arteries become completely blocked, a new blood supply develops around the blockage. This new blood supply, called collaterals, won’t deliver as much blood to your heart. This can lead to those same symptoms of chest pain and shortness of breath.
If you have these symptoms, a stress test can help determine if they are caused by a blockage in an artery or something else. The first step is to see a doctor.
Peripheral artery disease (PAD) is a buildup of cholesterol and plaque in the arteries that lead to your extremities. PAD can cause discomfort in your legs and feet, and limit your walking and activities. Severe PAD can progress to loss of limb. Your doctor can check for signs of the disease with a simple test of pulses in your feet.
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When cholesterol buildup blocks the arteries to your heart, this is called condition coronary artery disease (CAD), explains vascular surgeon Lee Kirksey, MD.
“In reality, PAD and CAD are associated with a single disease, atherosclerosis, which is a buildup of cholesterol in the arteries throughout the body,” Dr. Kirksey says. Sometimes the presence of PAD indicates an increased risk for heart disease, so screening and awareness of the connection between PAD and CAD is important.
Checking for pulses in your feet
The simplest test to screen for PAD is to have your physician check for the pulses in your feet during a routine physical exam. In each foot, there should be two pulses that are easily detected by a trained physician. This test is performed to determine whether the blood flow to your feet is normal.
The next step in screening is the ankle brachial index, which uses blood pressure cuffs on your arm and leg in combination with a Doppler probe, which uses an ultrasound wave, to help hear the pulse in the foot. “Using this technology, we can better assess the blood flow to the area,” Dr. Kirksey says. “For most people, blood pressure in the foot should be similar to the blood pressure in the arm. A drop of as little as 10 percent in that pressure can be an indication of peripheral artery disease.”
Generic screenings could offer false positives
You might have encountered offers for “comprehensive” screening/testing at community events, offered by for-profit companies, or surgical or interventional groups. These screenings often cover a wide range of conditions — everything from osteoporosis to coronary artery disease.
You are probably better off being seen by your primary care doctor, who knows you best, to find out whether you ought to have a specific test performed. There’s no proof of benefit to generic testing, and it can have unforeseen consequences, including false positive results that put you at risk for other invasive, unnecessary procedures.
Signs of a problem
People whose legs are painful or get tired easily or who have trouble walking distances because of leg cramps should have an assessment for PAD, Dr. Kirksey says. Current or past smokers, or anyone with a family history of PAD or symptoms of the disease, should also be assessed.
No symptoms, no testing needed
Screening for PAD probably doesn’t make sense for a healthy individual without symptoms, who is younger than 60 years old, has never smoked and has no family history of atherosclerosis or heart disease, he adds.
In this case, screening may actually expose a patient to more risk. This is because the tests can occasionally be incorrect and lead to much more invasive testing, which has its own inherent risks.
PAD may affect the whole body
It’s important to remember that atherosclerosis is not a localized process; it is a systemic disease that affects the arteries everywhere in the body. To that end, if you have PAD, you have a greater risk of having a stroke or heart attack, Dr. Kirksey notes.
Medication and lifestyle changes, including stopping smoking, are very important for patients who have any evidence of a decrease in the blood flow in their legs and feet.
So listen to your body and report when your body is talking to you. ‘Charlie horses’ in your legs and muscle cramps may be a sign of vascular disease.
Updated Classification System Captures Many More People at Risk for Heart Attack – 01/11/2017
“What we and others can conclude from such evidence is that far less severe blockages can cause trouble because the sticky plaques can lead to the clumping of blood cells in coronary arteries, producing small clots that may cause chest pain and ultimately may lead to a heart attack,” says Armin Zadeh, M.D., Ph.D., M.P.H., associate professor of medicine and member of the Heart and Vascular Institute at the Johns Hopkins University School of Medicine. “But because our current diagnostic criteria don’t point to an immediate problem, we aren’t always treating people who may have the same risk for heart attack as those with greater blockages.”
That gap in diagnosis and preventive therapy, Zadeh says, led them to undertake development of an updated classification system better able to capture those with nonobstructive heart disease.
