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    Coronary Artery Disease

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    What Is Ischemia?

    Cardiac ischemia occurs when plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to meet your heart's needs. Heart attacks can occur - with or without chest pain and other symptoms.

    Ischemia is most commonly experienced during:

    • Exercise or exertion
    • Eating
    • Excitement or stress
    • Exposure to cold

    Coronary artery disease can progress to a point where ischemia occurs even at rest. When this happens, it is a medical emergency and may be an indication of an impending heart attack. This is when to call your doctor, or go to the emergency room to be further evaluated. Ischemia can occur without any warning signs in anyone with heart disease, although it is more common in people with diabetes.

    What Are the Symptoms of Coronary Artery Disease?

    The most common symptom of coronary artery disease is angina, or chest pain. Angina can be described as a heaviness, pressure, aching, burning, numbness, fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw. Symptoms are often more subtle in women, with nausea, sweating, fatigue, or shortness of breath being more common, than the typical pressure-like chest discomfort.

    Other symptoms that can occur with coronary artery disease include:

    How Is Coronary Artery Disease Diagnosed?

    Your doctor can tell if you have coronary artery disease by:

    • Talking to you about your symptoms, medical history, and risk factors.
    • Performing a physical exam.
    • Performing diagnostic tests, including an electrocardiogram (ECG or EKG), echocardiogram, exercisestress tests, electron beam (ultrafast) CT scans, cardiac catheterization, and others. These tests help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart and the best form of treatment for you.

    How Is Coronary Artery Disease Treated?

    Treatment for coronary artery disease involves making lifestyle changes, taking medications, possibly undergoing invasive and/or surgical procedures, and seeing your cardiologist for regular checkups.

    • Reduce your risk factors. If you smoke, quit. Avoid processed foods and adopt a low-trans-fat, low-salt, and low-sugar diet. Keep your blood sugar in control if you have diabetes. Exercise regularly (but talk to your doctor before you starting an exercise program).
    • Medications. If making lifestyle changes isn't enough to manage your heart disease, medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The drugs you are on depend on you and your specific heart problem. If you have been diagnosed with coronary artery disease, then most likely you will be on aspirin and a statin, if not others.
    • Surgery and other procedures. Common procedures to treat coronary artery disease include balloon angioplasty (PTCA), stent placement, and coronary artery bypass surgery. All of these procedures increase blood supply to your heart, but they do not cure coronary heart disease. You will still need to decrease your risk factors to prevent future disease.

    Doctors are also studying several innovative ways to treat heart disease. Here are a couple of the more promising ones:

    • Angiogenesis. This involves giving substances, such as stem cells and other genetic material, through the vein or directly into damaged heart tissue to trigger the growth of new blood vessels to bypass the clogged ones.
    • EECP (Enhanced External Counterpulsation). Patients who have chronic angina but are not helped by nitrate medications or who do not qualify for various surgeries and procedures may find relief with EECP. The outpatient procedure involves using treatment cuffs placed on the legs that inflate and deflate, increasing the blood supply that feeds coronary arteries.
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