Why is it important to know if I have CAD?

- J. Clay Hays, Jr., M.D.

Is CAD dangerous? What causesCauses CAD? CAD? Blood supply to the involves not only the large coronary but smaller arteries that are referred to supply blood to sustain the heart. The collectively as collateral circulation. For those people arteries “know” when to expand and contract because who frequently, the number and size of these they are signaled by a sensitive coating inside the blood arteries is greater. This can become especially important vessels (). Arteries expand and contract to when a large is blocked, and smaller arteries help adjust to different levels of work needed by the heart. For supply blood to the heart muscle. instance, when you walk up a flight of stairs, the heart’s workload is greater than when you are sitting down Any condition that causes a sudden reduction (or watching TV; arteries constantly adjust. complete blockage) of blood flow to the heart is called (or ACS) and can Normally, we are born with healthy coronary arteries that cause damage to the heart muscle. This can be life- have smooth inner linings. But, by the time we become threatening and requires immediate emergency teenagers, the inside lining of the coronary arteries evaluation and treatment. may already show streaks of deposits. This build-up continues throughout life, with the rate of fatty build-up varying widely between people. It depends on many factors. As we grow older, fat deposits, along with other substances, continue to build up, stick together and form Long-term CAD can also cause the heart plaque. muscle to weaken, which can contribute to . The build-up of plaque in the blood vessels is called – the leading cause of CAD. This causes blood vessels to become progressively narrowed until it is hard for blood to pass through. If an artery is Coronary artery spasm is another type of coronary completely blocked it causes a life-threatening loss of artery problem. It is a temporary, sudden narrowing of blood flow. This leads to (known as ) or one of the coronary arteries caused by squeezing of a heart attack. A heart attack can occur as a result of a the muscles in the artery wall. This spasm can slow or clot that forms in the narrowed artery causing the blood stop blood flow to the heart, often causing symptoms supply to be cut off. of angina. This can happen without having cardiac risk factors or atherosclerosis. And, it can be silent with no symptoms, or it can cause chest pain, angina or a heart attack.

Coronary microvascular : When CAD happens inside of very small arteries, it is known as coronary microvascular disease. Researchers believe women are more likely to have this type of CAD because of lowered levels after . Broken Heart Syndrome?

Broken heart syndrome, also called , was first medically identified in 1990 in Japan and was named Takotsubo cardiomyopathy. Since then, interest in this condition has grown and cardiologists continue to observe and document this syndrome. If the coronary vessel narrows and a blood clot forms that breaks away and travels it is called a coronary Basically, the symptoms are similar to a heart attack thrombus. As it moves, the blood flow may be restored with chest pain and . An EKG also temporarily. But, if the clot suddenly lodges in an artery may show abnormalities, and the pumping chamber of that leads to the heart, it can cause a sudden blockage the heart (left ventricle) has an unusual shape during of blood supply to the heart muscle called a coronary contraction. Most patients go to the emergency room occlusion. because they think they are having a heart attack. What Causes CAD? Blood supply to the heart involves not only the large coronary arteries but smaller arteries that are referred to Coronary arteries supply blood to sustain the heart. The collectively as collateral circulation. For those people arteries “know” when to expand and contract because who exercise frequently, the number and size of these they are signaled by a sensitive coating inside the blood arteries is greater. This can become especially important vessels (endothelium). Arteries expand and contract to when a large artery is blocked, and smaller arteries help adjust to different levels of work needed by the heart. For supply blood to the heart muscle. instance, when you walk up a flight of stairs, the heart’s workload is greater than when you are sitting down Any condition that causes a sudden reduction (or watching TV; arteries constantly adjust. complete blockage) of blood flow to the heart is called acute coronary syndrome (or ACS) and can Normally, we are born with healthy coronary arteries that cause damage to the heart muscle. This can be life- have smooth inner linings. But, by the time we become threatening and requires immediate emergency teenagers, the inside lining of the coronary arteries evaluation and treatment. may already show streaks of fat deposits. This build-up continues throughout life, with the rate of fatty build-up varying widely between people. It depends on many factors. As we grow older, fat deposits, along with other substances, continue to build up, stick together and form Long-term CAD can also cause the heart plaque. muscle to weaken, which can contribute to heart failure. The build-up of plaque in the blood vessels is called atherosclerosis – the leading cause of CAD. This causes blood vessels to become progressively narrowed until it is hard for blood to pass through. If an artery is Coronary artery spasm is another type of coronary completely blocked it causes a life-threatening loss of artery problem. It is a temporary, sudden narrowing of blood flow. This leads to chest pain (known as angina) or one of the coronary arteries caused by squeezing of a heart attack. A heart attack can occur as a result of a the muscles in the artery wall. This spasm can slow or clot that forms in the narrowed artery causing the blood stop blood flow to the heart, often causing symptoms supply to be cut off. of angina. This can happen without having cardiac risk factors or atherosclerosis. And, it can be silent with no symptoms, or it can cause chest pain, angina or a heart attack.