At the heart of the new system are “earlier” stages, dubbed stage 1 and stage 2, that encompass the previously underrecognized and untreated population, and including patients with several moderate blockages in the high-risk category. In practice, the researchers say, that population is composed of people complaining about chest pain or unexplained shortness of breath during mild exertion. To diagnose heart disease with mild or moderate blockages — stages 1, 2 or even 3 — such individuals could undergo a cardiac CT or MRI scan.
Current and widely used guidelines call for anyone with chest pain to undergo a cardiac exercise or chemical stress test. Those who “fail” the test then generally undergo coronary angiography by cardiac catheterization, a form of invasive imaging with a dye injected into a catheter threaded into the heart’s blood vessel system, which visualizes blockages.
“The problem with this approach is that stress tests accurately detect only heart disease that is very advanced,” says Zadeh. “And cardiac catheterization, which can give an accurate reading about the percentage of blockage, is invasive, so we don’t want to be routinely doing that for people who do all right on a stress test or for those with borderline results.”
The suggested new system has five stages, which, Zadeh acknowledges, depend far more heavily on cardiac CT or MRI rather than stress testing.
Traditional treadmill stress tests, which use an EKG to measure the electric activity of the heart, run under $200 but go up to $500 if done with ultrasound imaging. Nuclear stress tests that use radioactive dyes to image the heart can cost around $950. Cardiac CT scans run between $400 and $600, and cardiac MRI scans cost a little over $800.
Stage 0 is defined as no visible heart disease based on a heart scan, meaning no visible plaque buildup in the heart’s arteries. Stage 1 would be considered mild heart disease, in which one to two blood vessels may be blocked less than 30 percent. Stage 2 is defined as moderate heart disease, with blockage between 30 and 49 percent in one to two vessels, or mild blockage in three blood vessels. At stage 3, a person would be considered to have severe heart disease, meaning one to two coronary arteries show more than 50 percent narrowing of the vessels diameter, or three blood vessels are moderately blocked in the 30 to 49 percent range. Very severe heart disease, or stage 4, has three or more vessels with over 50 percent blockage.
Based on data from the U.K. review and many others, Zadeh says, at each increasing stage, the risk of heart attack or death per year goes up, starting from a less than 0.1 percent risk a year among those at stage 0, 0.1 to 0.9 percent risk within a year at stage 1, 1 to 1.9 percent risk at stage 2, 2 to 3.9 percent risk at stage 3, and 4 percent or greater risk of heart attack or death for those at stage 4. The risks in these stages were established by coronary angiography from both cardiac catheterization and noninvasive CT scanning data.
“Heart disease deaths have dropped substantially thanks to better diagnosis and treatment, but particularly due to improved preventive measures, including treating risk factors such as high blood pressure and cholesterol,” says Zadeh. “However, heart disease will remain a leading cause of death until we achieve better population health and identify earlier the millions of people whose risks of heart attack are being missed, underdiagnosed and untreated. Expanding our diagnostic criteria for heart disease is a good first step, and we think there’s enough evidence to do so.”
In the U.S., according to government statistics, heart disease remains the leading cause of all adult deaths, killing more than 600,000 people each year, although the cancer death rate is rapidly closing the gap.
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If your coronary arteries become partially blocked, it can cause chest pain (angina). If they become completely blocked, it can cause a heart attack (myocardial infarction).
Some people experience different symptoms, including palpitations and unusual breathlessness. In some cases, people may not have symptoms of coronary heart disease at all before they are diagnosed.
If you think you are having a heart attack, dial triple zero (000) for immediate medical assistance.
Angina is chest pain or discomfort caused by insufficient blood flow and oxygen to the muscle of the heart. In most cases the lack of blood flow is due to a narrowing of the coronary arteries.
Angina isn’t a disease; it’s a symptom of an underlying heart problem, coronary heart disease (CHD), also called ‘ischaemic heart disease’.
Angina usually occurs during exertion or severe emotional stress. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver.
Angina attacks can be prompted by exertion or physical exercise, when the hardworking heart muscle requires greater amounts of oxygen. The pain usually fades away with rest.
Pain and discomfort are the main symptoms of angina which is described as pressure, squeezing, burning or tightness in the chest. The pain may feel like indigestion. Some people say that angina pain is hard to describe or they can’t tell exactly where the pain is coming from.
