Article Revisions
Coronary Artery Disease (CAD)
CAD is caused by a narrowing of the arteries that supply the heart muscle with blood. This narrowing is a result of atherosclerosis —the buildup of cholesterol and other fatty substances in the arteries. When the arteries narrow, blood flow is reduced. The reduced blood flow causes the heart muscle to receive less oxygen than it needs to function properly. This is termed ischemia. When ischemia occurs patients typically develop angina or chest pain originating from the heart. If the blood flow is completely cut off, a heart attack (myocardial infarction) will occur, and the heart muscle will be permanently damaged.
Blocked Coronary Artery |
CAD is the most common life-threatening disease in the United States. According to the American Heart Association, 80 million Americans have one or more forms of cardiovascular disease (eg, high blood pressure , heart disease, stroke , heart failure ).
Angina
Angina is a symptom of CAD. It has been described as chest pain or discomfort that has a squeezing or pressure-like quality, usually felt behind the breastbone (sternum), but sometimes felt in the shoulders, arms, neck, jaws, or back. Angina is an indicator that your heart is not getting all the oxygen it needs to keep working at its optimal level. People who have angina are at an increased risk of having a heart attack.
Having anginal pain, especially for the first time, may be frightening. People may mistake it for having a heart attack or mistakenly think it is heartburn . A stable pattern of angina does not necessarily mean a heart attack is about to occur. But if the pattern changes—for example, angina becomes more frequent, lasts longer, comes on more easily, or happens for the first time—the risk of a heart attack is higher. Listed below are some common differences between angina and heart attacks:
- Duration of pain —In general, anginal pain lasts for only a few minutes and is relieved by rest or nitroglycerin. Heart attack pain is usually more severe than anginal pain and may last longer, often 15 minutes or more. Pain that lasts less than 30 seconds and goes away with a few deep breaths or a change in position is usually not angina.
- External factors—Anginal pain is often brought on by exercise or activity, emotional tension, dreams, cold or windy weather, low blood sugar, or even eating. Your symptoms can subside when you alter the behavior or environmental trigger. Heart attack pain will usually not subside with rest and may be accompanied by other symptoms such as shortness of breath, nausea, or sweating. The elderly or people with diabetes may have less typical or more subtle symptoms signaling angina or heart attack. Some people may have “silent ischemia” and experience no symptoms.
Note of Caution
If you experience chest pain that is new, worsening, or persistent, call 911 immediately. Do not try to determine for yourself if the pain is due to angina, a heart attack, or some less serious condition. Do not drive yourself to the hospital. Heart attacks can cause severe, permanent damage to the heart or death. Seeking help quickly is important because some of the most effective treatments to increase survival and recovery are ideally given within the first hour after symptoms begin. About half of all deaths due to heart attack happen within one hour of the start of symptoms, often before a person gets to the hospital.
Types of Angina
There are three primary types of angina:
- Stable angina—The attacks are predictable, and the triggers that cause them can be identified. They do not occur when you are resting or relaxed, and symptoms will usually disappear after a few minutes of rest.
- Unstable angina—The symptoms are less predictable. Chest pain may occur while resting or even sleeping (nocturnal angina), and the discomfort may last longer and be more intense. Stable angina becomes unstable when symptoms occur more frequently, last longer, or are precipitated more easily. You should call your doctor immediately if you experience symptoms at rest, or a worsening pattern of symptoms.
- Variant or Prinzmetal's angina—This is usually caused by the spasm of a coronary vessel. It occurs when you are at rest and often in the middle of the night. It can be quite severe and in some cases associated with arrhythmias or abnormal heart rhythms.
[How are CAD and angina diagnosed?
[What are the treatments?][16]
Angina: Most Common Areas of Pain |
Signs and symptoms of CAD , angina , and heart attack include:
- Chest pain (angina)—This may feel like heaviness, burning, choking, tightness, pressure, or squeezing, usually behind the breastbone, but sometimes starting or radiating into the arms, left shoulder, neck, back, teeth, or jaw.
- Nausea and/or vomiting
- Dizziness
- Lightheadedness
- Difficulty breathing or shortness of breath particularly with physical exertion
- Sweating
The more signs and symptoms you have and the longer an episode of chest pain lasts (more than 15 minutes), the more likely it is that you are experiencing a heart attack, rather than an episode of angina. In this situation, seek medical care immediately.
