Coronary Heart Disease – Diagnosis and Treatments

Coronary Heart Disease

Methods of Diagnosis

Your healthcare provider diagnoses coronary artery disease (atherosclerosis) based on your medical and family histories, a physical exam, or results from the following tests.

• Physical Exam: During a physical exam, your health professional may use a stethoscope to check your arteries for an abnormal whooshing sound called heart murmur, which may indicate poor blood flow due to plaque (it should be noted that, the plaque in the heart arteries are different from dental plaque) buildup. He or she also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent, which can be a sign of a blocked artery.
• Diagnostic Tests: Your healthcare provider may recommend one or more tests to diagnose atherosclerosis. These tests can help define the extent of your disease and the best treatment plan.
  • Blood Tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may put you at risk for atherosclerosis.
  • Ankle/Brachial Index compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. Used to help diagnose Peripheral Arterial Disease (PAD).
  • EKG (Electrocardiogram) detects and records the heart’s electrical activity. It shows how fast the heart is beating and its rhythm (steady or irregular).
  • Echocardiography uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart, how well your heart chambers and valves are working, and areas of poor blood flow.
  • Computed Tomography Scan creates computer-generated pictures and can show hardening and narrowing of large arteries.
  • Stress Testing You exercise (or are given medicine if you are unable to exercise) to make your heart work hard and beat fast while heart tests are done. A stress test can show possible signs of Coronary Arteries Disease (CAD).
  • Angiography: Angiography uses dye and special X-rays to reveal the insides of your arteries. It can show whether plaque is blocking your arteries and how severe the blockage is.

Lifestyle changes

• Follow a Healthy Diet. This can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
• Exercise Regularly. Regular physical activity can lower many atherosclerosis risk factors, including LDL (“bad”) cholesterol, high blood pressure, and excess weight. It also can lower the risk of diabetes and raise your HDL (“good”) cholesterol, which helps prevent atherosclerosis. Talk to your healthcare provider before you start a new exercise plan.
• Maintain a Healthy Weight. Maintaining a healthy weight can lower your risk of atherosclerosis. A general goal is a body mass index (BMI) of less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI’s online BMI calculator to figure out your BMI, or your healthcare provider can help you. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating atherosclerosis. Your healthcare provider can help you set an appropriate goal.
• Quit Smoking. If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels, raising the risk of atherosclerosis. Talk to your healthcare provider about programs and products to help you quit.
• Manage Stress. Research shows that the most commonly reported “trigger” for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, drinking, smoking, or overeating to cope with stress is not healthy.

Medicines

To slow the buildup of plaque, your health professional may prescribe medicines to help lower your cholesterol level or blood pressure or to prevent blood clots from forming.

Medical Procedures and Surgery

In the event of severe atherosclerosis, your doctor may recommend one of several procedures or surgeries.

Angioplasty is a procedure to open blocked or narrowed coronary (heart) arteries. It can improve blood flow, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube, called a stent, is placed in the artery to keep it open after angioplasty.

Coronary artery bypass grafting (CABG) is a type of surgery that uses arteries or veins from other areas in your body to bypass your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent heart attack.

Bypass grafting also can be used for leg arteries. In this surgery, a healthy blood vessel is used to bypass a narrowed or blocked artery in one of your legs. The healthy blood vessel redirects blood around the artery, improving blood flow to the leg.

Carotid endarterectomy, or carotid artery surgery, removes plaque buildup from the carotid arteries in the neck. This procedure opens the arteries and improves blood flow to the brain, helping prevent a stroke.

Specialists Involved

If you have coronary artery disease, your healthcare provider may recommend other healthcare specialists. These may include:

• A cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. You may see a cardiologist if you have coronary heart disease (CHD).
• A vascular specialist. This is a doctor who specializes in diagnosing and treating blood vessel problems. You may see a vascular specialist if you have peripheral arterial disease (PAD).
• A neurologist. This is a doctor who specializes in diagnosing and treating nervous system disorders. You may see a neurologist if you’ve had a stroke due to carotid artery disease.

What questions to ask your Doctor?

1. Is my cholesterol level currently under control?
2. How often should I have my cholesterol checked?
3. What type of exercises would you recommend that I do to safely help lower my bad cholesterol and raise my good cholesterol?
4. Do I have any other risk factors that could affect my heart health?
5. What, if any, medications do I need to take? What are their side effects?