Coronary microvascular disease: When CAD happens inside of very small arteries, it is known as coronary microvascular disease. Researchers believe women are more likely to have this type of CAD because of lowered estrogen levels after menopause. Broken Heart Syndrome?

Broken heart syndrome, also called stress cardiomyopathy, was first medically identified in 1990 in Japan and was named Takotsubo cardiomyopathy. Since then, interest in this condition has grown and cardiologists continue to observe and document this syndrome. If the coronary vessel narrows and a blood clot forms that breaks away and travels it is called a coronary Basically, the symptoms are similar to a heart attack thrombus. As it moves, the blood flow may be restored with chest pain and shortness of breath. An EKG also temporarily. But, if the clot suddenly lodges in an artery may show abnormalities, and the pumping chamber of that leads to the heart, it can cause a sudden blockage the heart (left ventricle) has an unusual shape during of blood supply to the heart muscle called a coronary contraction. Most patients go to the emergency room occlusion. because they think they are having a heart attack. Interestingly, this can occur in patients whose arteries are Angina that is caused by atherosclerosis usually not narrowed nor have severe plaque buildup present. In occurs when the heart is working harder than 85% of cases the attack is triggered by an emotionally or usual, during exertion such as exercising or physically stressful event. Emotional causes might include . grief from the of a loved one, fear (from such events as a violent attack, threats or stage fright) or life stressors People describe angina pain in different ways but usually such as serious arguments, divorce, job loss or financial say that it is chest discomfort, heaviness, tightness, problems. Physical stressors might include serious health crushing, constricting, pressure, aching, burning, problems such as , chemotherapy, an asthma attack numbness, fullness or squeezing. or surgery. Only about 2% of angina is caused by coronary artery Usually, the stressor or stressors leading up to the attack spasms. It is more common among those who smoke, can be identified, but not always. It is unknown whether or have high blood pressure or have high . It can not chronic stressors (rather than one major event) might be related to withdrawal, a high level of stress, cause this syndrome. exposure to cold, some (vasoconstrictors that cause contracting of blood vessels) or stimulant drugs such With and treatment, the vast majority of as amphetamines and cocaine. patients survive such an attack and few (less than 5%) will have a repeat episode. If angina is caused by coronary artery spasms it may be somewhat different, usually happening at night or the same Treatment for this syndrome includes diagnostic tests and time each day, usually between midnight and 8 AM. Pain is . Some patients may need to be in the hospital typically temporary, lasting from 5 to 30 minutes. It may also until they are stable. Typically, complications are relatively occur at rest. rare and recovery is quick and complete.

So, a perfectly, healthy person can truly have a “broken What Is the Difference Between heart” with actual heart attack symptoms, but when promptly diagnosed and treated, symptoms can most often be Angina and a Heart Attack? reversed without complications or long term effects. The symptoms are similar and angina can be a warning that a heart attack may be near. What areare the Symptomssymptoms of of CAD? CAD? In addition to pain, other symptoms of CAD Early CAD may not cause any symptoms. The most include: common problem caused by CAD is (lack of Shortness of breath and blood to the heart muscle). When ischemia (irregular heartbeat, skipped beats occurs in the heart, the symptom or pain that is felt is known as angina pectoris, commonly called angina. or a “flipflop” feeling) The pain is usually severe and is felt under the chest A faster than usual heartbeat bone (sternum) or left side of the chest and can spread Dizziness to the neck, shoulder or arm. A person may faint/lose Nausea consciousness during an episode of chest pain. Extreme weakness Sweating Types of angina include:

Differences between men and women: Stable angina: Happens when the heart works There is increasing evidence that men and women harder and has a regular pattern. Treatment typically is experience the symptoms differently. Women have heart effective for this type of angina. attack symptoms that include: : The most dangerous type that Pain or discomfort in the chest, left arm or back does not follow a pattern. It can happen at any time, Unusually rapid heartbeat whether the heart is working harder or not. It may not Shortness of breath go away with rest or medication. It also may be a sign of Nausea or fatigue an impending heart attack. If you experience any of these symptoms, get help Variant angina: A rare type that happens when you are immediately. Call 911 or have someone drive you at rest and is often helped by medication. to the nearest emergency room. Do not wait. Interestingly, this can occur in patients whose arteries are Angina that is caused by atherosclerosis usually not narrowed nor have severe plaque buildup present. In occurs when the heart is working harder than 85% of cases the attack is triggered by an emotionally or usual, during exertion such as exercising or physically stressful event. Emotional causes might include walking. grief from the death of a loved one, fear (from such events as a violent attack, threats or stage fright) or life stressors People describe angina pain in different ways but usually such as serious arguments, divorce, job loss or financial say that it is chest discomfort, heaviness, tightness, problems. Physical stressors might include serious health crushing, constricting, pressure, aching, burning, problems such as stroke, chemotherapy, an asthma attack numbness, fullness or squeezing. or surgery. Only about 2% of angina is caused by coronary artery Usually, the stressor or stressors leading up to the attack spasms. It is more common among those who smoke, can be identified, but not always. It is unknown whether or have high blood pressure or have high cholesterol. It can not chronic stressors (rather than one major event) might be related to alcohol withdrawal, a high level of stress, cause this syndrome. exposure to cold, some medications (vasoconstrictors that cause contracting of blood vessels) or stimulant drugs such With medical diagnosis and treatment, the vast majority of as amphetamines and cocaine. patients survive such an attack and few (less than 5%) will have a repeat episode. If angina is caused by coronary artery spasms it may be somewhat different, usually happening at night or the same Treatment for this syndrome includes diagnostic tests and time each day, usually between midnight and 8 AM. Pain is medication. Some patients may need to be in the hospital typically temporary, lasting from 5 to 30 minutes. It may also until they are stable. Typically, complications are relatively occur at rest. rare and recovery is quick and complete.