References:
Angina. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/angina.html . Accessed November 2003.
Braunwald E, Zipes D, Libby P. Heart Disease: A Textbook of Cardiovascular Medicine.Philadelphia, PA: WB Saunders; 2001
Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Updated February 2009. Accessed June 18, 2009.
Cardiovascular disease statistics. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4478 . Accessed June 18, 2009.
Coronary Artery Disease (CAD)
CAD is caused by a narrowing of the arteries that supply the heart muscle with blood. This narrowing is a result of atherosclerosis —the buildup of cholesterol and other fatty substances in the arteries. When the arteries narrow, blood flow is reduced. The reduced blood flow causes the heart muscle to receive less oxygen than it needs to function properly. This is termed ischemia. When ischemia occurs patients typically develop angina or chest pain originating from the heart. If the blood flow is completely cut off, a heart attack (myocardial infarction) will occur, and the heart muscle will be permanently damaged.
Blocked Coronary Artery |
CAD is the most common life-threatening disease in the United States. According to the American Heart Association, 80 million Americans have one or more forms of cardiovascular disease (eg, high blood pressure , heart disease, stroke , heart failure ).
Angina
Angina is a symptom of CAD. It has been described as chest pain or discomfort that has a squeezing or pressure-like quality, usually felt behind the breastbone (sternum), but sometimes felt in the shoulders, arms, neck, jaws, or back. Angina is an indicator that your heart is not getting all the oxygen it needs to keep working at its optimal level. People who have angina are at an increased risk of having a heart attack.
Having anginal pain, especially for the first time, may be frightening. People may mistake it for having a heart attack or mistakenly think it is heartburn . A stable pattern of angina does not necessarily mean a heart attack is about to occur. But if the pattern changes—for example, angina becomes more frequent, lasts longer, comes on more easily, or happens for the first time—the risk of a heart attack is higher. Listed below are some common differences between angina and heart attacks:
- Duration of pain —In general, anginal pain lasts for only a few minutes and is relieved by rest or nitroglycerin. Heart attack pain is usually more severe than anginal pain and may last longer, often 15 minutes or more. Pain that lasts less than 30 seconds and goes away with a few deep breaths or a change in position is usually not angina.
- External factors—Anginal pain is often brought on by exercise or activity, emotional tension, dreams, cold or windy weather, low blood sugar, or even eating. Your symptoms can subside when you alter the behavior or environmental trigger. Heart attack pain will usually not subside with rest and may be accompanied by other symptoms such as shortness of breath, nausea, or sweating. The elderly or people with diabetes may have less typical or more subtle symptoms signaling angina or heart attack. Some people may have “silent ischemia” and experience no symptoms.
Note of Caution
If you experience chest pain that is new, worsening, or persistent, call 911 immediately. Do not try to determine for yourself if the pain is due to angina, a heart attack, or some less serious condition. Do not drive yourself to the hospital. Heart attacks can cause severe, permanent damage to the heart or death. Seeking help quickly is important because some of the most effective treatments to increase survival and recovery are ideally given within the first hour after symptoms begin. About half of all deaths due to heart attack happen within one hour of the start of symptoms, often before a person gets to the hospital.
Types of Angina
There are three primary types of angina:
- Stable angina—The attacks are predictable, and the triggers that cause them can be identified. They do not occur when you are resting or relaxed, and symptoms will usually disappear after a few minutes of rest.
- Unstable angina—The symptoms are less predictable. Chest pain may occur while resting or even sleeping (nocturnal angina), and the discomfort may last longer and be more intense. Stable angina becomes unstable when symptoms occur more frequently, last longer, or are precipitated more easily. You should call your doctor immediately if you experience symptoms at rest, or a worsening pattern of symptoms.
- Variant or Prinzmetal's angina—This is usually caused by the spasm of a coronary vessel. It occurs when you are at rest and often in the middle of the night. It can be quite severe and in some cases associated with arrhythmias or abnormal heart rhythms.
How are CAD and angina diagnosed?
References:
American Heart Association website. Available at: http://www.americanheart.org .