The most common symptoms of angina can include:
- pain or discomfort in the middle of the chest
- pain may be accompanied by breathlessness and sweating
- pressure or a feeling of tightness in the chest
- radiating pain to the neck, jaw and left arm, or both arms
- sometimes, radiating pain in the upper back and shoulders
Signs and symptoms such as nausea, fatigue, dizziness, sweating, light-headedness, or weakness also may occur.
Angina is often triggered by physical activity or stressful situations. The symptoms usually pass in less than 10 minutes and can be relieved by resting or using a nitrate tablet or spray.
Heart attacks can cause permanent damage to the heart muscle and, if not treated straight away, can be fatal.
The discomfort or pain of a heart attack is similar to that of angina, but it is often more severe and usually longer lasting.
The symptoms of a heart attack can be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn.
Or you may experience minimal or no pain.
A heart attack can happen at any time, including while you are resting.
Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray.
Heart failure can occur in people with CHD. The heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or gradually, over time (chronic heart failure).
Coronary Artery Disease Symptoms
One common symptom of CAD is a type of chest pain called angina. Angina may feel like tightness, heaviness, or pressure in your chest. It may involve an aching, burning, or numb sensation. It can also feel like fullness or squeezing.
You may also feel angina radiating to your back, jaw, neck, shoulders, or arms. The discomfort may also extend from your shoulder down to your fingers or into your upper abdomen. You typically won’t feel angina pain above your ears or below your belly button.
Sometimes angina causes only a vague feeling of pressure, heaviness, or discomfort. It can masquerade as indigestion or shortness of breath. Women and older adults are more likely than men and younger people to have this kind of angina.
Angina can cause other symptoms too, such as sweating or a general sense that something is wrong.
Cause of angina
Angina results from ischemia. Ischemia happens when your heart isn’t getting enough blood with oxygen. This can make your heart muscle cramp and function abnormally.
It usually happens when you’re involved in an activity that requires extra oxygen, such as exercising or eating. When you experience stress or cold temperatures and your body is trying to cope, your heart can also become deprived of oxygen.
Ischemia from CAD doesn’t always produce symptoms. Sometimes anginal symptoms don’t occur until a person is to the point of having a devastating cardiac problem, such as a heart attack, heart failure, or heart rhythm abnormality. This condition is called “silent ischemia.”
Stable and unstable angina
Angina may be classified as stable or unstable.
- Happens at predictable times. For example, it commonly happens during periods of stress or exertion when your heart is working harder and needs more oxygen.
- Usually lasts for a few minutes and disappears with rest.
- Sometimes also called “chronic stable angina” in that, when it does occur, each episode is similar, brought on by making the heart work harder, and predictable within a long timeframe.
- Also called “rest angina,” it occurs when no particular demand is being placed on your heart.
- The pain usually doesn’t get better with rest and can worsen with each episode or be excruciatingly severe out of nowhere. It can even wake you up from a sound sleep.
- Thought to be due to an acute rupture of an atherosclerotic plaque and subsequent associated blood-clot formation inside a coronary artery, causing a sudden and severe blockage of blood flow to the heart muscle.
Blocked Heart Arteries:
Symptoms, Prevention, Diagnosis and Treatment
7.Treatment and Surgery
Once coronary artery disease is diagnosed, patients have several options to manage or treat it. Your doctor might recommend lifestyle changes along with treatment with drugs. In some cases, your doctor might suggest a surgical procedure based on the seriousness of the condition.
Your doctor might recommend the following lifestyle measures to maintain healthy arteries or manage blood cholesterol levels.
- Quit smoking: Smoking is a major risk factor for CAD. The blood vessels are constricted with nicotine forcing the heart to work harder. On the other hand, carbon monoxide reduces oxygen in the blood and damages the lining of blood vessels. Vascular injury is the main reason for plaque formation. Quitting smoking can help in maintaining healthy arteries.
- Manage blood pressure: Blood pressure should be checked regularly, especially in those who have blood pressure higher than normal or have a history of heart disease. Follow the doctor’s advice in managing blood pressure with drugs and diet.