So, a perfectly, healthy person can truly have a “broken What Is the Difference Between heart” with actual heart attack symptoms, but when promptly What is the difference between diagnosed and treated, symptoms can most often be anginaAngina and aa Heartheart Attack?attack? reversed without complications or long term effects. The symptoms are similar and angina can be a warning What are the Symptoms of CAD? that a heart attack may be near. In addition to pain, other symptoms of CAD Early CAD may not cause any symptoms. The most include: common problem caused by CAD is ischemia (lack of Shortness of breath oxygen and blood to the heart muscle). When ischemia Palpitations (irregular heartbeat, skipped beats occurs in the heart, the symptom or pain that is felt is known as angina pectoris, commonly called angina. or a “flipflop” feeling) The pain is usually severe and is felt under the chest A faster than usual heartbeat bone (sternum) or left side of the chest and can spread Dizziness to the neck, shoulder or arm. A person may faint/lose Nausea consciousness during an episode of chest pain. Extreme weakness Sweating Types of angina include:

Differences between men and women: Stable angina: Happens when the heart works There is increasing evidence that men and women harder and has a regular pattern. Treatment typically is experience the symptoms differently. Women have heart effective for this type of angina. attack symptoms that include: Unstable angina: The most dangerous type that Pain or discomfort in the chest, left arm or back does not follow a pattern. It can happen at any time, Unusually rapid heartbeat whether the heart is working harder or not. It may not Shortness of breath go away with rest or medication. It also may be a sign of Nausea or fatigue an impending heart attack. If you experience any of these symptoms, get help Variant angina: A rare type that happens when you are immediately. Call 911 or have someone drive you at rest and is often helped by medication. to the nearest emergency room. Do not wait. What else can I do? Take . “If you feel symptoms suggestive of a heart attack, take 325 mg of aspirin (one regular size aspirin tablet). This will help the threat of blood clots that may be forming in your heart.” - J. Clay Hays, Jr., M.D.

How isIs CAD diagnosed?Diagnosed? The cardiologists at Jackson Heart Clinic will complete a medical history and physical exam and may order tests to diagnose CAD. Diagnostic tests can tell whether or not you have CAD, but can also indicate how advanced it is. Tests will also give your cardiologist information about how to best treat your particular case.

Blood tests: Certain blood tests will give your cardiologist an indication that is present. Your levels of cholesterol and other specific measures will also be helpful to diagnose CAD.

Chest X-ray: An X-ray of the chest gives a picture of your heart, lungs and other organs in the chest.

Echocardiogram: Creates a picture of your heart using ultrasound. An X-ray of the chest gives a picture of your heart, lungs and other organs in the chest. CAC (coronary artery calcium score): This test shows great promise in predicting those at high risk of a heart attack. The procedure creates an image that shows the degree of calcium deposits in the coronary arteries. Both are advanced forms of imaging technology Nuclear stress test: This test is similar to the exercise electron beam tomography or CT scan. stress test except that you will receive an IV nuclear medication that can show how the blood travels in the EKG (Electrocardiogram): An EKG records electrical heart during exercise. It helps to diagnose heart disease impulses produced by your heart. This is done using or can show if disease has grown worse. electrodes that are attached to your arm, chest and leg. The electrode wires are attached to a device that Coronary computed tomography angiogram: This records the electrical impulses for the doctor to is a procedure that requires a cardiologist to pass a interpret. The EKG can measure any damage present thin catheter through an artery into your heart. As the in the heart, the heart rate and whether or not the heart catheter moves along, X-rays are taken to help position is beating normally. In addition, the EKG can be used to the catheter. Then a contrast material is injected into determine the effects of drugs or devices that affect the the catheter that allows x-rays to show any blockages heart. It can also indicate the size and position of heart in blood flow to the heart. This test is particularly helpful chambers. to diagnose specific conditions of the coronary arteries and heart. It can show how many coronary arteries are Exercise stress test: This test shows how your heart blocked, where they are blocked and how severe the performs with increased workload and whether or not blockages are. The test is a bit more risky than some your heart is getting ample blood supply. Similar to a tests but very safe when done by an experienced simple EKG, electrodes are placed on your body and cardiac team. are connected to a device that monitors your heart and blood pressure as you exercise on a treadmill. In summary, the information above provides a brief The test will also show how quickly your heart description of possible tests that we might order to recovers after working hard. facilitate your care. You will be given more detailed information if you are scheduled for any of these tests. What else can I do? Take Aspirin. “If you feel symptoms suggestive of a heart attack, take 325 mg of aspirin (one regular size aspirin tablet). This will help the threat of blood clots that may be forming in your heart.”