Braunwald E, Zipes D, Libby P. Heart Disease: A Textbook of Cardiovascular Medicine.Philadelphia, PA: WB Saunders; 2001
Your doctor will ask about your symptoms and medical history and do a complete physical exam. To diagnose CAD or angina , the following may be helpful:
History
The diagnosis of angina is based mainly on your description of symptoms and precipitating factors. Other medical conditions, such as hypertension or diabetes , increase the risk of CAD.
Physical Examination
Since high cholesterol is a risk factor for CAD, doctors will look for evidence of elevated cholesterol, such as a collection of fatty tissue near the eyes. Your doctor will also listen for extra sounds in the heart, known as murmurs or gallops, which may suggest heart disease.
Blood Tests
Increased levels of total cholesterol, triglycerides, and blood sugar are risk factors for CAD, as are increased levels of homocysteine and c-reactive protein. Angina may be precipitated or worsened by anemia , overactive thyroid , and kidney failure. Testing for the presence/quantity of heart muscle enzymes in the blood may indicate heart muscle damage.
Electrocardiogram (EKG)
During an EKG , Electrodes are attached to your skin to record the electrical activity of your heart. This test can identify heart rhythm problems and damage to your heart caused by a previous heart attack . During anginal attacks, the EKG may show specific changes. Using this test to diagnose CAD has its limitations because other heart problems can also cause changes in the heart’s electrical waves.
Stress Test
Stress test will show how well the heart is functioning. Depending on your health, you may take a stress test involving exercise (sometimes on a treadmill) or take medication that will increase blood flow to the heart. You may be hooked up to an EKG or other heart monitor. If the exercise or medication causes an increased need for blood flow that the blood vessels diseased by CAD cannot accommodate, the EKG will appear abnormal. Also, a radioactive tracer can be injected so the doctor will be able to see which parts of the heart are not getting an adequate blood supply.
Nuclear scanning
With this test, your doctor can see damaged areas of the heart and examine the heart’s pumping action. A small amount of radioactive material is injected into one of your veins, usually in the arm. The healthy heart muscle takes up this material. Then, a scanning camera reads where the material does or does not show up. This determines which areas of the heart muscle have been previously damaged.
A variety of imaging techniques may be used to examine the heart muscle after the radioactive material has been injected. These include: scintigraphy, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and single-photon emission computerized tomography (SPECT) imaging. Nuclear scanning can be performed with the patient at rest, immediately following exercise, or after the administration of a medication that simulates the stress of exercise.
Echocardiogram
During an echocardiogram , an ultrasound image of the heart demonstrates the heart muscle's movement with each heartbeat. When the heart doesn’t get enough blood, the walls of the heart show irregular motion. The echocardiogram can be performed at rest, during exercise, or after the administration of medication that simulates the stress of exercise.
Coronary Angiography
A coronary angiography is the most accurate way to measure the severity of CAD. It is also the most expensive and invasive method. A thin tube (catheter) is put into an artery of the arm or leg and passed through the body into the arteries of the heart. A dye is injected through the catheter and into the heart’s arteries. Several x-ray images are taken. These pictures will show the amount of blockage caused by atherosclerosis .
Developing Technologies
Developing technologies include the following:
- Magnetic resonance angiography (MRA) —The MRA test uses MRI technology to identify coronary artery blockages. This technique has its limitations and is not commonly used.
- Electron beam CT scan (EBCT) —This is a “heart scan” that uses some radiation to detect tiny calcium deposits in the lining of the coronary arteries. This technique is appealing because it is not invasive, physically exerting, or risky. However, results can often be incorrect or misleading, so research is still being done on EBCT.
- Computed tomography angiography (CTA) —CTA uses 64 slice CT imaging—along with an IV contrast injected in the hand or arm—to image the coronary arteries and look for blockages. This test is similar to coronary angiography, but poses less risk because there is no need for an invasive catheter placement.
You can reduce your risk of angina and CAD by making certain lifestyle changes. These include:
Lose Excess Weight
Excess weight puts a strain on the heart muscle, which eventually can lead to angina and CAD. If you are overweight or obese , adopt a sensible eating plan and exercise regularly to lose weight gradually, and maintain your weight at the desired level.
Quit Smoking
Smoking damages your blood vessels, reduces the amount of oxygen in your blood, and forces your heart to work harder. Discuss with your doctor the best way to help you quit smoking .
Limit Alcohol Intake
Alcohol should be limited to no more than 1 to 2 ounces a day. In this quantity, alcohol may have a beneficial effect on raising your good cholesterol (HDL).