- Manage cholesterol: You have to manage blood cholesterol levels regularly to keep a check. It includes observing the levels of LDL, HDL and TG. Know more about the good cholesterol and bad cholesterol and the foods that help in managing them.
- Manage blood sugar levels: In patients who are diabetic, tight blood sugar management can help manage coronary artery disease.
- Following a healthy diet: Eat healthy food that includes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts and also food which is low in saturated fat, cholesterol and sodium. This can help you control your weight, blood pressure and cholesterol. Avoid saturated fat and trans fat, excess salt, and excess sugar.
- Exercise regularly: Keeping active with exercise can help you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. These are all risk factors for coronary artery disease.
- anage body weight: The risk of coronary artery disease increases with weight. Losing even a small percentage of weight can help in dramatically reducing risk factors of coronary artery disease.
- Manage stress: Practice techniques to manage stress.
If lifestyle changes are not adequate, or for better results, your doctor might recommend medication to keep the heart healthier. It is important to follow the dose and take the medication regularly.
- Medication to manage blood cholesterol: Blood cholesterol is the main reason behind the plaque formation that clogs the arteries. Your doctor may recommend drugs to manage bad cholesterol (LDL) or improve the good cholesterol (HDL). He may also recommend medication to manage triglycerides (TGs). Your doctor may choose from a range of cholesterol lowering medication including statins, niacin, fibrates and bile acid sequestrants.
- Aspirin: Aspirin or agents called blood thinners can reduce the tendency of blood to clot. Blood clots can block arteries and hence taking aspirin or blood thinners daily can help in preventing the formation of clots. Aspirin can also prevent future heart attacks however in some cases it may be inappropriate such as in patients having bleeding disorder. You have to inform your doctor in advance if you have any bleeding disorder.
- Beta blockers: These medications slow the heart rate and decrease blood pressure, which decreases the heart’s demand for oxygen. Beta blockers reduce the risk of future attacks in patients who had attacks earlier.
- Calcium channel blockers: In cases where beta blockers are not effective or if the patient is unable to take beta blockers the doctor might recommend calcium channel blockers. This medication can help in improving the symptoms of chest pain (angina).
- Ranolazine: Your doctor may prescribe this drug along with a beta blocker or instead of a beta blocker if you cannot take it. It helps in managing chest pain (angina).
- Nitroglycerin: Nitroglycerin is available as tablets, sprays and patches and can help in controlling the chest pain. It temporarily dilates coronary arteries and reduce the heart’s demand for blood.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): These drugs decrease blood pressure and may help prevent progression of coronary artery disease.
Sometimes more aggressive procedures are needed to restore and improve blood flow, these include.
- Angioplasty and stent placement (percutaneous coronary revascularization): In this procedure a long, thin tube called a catheter is inserted into the narrowed part of the blocked artery. The surgeon will insert a wire with a deflated balloon through the catheter to the narrowed area of the blocked artery. Once in place, the balloon is then inflated resulting in the compression of the plaque deposits against the artery wall. The heart artery surgery might often leave the stent in the artery to keep it open. Some stents will have the ability to release medication to keep the arteries open.
- Coronary artery bypass grafting: In this procedure a surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of the body. After the procedure the blood flows around the blocked or narrowed coronary artery. This surgery is done through open heart procedure and is often reserved for cases of multiple narrowed coronary arteries. You will be advised to stay in the hospital for at least 5 days.
What is coronary microvascular disease (MVD)?
Coronary microvascular disease (sometimes called small artery disease or small vessel disease) is heart disease that affects the walls and inner lining of tiny coronary artery blood vessels that branch off from the larger coronary arteries. Coronary heart disease (CHD), also called coronary artery disease, involves plaque formation that can block blood flow. In coronary MVD, the heart’s tiny coronary artery blood vessels do not have plaque, but damage to the inner walls of the blood vessels that can lead to spasms and decrease blood flow to the heart muscle.
Women more frequently develop coronary microvascular disease and it occurs particularly in younger women; however, men and women who have coronary MVD often have diabetes, high blood pressure or a family history of cardiomyopathy.