How Is CAD Diagnosed?

The cardiologists at Jackson Heart Clinic will complete a medical history and physical exam and may order tests to diagnose CAD. Diagnostic tests can tell whether or not you have CAD, but can also indicate how advanced it is. Tests will also give your cardiologist information about how to best treat your particular case.

Blood tests: Certain blood tests will give your cardiologist an indication that coronary artery disease is present. Your levels of cholesterol and other specific measures will also be helpful to diagnose CAD.

Chest X-ray: An X-ray of the chest gives a picture of your heart, lungs and other organs in the chest.

Echocardiogram: Creates a picture of your heart using ultrasound. An X-ray of the chest gives a picture of your heart, lungs and other organs in the chest. CAC (coronary artery calcium score): This test shows great promise in predicting those at high risk of a heart attack. The procedure creates an image that shows the degree of calcium deposits in the coronary arteries. Both are advanced forms of imaging technology Nuclear stress test: This test is similar to the exercise electron beam tomography or CT scan. stress test except that you will receive an IV nuclear medication that can show how the blood travels in the EKG (Electrocardiogram): An EKG records electrical heart during exercise. It helps to diagnose heart disease impulses produced by your heart. This is done using or can show if disease has grown worse. electrodes that are attached to your arm, chest and leg. The electrode wires are attached to a device that Coronary computed tomography angiogram: This records the electrical impulses for the doctor to is a procedure that requires a cardiologist to pass a interpret. The EKG can measure any damage present thin catheter through an artery into your heart. As the in the heart, the heart rate and whether or not the heart catheter moves along, X-rays are taken to help position is beating normally. In addition, the EKG can be used to the catheter. Then a contrast material is injected into determine the effects of drugs or devices that affect the the catheter that allows x-rays to show any blockages heart. It can also indicate the size and position of heart in blood flow to the heart. This test is particularly helpful chambers. to diagnose specific conditions of the coronary arteries and heart. It can show how many coronary arteries are Exercise stress test: This test shows how your heart blocked, where they are blocked and how severe the performs with increased workload and whether or not blockages are. The test is a bit more risky than some your heart is getting ample blood supply. Similar to a tests but very safe when done by an experienced simple EKG, electrodes are placed on your body and cardiac team. are connected to a device that monitors your heart and blood pressure as you exercise on a treadmill. In summary, the information above provides a brief The test will also show how quickly your heart description of possible tests that we might order to recovers after working hard. facilitate your care. You will be given more detailed information if you are scheduled for any of these tests. What Are the Treatments for Even though you can’t change your inherited risk, What are the treatments for you can work on modifiable risk factors- things that CAD? you can change to improve your health and help minimize your overall risk for cardiovascular events If you have been diagnosed with CAD, your questions in the future. For instance, don’t add to your risk by will probably include “Why me?” and “What’s next?” , becoming overweight, or not exercising. Remember that treating CAD can increase your quality of life and potentially reduce your risk of a heart attack. And be sure to monitor your blood pressure and have simple blood tests to check your cholesterol Why me? The reality is that you have probably had and blood sugar levels. These steps can have a CAD for some time and probably also have risk factors positive impact on your health now and in the future! that have led to the development of CAD.

What are the risk factors? Risk factors for CAD include anything that increases your chance of having it. This includes risk factors that you cannot change, as well as those that you can change. Sometimes Risk factors that can be controlled include: CAD develops in a person who has no known risk factors. Smoking or tobacco use of any kind; exposure to secondhand smoke Risk factors that you cannot change include: High blood pressure High Gender: Men are at greater risk than women and tend Uncontrolled to have heart attacks earlier in life. But, after age 70 the Physical inactivity risk is even between men and women. Overweight Uncontrolled stress or • Women tend to have Coronary Heart Disease about Diet high in saturated fat and cholesterol 10 years later than men, but it still is the #1 killer of women in the . Drinking too much alcohol