Limit Fat and Cholesterol
Diets that are high in saturated fat, transfat, and cholesterol increase your risk of CAD. Saturated fat and cholesterol are found in animal products, most dairy products (such as milk, cream, and cheese), lard, and palm and coconut oils, among other foods. Transfat is found in margarine and vegetable shortening, as well as foods containing these products. A registered dietitian can help you reduce saturated fats and cholesterol in your diet. Good dietary choices include fresh fruits and vegetable, as well as lean meats and fish—particularly fish rich in omega-3 fatty acids , such as salmon.
Talk to Your Doctor About Taking Medicine
Taking a low-dose aspirin every day may help to reduce your risk of heart attack and stroke. Most people are able to tolerate aspirin. But, in rare cases, even small amounts can lead to serious bleeding, particularly from the gastrointestinal (GI) tract. Also, aspirin may not work as well when combined with other pain medicines. Talk to your doctor about whether daily aspirin therapy is right for you.
Another option is to take statin drugs. Statins are used to treat high cholesterol . But, some statins can be used even if you do not have cholesterol problems. If you are a man over age 50 or a women over age 60 with certain risk factors (eg, elevated C-reactive protein, high blood pressure , low HDL "good" cholesterol, smoking), your doctor may recommend that you take rosuvastatin to reduce your risk of heart disease.
Control Blood Glucose Levels If You have Diabetes
People who have diabetes may reduce their risk of heart attack or other cardiac events if they maintain their blood glucose near normal levels. There are many other proven health benefits to maintaining tight control of blood glucose. If you have diabetes, talk to your doctor about ways to manage your blood sugar.
Maintain Normal Blood Pressure
High blood pressure (hypertension) is one of the most critical risk factors for angina and coronary artery disease. Hypertension causes the heart muscles to work harder; the increased strain on the heart can lead to heart failure. Discuss with your doctor the best way to reach and maintain a healthy blood pressure, which involves diet, weight and exercise controls, and possibly medicine.
Exercise Regularly
For people who have not yet developed CAD, regular aerobic exercise, such as brisk walking or using a stationary bike or treadmill, is recommended. Exercise will strengthen the heart muscle and can help lower blood pressure. Exercise is recommended in moderation (at least 3-4 times a week for 30 minutes). However, if you already have CAD, talk to your doctor before starting any new exercise program.
Learn to Conquer Stress
Emotional stress may bring on anginal pain. Think about what you can do in your life to cut down on stressful activities and situations. Consider learning meditation, progressive relaxation, or other techniques that you can use when you feel stressed. Try to work in an afternoon nap, since rest seems to be protective against both angina and stress.
When to Contact Your Doctor
There are some common warning signs that may signal angina and CAD. Contact your healthcare provider if you notice any of these symptoms:
- Chest pain
- Shortness of breath out of proportion to exercise or exertion
- Increased fatigue
References:
American Heart Association website. Available at: http://www.americanheart.org .
References:
Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Updated February 2009. Accessed June 18, 2009.
Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 2010. Accessed April 9, 2010.
Coronary artery disease major risk factors. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 2010. Accessed April 9, 2010.
Depression is a risk factor for coronary artery disease in men. Archives of Internal Medicine.1998;158.
The Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA.2002;288:2015-2022.
Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.8th ed. Philadelphia, PA: WB Saunders; 2007.
Mosca L. C-reactive protein—to screen or not to screen. N Engl J Med.2002;347:1615-1617.
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med.2002;347:1557-1565.
Risk factors and coronary heart disease. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4726 . Accessed November 2003.
Wilson P. Homocysteine and coronary heart disease. How great is the hazard? JAMA.2002;288:2042-2043.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Fung TT, Malik V, Rexrode KM, Manson JE, Willett WC, Hu FB. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr.2009;89:1037-1042.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA.2009;301:2024-2035.
Angina: Most Common Areas of Pain |
Signs and symptoms of CAD , angina , and heart attack include:
- Chest pain (angina)—This may feel like heaviness, burning, choking, tightness, pressure, or squeezing, usually behind the breastbone, but sometimes starting or radiating into the arms, left shoulder, neck, back, teeth, or jaw.