Diagnosing coronary MVD has been a challenge for doctors. Standard tests used to diagnose coronary heart disease are not designed to detect coronary MVD, so more research is needed to find the best diagnostic tests and treatments for the disease.
According to the National Heart, Lung, and Blood Institute’s (Women’s Ischemia Syndrome Evaluation), research is ongoing to learn more about the role of hormones in heart disease and to find better ways to diagnose coronary MVD.
Other names for coronary microvascular disease
- Cardiac syndrome X
- Nonobstructive coronary heart disease
What causes coronary microvascular disease?
The same risk factors that cause atherosclerosis may cause coronary microvascular disease (MVD). Atherosclerosis is a disease in which plaque builds up inside the arteries.
Risk factors for atherosclerosis include:
- Unhealthy blood cholesterol levels
- High blood pressure
- Overweight and obesity
- Unhealthy diet
- Older age
- Family history of heart disease
Understand your risk for coronary microvascular disease
Women may be at risk for coronary MVD if they have lower than normal estrogen levels at any point in their adult lives. Low estrogen levels before menopause can raise younger women’s risk for coronary MVD and can be caused by stress and also a functioning problem with the ovaries.
Women who have high blood pressure before menopause, especially high systolic blood pressure, are at increased risk for coronary MVD. After menopause, women tend to have more of the traditional risk factors for atherosclerosis, which also puts them at higher risk for coronary MVD.
Women who have heart disease are more likely to have a worse outcome, such as a heart attack, if they also have anemia because anemia is thought to slow the growth of cells needed to repair damaged blood vessels.
What are the signs and symptoms of coronary microvascular disease?
Women with coronary MVD often have chest pain called angina, also called microvascular angina usually lasting longer than 10 minutes, and it can last longer than 30 minutes.
Other signs and symptoms of coronary MVD are:
- shortness of breath
- sleep problems
- lack of energy
People that experience coronary MVD symptoms often first notice them during their routine daily activities and times of mental stress but less often during physical activity or exertion. This differs from heart disease, in which symptoms often first appear while a person is being physically active. If you have coronary MVD, learn the warning signs of a heart attack and the warning signs of a heart attack in women.
Diagnosis of Coronary Microvascular Disease
Your healthcare provider will diagnose coronary MVD based on your medical history, a physical exam, and test results. They will also check to see whether you have any risk factors for heart disease. For example, your doctor may measure your weight and height to check for overweight or obesity. He or she also may recommend tests for high cholesterol, metabolic syndrome, and diabetes.
The risk factors for coronary MVD and traditional heart disease often are the same. Thus, your doctor may recommend tests for heart disease, such as:
- Coronary angiography (PDF)
- Stress test
- Magnetic Resonance Imaging (MRI)
Unfortunately, standard tests for CHD aren’t designed to detect coronary MVD. These tests look for blockages in the large coronary arteries. Coronary MVD affects the tiny coronary arteries. If test results show that you don’t have heart disease, your doctor might still diagnose you with coronary MVD. This could happen if signs are present that not enough oxygen is reaching your heart’s tiny arteries.
Coronary MVD symptoms often first occur during routine daily tasks. Because of this, your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index (DASI). The will ask you how well you’re able to do daily activities, such as shopping, cooking, and going to work.
The DASI results will help your doctor decide which kind of stress test you should have. The results also give your doctor information about how well blood is flowing through your coronary arteries.
Duke Activity Status Index (DASI)
The Duke Activity Status Index is a self-administered questionnaire that measures a patient’s functional capacity. It can be used to get a rough estimate of a patient’s peak oxygen uptake.
- Can you take care of yourself (eating, dressing, bathing or using the toilet)?
- Can you walk indoors, such as around your house?
- Can you walk a block or two on level ground?
- Can you climb a flight of stairs or walk up a hill?
- Can you run a short distance?
- Can you do light work around the house, such as dusting or washing dishes?
- Can you do moderate work around the house, such as vacuuming, sweeping floors or carrying in groceries?
- Can you do heavy work around the house, such as scrubbing floors or lifting and moving heavy furniture?
- Can you do yard work, such as raking leaves, weeding or pushing a power mower?
- Can you have sexual relations?