• Although death rates from CAD have dropped over the years, they have not dropped for women as much Researchers continue studying other factors that are as for men. related to CAD. There is evidence that apnea may be related to the development of CAD. In addition, lack of Age: Everyone over age 65 is at greater risk of CAD. sleep or too much sleep may also be related. The roles Family history of heart disease: If your parent had of C-reactive (a body protein that may be higher heart disease, your risk is greater, especially if they with ), high triglycerides (a type of fat/lipid were diagnosed before age 50. in the blood), homosysteine (an amino acid in the body) and (a) are also being explored to see if they Race: African Americans tend to have higher blood are related to having CAD. pressure and also a greater risk of heart disease. Mexican Americans, American Indians, native What’s Next? Hawaiians and some Asians also have a higher risk. In general, higher risk is related to greater levels of and diabetes in these populations. Options for treating CAD are better than ever before! Your cardiologist will address your risk factors and will develop a treatment plan especially designed for you. Often, risk factors can be reduced by making lifestyle changes. However, medication may be used to reduce levels of cholesterol and help keep the blood flowing. If you need help with these changes, your cardiologist will offer more detail and support. What Are the Treatments for Even though you can’t change your inherited risk, you can work on modifiable risk factors- things that CAD? you can change to improve your health and help minimize your overall risk for cardiovascular events If you have been diagnosed with CAD, your questions in the future. For instance, don’t add to your risk by will probably include “Why me?” and “What’s next?” smoking, becoming overweight, or not exercising. Remember that treating CAD can increase your quality of life and potentially reduce your risk of a heart attack. And be sure to monitor your blood pressure and have simple blood tests to check your cholesterol Why me? The reality is that you have probably had and blood sugar levels. These steps can have a CAD for some time and probably also have risk factors positive impact on your health now and in the future! that have led to the development of CAD. - Philip L. Chustz, M.D. What are the risk factors? Risk factors for CAD include anything that increases your chance of having it. This includes risk factors that you cannot change, as well as those that you can change. Sometimes Risk factors that can be controlled include: CAD develops in a person who has no known risk factors. Smoking or tobacco use of any kind; exposure to secondhand smoke Risk factors that you cannot change include: High blood pressure High triglycerides Gender: Men are at greater risk than women and tend Uncontrolled diabetes to have heart attacks earlier in life. But, after age 70 the Physical inactivity risk is even between men and women. Overweight Uncontrolled stress or anger • Women tend to have Coronary Heart Disease about Diet high in saturated fat and cholesterol 10 years later than men, but it still is the #1 killer of women in the United States. Drinking too much alcohol

• Although death rates from CAD have dropped over the years, they have not dropped for women as much Researchers continue studying other factors that are as for men. related to CAD. There is evidence that may be related to the development of CAD. In addition, lack of Age: Everyone over age 65 is at greater risk of CAD. sleep or too much sleep may also be related. The roles Family history of heart disease: If your parent had of C-reactive protein (a body protein that may be higher heart disease, your risk is greater, especially if they with inflammation), high triglycerides (a type of fat/lipid were diagnosed before age 50. in the blood), homosysteine (an amino acid in the body) and lipoprotein (a) are also being explored to see if they Race: African Americans tend to have higher blood are related to having CAD. pressure and also a greater risk of heart disease. Mexican Americans, American Indians, native What’s next?Next? Hawaiians and some Asians also have a higher risk. In general, higher risk is related to greater levels of obesity and diabetes in these populations. Options for treating CAD are better than ever before! Your cardiologist will address your risk factors and will develop a treatment plan especially designed for you. Often, risk factors can be reduced by making lifestyle changes. However, medication may be used to reduce levels of cholesterol and help keep the blood flowing. If you need help with these changes, your cardiologist will offer more detail and support. In addition to slowing the progress of the disease, 3. Surgical Procedures: Generally, surgery is not treatment is also aimed at lowering your risk of heart needed to treat CAD, except in advanced cases attack and death from CAD. when blood flow to your heart is interfering with heart function. In such cases, surgery can be life-saving. Your cardiologist may recommend a surgical The treatment recommended by your cardiologist procedure when one or more of your coronary arteries depends on your age, overall health and the degree of is blocked and if other treatments have not helped. your CAD. The recommendation for surgery always comes as a result of careful evaluation of your specific situation and your preferences, in order to give you the best possible options and outcomes. If your cardiologist TreatmentsTreatments of of CAD CAD May may Include include recommends any of these procedures, you will receive extensive information and preparation to guide your oneOne oror moreMore of thethe Following:following: decision making.