- Nausea and/or vomiting
- Dizziness
- Lightheadedness
- Difficulty breathing or shortness of breath particularly with physical exertion
- Sweating
The more signs and symptoms you have and the longer an episode of chest pain lasts (more than 15 minutes), the more likely it is that you are experiencing a heart attack, rather than an episode of angina. In this situation, seek medical care immediately.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop CAD or angina with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing CAD or angina . If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Lifestyle Factors
Certain lifestyle factors may increase the risk of atherosclerosis , which can lead to CAD. These include:
- Physical inactivity
- Smoking , which damages both blood vessels and lungs
- A diet high in saturated fat, transfat, cholesterol, and/or calories—A study found that women who regularly drink beverages with sugar may be at an increased risk of developing CAD. Consumption of High Fructose Corn Syrup may especially elevate risk of CAD.
- Excessive consumption of alcohol , which can lead to high blood pressure and high triglyceride levels
Certain Conditions
These conditions put you are at greater risk of developing angina and CAD:
- High blood pressure
- High cholesterol and triglycerides
- Diabetes
- Obesity and overweight
- Metabolic syndrome
- Stress
- Depression
Genetic Factors
You are at greater risk if you have a strong family history of CAD or angina.
Gender
Men tend to develop atherosclerosis earlier the women. However, a woman’s risk rises once she enters menopause , and heart disease is the leading cause of death in both sexes.
Certain Blood Test Results
Recent research has found an association between levels of certain amino acids or proteins in the blood and the risk of developing CAD. Clinicians and policy makers have not yet recommended widespread screening for these levels since they are not sure that these tests will add benefit to those already in place for the general population. Talk to your doctor to find out the latest recommendations and see if these tests make sense for you.
- Homocysteine—High levels may mean an increased risk of CAD.
- C-reactive protein—High levels may mean an increased risk of CAD.
Age
Your risk of angina and CAD increases as you get older. Men older than 45 and women older than 55 (or younger if they have premature menopause) are at greater risk of heart disease.
Race and Ethnic Factors
African Americans have a higher incidence of hypertension than Caucasians and, therefore, a higher risk of developing CAD. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians, and some Asian Americans.
References:
American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .
Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.8th ed. Philadelphia, PA: WB Saunders; 2007.
HeartInfo.org website. Available at: http://www.heartinfo.org .
References:
American Dietetic Association website. Available at: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/index.html .
American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .
Daily aspirin therapy. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/daily-aspirin-therapy/HB00073/NSECTIONGROUP=2 . Updated August 2008. Accessed February 12, 2010.
Heart attack. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated September 2009. Accessed February 12, 2010.
The Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA.2002;288:2015-2022.
Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.8th ed. Philadelphia, PA: WB Saunders; 2007.
Wilson P. Homocysteine and coronary heart disease. How great is the hazard? JAMA.2002;288:2042-2043.
12/21/2006 DynaMed's Systematic Literature Surveillance : Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med.2006;166:2307-2313.
12/4/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Ebbing M, Bonaa KH, Nygard O, et al. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA.2009;302(19):2119-21126.
2/12/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA approves new indication for Crestor. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm200128.htm . Published February 9, 2010. Accessed February 12, 2010.
American Heart Association
Address:
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA-1 (1-800-242-8721)
Internet Address:
http://www.americanheart.org/
Description of services provided:
The American Heart Association provides general information about heart disease, including educational information, news, research, health programs, and dietary information.
Centers for Disease Control
Address:
1600 Clifton Rd.
Atlanta, GA 30333
Phone:
1-404-639-3534
1-800-311-3435
Internet address:
http://www.cdc.gov
Description of services provided:
This site provides educational and statistical information about cardiovascular health.
National Heart, Lung and Blood Institute
Address:
PO Box 30105
Bethesda, MD 20824-0105
Phone:
1-301-592-8573
1-240-629-3255 TTY
Internet address:
http://www.nhlbi.nih.gov/
Description of services provided:
This government site provides information about all types of cardiovascular conditions. Included are educational fact sheets, dietary information, research news, scientific resources, and clinical guidelines.
References:
American Diabetes Association website. Available at: http://www.diabetes.org/home.jsp .
American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .
Balbarini A, Buttitta F, Limbruno U, et al. Usefulness of carotid intima-media thickness measurement and peripheral B-mode ultrasound scan in the clinical screening of patients with coronary artery disease. Angiology.2000;51:269-279.
Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Updated February 2009. Accessed June 18, 2009.
European Heart Journal website. Available at: http://eurheartj.oxfordjournals.org/ .
HeartInfo.org website. Available at: HeartInfo.org.
Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.8th ed. Philadelphia, PA: WB Saunders; 2007.
RadiologyInfo website. Available at: http://www.radiologyinfo.org/index.cfm?bhcp=1 .
Zebrack JS, Muhlestein JB, Horne BD, Anderson JL. Intermountain Heart Collaboration Study Group. C-reactive protein and angiographic coronary artery disease: independent and additive predictors of risk in subjects with angina. J Am Coll Cardiol.2002;39:632-637.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions. Most screening is aimed at primary prevention and identifying the risk factors associated with the development of CAD and angina .
Screening Tests
Blood Pressure Check
High blood pressure is one of the most critical risk factors for CAD. Your doctor should check your blood pressure as a part of each exam. If you have chronically high blood pressure, your doctor may advise you of ways to monitor your blood pressure at home.
Electrocardiogram (EKG)
If your doctor suspects that you are at risk of developing CAD, you may have an EKG performed. This test records the electrical activity of your heart through electrodes attached to the skin. A “normal” EKG does not mean you are free of CAD, since most early changes are not seen on this test. But an EKG can sometimes document damage from an old, “silent” heart attack , as well as irregular rhythms.
Blood Tests
These are especially important in checking for diabetes (blood glucose) and cholesterol levels (total cholesterol, LDL, and HDL). C-reactive protein (CRP), a marker of inflammation, is associated with CAD and may be a helpful screening test in high risk populations. Although, the correlation between CRP levels and the extent of CAD is low.
Chest X-ray
Your doctor may order chest x-rays to check your heart's size and to check your lungs for signs of lung congestion.
Cardiac CT Scan
Also known as coronary artery calcium scoring, this noninvasive x-ray examination detects calcium levels in the coronary arteries, expressing the findings as a "calcium score". Calcium build-up is a marker of CAD.
Existence of Erectile Dysfunction (ED)
ED has been found to precede CAD by an average of 2-3 years. One study found that men with type 2 diabetes and CAD were almost eight times as likely to have ED as diabetic men without CAD.
Ankle-brachial Indices
Peripheral arterial disease (PAD) , the hardening of the arteries outside of the heart, is also a marker for increased cardiac risk. An ankle-brachial index measurement is done to screen for and diagnose PAD. Blood pressure is measured at your ankle and at your arm. If blood pressure is lower in your ankle, it indicates that an artery between your heart and your leg may be blocked. Atherosclerosis or hardening of the arteries is a systemic disease, and its presence in one area of the body increases your risk for disease in other areas as well.
Carotid Intima-media Thickness (IMT)
This condition is related to CAD, but research is inconclusive and the relationship is not clinically significant enough to recommend measurement of IMT as a screening tool.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with CAD . By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your doctor
About CAD
- What is my or my family member's diagnosis?
- What degree or percent of the arteries are blocked?
About Your Risk of Developing CAD
- Is anyone in my family at risk for developing CAD?
- What can I do to lessen the possibility of CAD?
About Treatment Options
- What type of treatment do you recommend for my case?
- Will I need to have surgery?
- How long does it take to recovery from surgery?
- What other treatment options are available?
About Medication
- What is the name of the medicine? Is this the brand or generic name? Does it matter which one is used?
- What is the medicine supposed to do?
- How and when should it be taken—and for how long?
- What foods, drinks, and other medicines should be avoided while taking this medicine?
- What are the possible side effects? What should be done if they occur?
- Is any written information available about the medicine?
- A certain medication is causing side effects that are difficult to deal with. Is there some way to minimize those side effects? Is there another equally good medication available?
About Lifestyle Changes
- What are some specific ways that daily life will change? Can I still work, play golf, have sex, do the laundry? (Fill in whatever activity you're wondering about.)
- What strategies have other patients found useful for motivating themselves to eat better, exercise, and stop smoking?
- Can you refer me to a registered dietitian to help me with my diet?
- Is it safe for me to begin an exercise program? What types of exercise do you recommend for me?
About Outlook
- What should I expect within the next few weeks, months, and years?
- What is the likely progression of the condition?
- What are the most important things I can do to manage this condition?