Latest Update on CHD

• New research from the Women’s Health Initiative (WHI) confirm that combination hormone therapy (HT) increases the risk of heart disease in healthy postmenopausal women. Researchers report a trend toward an increased risk of heart disease during the first two years of hormone therapy among women who began therapy within 10 years of menopause, and a more marked elevation of risk among women who began hormone therapy more than 10 years after menopause. Analyses indicate that overall a woman’s risk of heart disease more than doubles within the first two years of taking combination HT.
• Cholesterol screening rates for young adults who have at least one of the common risk factors for bad cholesterol is low. This is a possible breakthrough and good news for young adults, according to the Centers for Disease Control and Prevention (CDC). Young men and women who tend to have a high burden of risk factors for heart disease, needs to evaluate their work and family lifestyle and keep to the advises from their doctors. In the past, study have indicated tremendous improvement from patients who keep to best practices when it concerns lowering all of the risk factors of CHD.
• Other health providers have found great success with their patients by prescribing diuretics without any receptor blockers, eliminating strenuous/exhausting tension to the heart pulmonary valves and muscles.

Angiotensin II Receptor Blockers (ARBs)

Examples

Generic Name	Brand Name
candesartan	Atacand
eprosartan	Teveten
irbesartan	Avapro
losartan	Cozaar
olmesartan	Benicar
telmisartan	Micardis
valsartan	Diovan

Angiotensin II receptor blockers combined with diuretic

Generic Name	Brand Name
irbesartan and hydrochlorothiazide	Avalide
losartan and hydrochlorothiazide	Hyzaar

How It Works

Angiotensin II receptor blockers inhibit a substance that causes blood vessels to narrow(constrict). As a result, blood vessels relax and widen (dilate), making it easier for blood to flow through the vessels, which reduces blood pressure.These medicines also increase the release of water and salt (sodium) to the urine, which in turn lowers blood pressure as well.

Preventing the blood vessels from constricting helps improve blood flow, which reduces the backup of blood in the heart and lungs. It also decreases the pressure that the left ventricle of the heart must pump against.

Angiotensin II receptor blockers also act directly on the hormones that regulate sodium and water balance.

Why It Is Used

Angiotensin II receptor blockers can be used to treat coronary artery disease, heart failure, high blood pressure, or kidney disease.

An angiotensin II receptor blocker (ARB) may be used instead of an angiotensin-converting enzyme(ACE) inhibitor if you are not able to tolerate certain side effects of an ACE inhibitor. ACE inhibitors can cause an annoying cough. Thiscough may be hard for some people to live with.So doctors may prescribe an ARB instead, because ARBs are less likely to cause a cough.

How Well It Works

ARBs can lower the risk of death from heart failure.ARBs also reduce the number of people with heart failure who need to go into the hospital. ARBs have been shown to work as well as ACE inhibitors for heart failure.¹ ARBs are less likely to cause the cough that is associated with ACE inhibitors.

If you are taking an ARB because you have diabetes and early signs of kidney problems, or have kidney disease, these medicines can slow or prevent further damage to your kidneys.

Side Effects

All medicines have side effects. But many people don’t feel the side effects, or they are able to deal with them. Ask your pharmacist about the sideeffects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

• Usually the benefits of the medicine are more important than any minor side effects.
• Side effects may go away after you take the medicine for a while.
• If side effects still bothers you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call or other emergency services right away if you have:

• Trouble breathing.
• Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

• Hives.

Common side effects of this medicine include:

• Dizziness or lightheadedness.
• Sinus problems, such as a stuffy nose or a runny nose.
• Stomach problems.

See Drug Reference for a full list of side effects.(Drug Reference is not available in all systems.)

What To Think About

Tell your doctor about all of the other medications that you take, including prescription and over-the-counter medications. ARBs may interact with other medicines such as NSAID pain relievers(nonsteroidal anti-inflammatory drugs), antacids, potassium supplements, certain diuretics, and lithium. If you are taking one of these medicines,talk with your doctor before taking an ARB.

Taking medication

Medication is one of the many tools your doctor has to treat a health problem. Taking medication as your doctor suggests will improve your health and may prevent future problems. If you don’t take your medications properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medication. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medications as Prescribed.

For tips on taking medication for heart failure, see:

Heart Failure:

Taking Medication Properly

Advice for women

Do not use this medication if you are pregnant or planning to get pregnant. If you need to use this medication, talk to your doctor about how you can prevent pregnancy.

Checkups

You will likely have regular blood tests to monitor how the medication is working in your body and to see if this medication is causing problems.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medications you take.