1. Lifestyle changes: Symptoms of CAD may get better or procedure: A balloon when life style changes are made. Similarly, the angioplasty procedure involves the insertion of a thin changes can help keep it from becoming worse. catheter with a plastic bulb into the blocked artery. Then, a tiny balloon at the end of the catheter is Don’t Smoke: Blood vessels constrict when inflated to open the artery. Sometimes a thin, mesh any type of nicotine is used. If you need help with tube (called a stent) is left in place to keep the artery this, ask your cardiologist for recommendations. open. The stent may contain medication that helps keep the artery open over time. Not every blockage Exercise: Your cardiologist will advise you can be treated with angioplasty. about what level of exercise is recommended in your particular case. An exercise or rehabilitation plan Bypass surgery (also known as coronary artery may be ordered by your cardiologist as an important bypass grafting or CABG): A procedure to create a part of your CAD treatment plan. new passage for blood to get to the heart. This is done by removing a blood vessel from another part Your diet: A heart- that is low in of your body and then reattaching it above and saturated fat and high in essential nutrients can help below a blocked artery. This re-routes the blood slow down the progress of CAD. If started earlier around the blockage and gives the heart the blood in life, it can even act to prevent CAD. Your supply that it needs. cardiologist can provide additional information about a healthy diet. Minimally invasive bypass surgery: This procedure has the same goals as a traditional Weight loss: If you need to lose weight, a heart by-pass surgery but is done without stopping the healthy diet will help. If you have problems with this, heart or using a heart-lung machine during the ask your cardiologist for help or a consultation with a procedure. It is known as off pump coronary artery dietary expert. bypass, or OPCAB.

2. Medication: Your cardiologist may prescribe different types of medications for CAD for the treatment of high blood pressure, high cholesterol, irregular heartbeat or poor blood flow. Aspirin or other drugs may be prescribed to help prevent blood clots.

Treating CAD can improve a patient’s quality of life and functional status and potentially reduce his/her risk of death. - Philip L. Chustz, M.D. In addition to slowing the progress of the disease, 3. Surgical Procedures: Generally, surgery is not treatment is also aimed at lowering your risk of heart needed to treat CAD, except in advanced cases attack and death from CAD. when blood flow to your heart is interfering with heart function. In such cases, surgery can be life-saving. Your cardiologist may recommend a surgical The treatment recommended by your cardiologist procedure when one or more of your coronary arteries depends on your age, overall health and the degree of is blocked and if other treatments have not helped. your CAD. The recommendation for surgery always comes as a result of careful evaluation of your specific situation and your preferences, in order to give you the best possible options and outcomes. If your cardiologist Treatments of CAD May Include recommends any of these procedures, you will receive extensive information and preparation to guide your One or More of the Following: decision making.

1. Lifestyle changes: Symptoms of CAD may get better Angioplasty or stent procedure: A balloon when life style changes are made. Similarly, the angioplasty procedure involves the insertion of a thin changes can help keep it from becoming worse. catheter with a plastic bulb into the blocked artery. Then, a tiny balloon at the end of the catheter is Don’t Smoke: Blood vessels constrict when inflated to open the artery. Sometimes a thin, mesh any type of nicotine is used. If you need help with tube (called a stent) is left in place to keep the artery this, ask your cardiologist for recommendations. open. The stent may contain medication that helps keep the artery open over time. Not every blockage Exercise: Your cardiologist will advise you can be treated with angioplasty. about what level of exercise is recommended in your particular case. An exercise or rehabilitation plan Bypass surgery (also known as coronary artery may be ordered by your cardiologist as an important bypass grafting or CABG): A procedure to create a part of your CAD treatment plan. new passage for blood to get to the heart. This is done by removing a blood vessel from another part Your diet: A heart-healthy diet that is low in of your body and then reattaching it above and saturated fat and high in essential nutrients can help below a blocked artery. This re-routes the blood slow down the progress of CAD. If started earlier around the blockage and gives the heart the blood in life, it can even act to prevent CAD. Your supply that it needs. cardiologist can provide additional information about a healthy diet. Minimally invasive bypass surgery: This procedure has the same goals as a traditional Weight loss: If you need to lose weight, a heart by-pass surgery but is done without stopping the healthy diet will help. If you have problems with this, heart or using a heart-lung machine during the ask your cardiologist for help or a consultation with a procedure. It is known as off pump coronary artery dietary expert. bypass, or OPCAB.

2. Medication: Your cardiologist may prescribe different types of medications for CAD for the treatment of high blood pressure, high cholesterol, irregular heartbeat or poor blood flow. Aspirin or other drugs may be prescribed to help prevent blood clots.

Treating CAD can improve a patient’s quality of life and functional status and potentially reduce his/her risk of death. WebMD (2015) Coronary Artery Disease. Accessed 9/17/2015 from: http://www.webmd.com/ Remember These heart-disease/guide/heart-disease-coronary-artery-diseaseWebMD (2015) Coronary Artery Remember these Disease. Accessed 9/17/2015 from: http://www.webmd.com/heart-disease/guide/heart-disease- coronary-artery-disease Importantimportant Facts facts Patient Resources: Symptoms of CAD can be mistaken for something else, Explore these resources for more information about CAD. such as severe gas or . American Heart Association (Local) 4830 McWillie Circle Jackson, MS 39206 If you have CAD, your risk of heart attack, stroke and Phone: (601) 321-1200 heart failure is greater than those who do not have this Fax: (601) 321-1201 problem. American Heart Association (National) Customer Service 1-800-AHA-USA-1 If you have acute symptoms of a heart attack, call 911 1-800-242-8721 www.heart.org/pad or your local emergency number quickly. Center for Disease Control (CDC) Division for Heart Disease and Stroke Prevention • Do not try to drive yourself to the hospital! For Coronary Artery Disease http://www.cdc.gov/heartdisease/coronary_ad.htm