- Can you participate in moderate recreational activities, such as golf, bowling, dancing, doubles tennis or throwing a baseball or football?
- Can you participate in strenuous sports, such as swimming, singles tennis, football, basketball or skiing?
Duke Activity Status Index (DASI) = sum of “Yes” replies ___________
VO2peak = (0.43 x DASI) + 9.6
VO2peak = ___________ ml/kg/min ÷ 3.5 ml/kg/min = __________ METS
Your doctor also may recommend blood tests, including a test for anemia. Anemia is thought to slow the growth of cells needed to repair damaged blood vessels.
Research is ongoing for better ways to detect and diagnose coronary MVD. Currently, researchers have not agreed on the best way to diagnose the disease.
Treatment of Coronary Microvascular Disease
Relieving pain is one of the main goals of treating coronary microvascular disease (MVD). Treatments also are used to control risk factors and other symptoms.
Treatments may include medicines such as:
- Cholesterol medication to improve cholesterol levels
- Antithrombotic medications to lower blood pressure and decrease the heart’s workload
- Medication to help prevent blood clots or control inflammation
- Nitroglycerin to relax blood vessels, improve blood flow to the heart muscle, and treat chest pain
Prevention of Coronary Microvascular Disease
No specific studies have been done on how to prevent coronary microvascular disease (MVD). Researchers don’t yet known how or in what way preventing coronary MVD differs from preventing heart disease. Lifestyle changes and ongoing care can help you lower your risk for heart disease.
- Lifestyle Changes – If lifestyle changes aren’t enough, your doctor may prescribe medicines to control your risk factors. Take all of your medicines as your doctor advises.
- Know your body mass index (BMI)
- Know your family history of heart disease
Coronary Artery Disease
Expert Diagnosis of Coronary Artery Disease
Coronary artery disease develops over time. This means it can develop without your even knowing, until it causes symptoms. That’s why it’s important to seek care from cardiovascular experts with the knowledge and technology to provide an accurate diagnosis.
Learn more about heart and vascular diagnosis and testing at Aurora.
If we suspect coronary artery disease, we’ll ask about your symptoms and perform a physical exam. We also may use other tools, such as:
- Electrocardiogram (EKG): A 12-lead electrocardiogram is our standard for EKGs. During this procedure, you recline on a table, with 12 electrodes attached to your body. The test lasts about 10 minutes, and it helps doctors measure your heart’s activity.
- Echocardiogram: An echo test (also called heart ultrasound) produces pictures of your heart’s size and motion.
- Stress test: Sometimes, people are tested while they exercise so doctors can see how their heart functions when it works hard. A stress test also can be done with medication, for people who are unable to exercise.
- Blood tests: Blood tests can check oxygen levels and organ function.
- Heart catheterization: Heart catheterization can help us understand what stage coronary artery disease has reached. We may use this test with other tools to help us provide an accurate diagnosis. These tools may include optimal coherence tomography (OCT), which uses light to provide an image of the artery. We also might use fractional flow reserve (FFR), which measures the pressure inside a narrowed artery.
Doctors use a variety of imaging methods to get a picture of your blood vessels and organs, so they can choose the right treatment for you. Options include:
- Cardiac CT: A computed tomography (CT) scan of your heart creates 3-D images that show calcium deposits that cause blockages.
- Chest X-ray: We may take a chest X-ray to examine the internal structures of your chest.
- Computed tomography angiography (CTA): Angiography uses dye to show the inside of your arteries. A computed tomography (CT) scan generates images of the heart, brain and other areas to see if blood vessels have hardened or have buildup.
- Magnetic resonance angiography (MRA): MRA is similar to CTA but uses magnetic fields to make images of organs and blood vessels.
- Electron beam CT scan (EBCT): This test, sometimes called Ultrafast CT, uses an electron gun to check for calcium buildup in the heart’s blood vessels.
- Intravascular ultrasound: Doctors can study the walls of the artery in a cross-sectional view from within the blood vessel. With this highly advanced tool, we can determine plaque’s location in the artery, which helps us to plan the right treatment.
- Nuclear imaging: Nuclear cardiology imaging gives doctors a picture of how well your heart is functioning, without invasive tests.