• Do not wait! Your life may depend on it! For General information: [email protected] CDC/NCCDPHP/DHDSP 4770 Buford Hwy, NE Mail Stop F-72 Atlanta, GA 30341-3717

Call: 800-CDC-INFO In Summary Fax: 770-488-8151

American College of : Cardio smart www.cardiosmart.org This brochure has provided thorough information http://assets.cardiosource.com/cardiosmart/csp/english/zx1311.pdf about CAD symptoms, diagnosis, and treatment. CAD: Helping a Loved One And, although CAD can be life-threatening, it can be https://www.cardiosmart.org/Healthwise/ue47/00ab/c/ue4700abc treated so that your symptoms are manageable and National Institutes of Health the progress of the disease lessened. With your new National Heart, Lung, and Blood Institute, National Institutes of Health – NHLBI At this website you will find links to information about every aspect of CAD. You can also knowledge of the problem, you can work with your write or call for hard copy of the information. DHHS, NIH (National Heart, Lung & Blood Institute (2015) What is coronary heart disease?. Accessed 9/18/2015 from: cardiologist at Jackson Heart Clinic to develop a plan http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ that works best for you and your unique needs. It is and for general information about other heart topics: our goal for you to have the highest possible level www.nhlbi.nih.gov of cardiovascular health and enjoy your life to the Or write to: National Heart, Lung, and Blood Institute, National Institutes of Health - NHLBI fullest degree possible! Building 31, Room 5A52 31 Center Drive, MSC 2486 Bethesda, MD 20892-2470 301-592-8573 (Voice, Information Center) 301-592-8563 (FAX, Information Center) References: WebMD This site offers basic information about CAD and many links to related topics American Heart Association (2015) Coronary artery disease- coronary heart disease. Accessed http://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease 9/17/2015 from: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery- Disease---The-ABCs-of-CAD_UCM_436416_Article.jsp

Casey, T (July 6, 2015) Coronary artery calcification test predicts mortality over 15-year period. Cardiology Business. Accessed 9/18/2015. Jackson Heart Physicians: Centers for Disease Control and prevention (2015) Coronary artery disease – CAD. Accessed 9/18/2015 from http://www.cdc.gov/heartdisease/coronary_ad.htm

DHHS, NIH (National Heart, Lung & Blood Institute (2015) What is coronary heart disease?. Accessed 9/18/2015 from: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ Jefferson A. Fletcher, M.D. R. Harper Stone, M.D. David H. Mulholland, M.D. Mayo Clinic Staff (2015) Coronary Artery Disease. Accessed 9/17/2015 from http://www. mayoclinic.org/diseases-conditions/coronary-artery-disease/basics/definition/con-20032038 Jimmy W. Lott, M.D. J. Clay Hays, Jr., M.D. Sharkey, SW, Lesser, JR, & Maron, BJ (2011) Cardiology Patient Page. Takotsubo (Stress) Cardiomyopathy. American Heart Association. Accessed 10/7/2015 from: http://circ.ahajournals. Richard D. Guynes, M.D. org/content/124/18/e460.full. D. Russell Young, M.D. V. Reid Cotten, M.D. University of Chicago Medical Center (2015) Coronary artery disease and chest pain. Accessed J. Gray Bennett, M.D. 9/17/2015 from: http://www.uchospitals.edu/specialties/heart/services/coronary-artery-disease/ William H. Crowder, M.D.

UpToDate Patient Information: Coronary Heart Disease. UpToDate. Accessed 9/17/2015 from Douglas D. Harkins, M.D. http://www.uptodate.com/contents/coronary-heart-disease-the-basics B. Judson Colley III, M.D., M.P.H. Philip L. Chustz, M.D. WebMD (2015) Coronary Artery Disease. Accessed 9/17/2015 from: http://www.webmd.com/ Remember These heart-disease/guide/heart-disease-coronary-artery-diseaseWebMD (2015) Coronary Artery Disease. Accessed 9/17/2015 from: http://www.webmd.com/heart-disease/guide/heart-disease- Important Facts coronary-artery-disease Patient Resources: Symptoms of CAD can be mistaken for something else, Patient resources: Explore these resources for more information about CAD. such as severe gas or indigestion. American Heart Association (Local) 4830 McWillie Circle Jackson, MS 39206 If you have CAD, your risk of heart attack, stroke and Phone: (601) 321-1200 heart failure is greater than those who do not have this Fax: (601) 321-1201 problem. American Heart Association (National) Customer Service 1-800-AHA-USA-1 If you have acute symptoms of a heart attack, call 911 1-800-242-8721 www.heart.org/pad or your local emergency number quickly. Center for Disease Control (CDC) Division for Heart Disease and Stroke Prevention • Do not try to drive yourself to the hospital! For Coronary Artery Disease http://www.cdc.gov/heartdisease/coronary_ad.htm

• Do not wait! Your life may depend on it! For General information: [email protected] CDC/NCCDPHP/DHDSP 4770 Buford Hwy, NE Mail Stop F-72 Atlanta, GA 30341-3717

Call: 800-CDC-INFO In Summary Fax: 770-488-8151

American College of Cardiology: Cardio smart www.cardiosmart.org This brochure has provided thorough information http://assets.cardiosource.com/cardiosmart/csp/english/zx1311.pdf about CAD symptoms, diagnosis, and treatment. CAD: Helping a Loved One And, although CAD can be life-threatening, it can be https://www.cardiosmart.org/Healthwise/ue47/00ab/c/ue4700abc treated so that your symptoms are manageable and National Institutes of Health the progress of the disease lessened. With your new National Heart, Lung, and Blood Institute, National Institutes of Health – NHLBI At this website you will find links to information about every aspect of CAD. You can also knowledge of the problem, you can work with your write or call for hard copy of the information. DHHS, NIH (National Heart, Lung & Blood Institute (2015) What is coronary heart disease?. Accessed 9/18/2015 from: cardiologist at Jackson Heart Clinic to develop a plan http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ that works best for you and your unique needs. It is and for general information about other heart topics: our goal for you to have the highest possible level www.nhlbi.nih.gov of cardiovascular health and enjoy your life to the Or write to: National Heart, Lung, and Blood Institute, National Institutes of Health - NHLBI fullest degree possible! Building 31, Room 5A52 31 Center Drive, MSC 2486 Bethesda, MD 20892-2470 301-592-8573 (Voice, Information Center) 301-592-8563 (FAX, Information Center) References: WebMD This site offers basic information about CAD and many links to related topics American Heart Association (2015) Coronary artery disease- coronary heart disease. Accessed http://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease 9/17/2015 from: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery- Disease---The-ABCs-of-CAD_UCM_436416_Article.jsp

Casey, T (July 6, 2015) Coronary artery calcification test predicts mortality over 15-year period. Cardiology Business. Accessed 9/18/2015. Jackson Heart Physicians: Centers for Disease Control and prevention (2015) Coronary artery disease – CAD. Accessed Jefferson A. Fletcher, M.D. 9/18/2015 from http://www.cdc.gov/heartdisease/coronary_ad.htm R. Harper Stone, M.D. DHHS, NIH (National Heart, Lung & Blood Institute (2015) What is coronary heart disease?. David H. Mulholland, M.D. Accessed 9/18/2015 from: Jimmy W. Lott, M.D. http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ J. Clay Hays, Jr., M.D. Richard D. Guynes, M.D. Mayo Clinic Staff (2015) Coronary Artery Disease. Accessed 9/17/2015 from http://www. D. Russell Young, M.D. mayoclinic.org/diseases-conditions/coronary-artery-disease/basics/definition/con-20032038 V. Reid Cotten, M.D. Sharkey, SW, Lesser, JR, & Maron, BJ (2011) Cardiology Patient Page. Takotsubo (Stress) J. Gray Bennett, M.D. Cardiomyopathy. American Heart Association. Accessed 10/7/2015 from: http://circ.ahajournals. org/content/124/18/e460.full. William H. Crowder, M.D. Douglas D. Harkins, M.D. B. Judson Colley III, M.D., M.P.H. University of Chicago Medical Center (2015) Coronary artery disease and chest pain. Accessed 9/17/2015 from: http://www.uchospitals.edu/specialties/heart/services/coronary-artery-disease/ Philip L. Chustz, M.D. A. Gene Hutcheson, M.D. UpToDate Patient Information: Coronary Heart Disease. UpToDate. Accessed 9/17/2015 from http://www.uptodate.com/contents/coronary-heart-disease-the-basics Brett A. Bennett, M.D. Donny R. Stokes, M.D. Sandra S. McCearley, M.D. Jingyuan (Jimmy) Ma, M.D. ©2019©2016 Jackson Heart ©2016 Jackson Heart Suite D Suite 61 Suite 61 Suite 61 601-982-7850 601-982-7850 601-982-7850 Madison Clinic Flowood Clinic Dominican Plaza Dominican Plaza Dominican Plaza 970 Lakeland Drive Madison, MS 39110 Jackson, MS 39216 Flowood, MS 39232 970 Lakeland Drive 970 Lakeland Drive Jackson, MS 39216 Jackson, MS 39216 794 Highway 51 North www.jacksonheart.com www.jacksonheart.com www.jacksonheart.com 205A Belle Meade Pointe 205A