Heart and Vascular Disease

Coronary artery disease

The heart muscle, like all other muscles in the body, needs a steady blood supply to keep functioning. The arteries that supply blood to the heart muscle are the coronary arteries. Coronary artery disease is buildup of plaque (a collection of debris, cells and cholesterol) in the arteries. Frequency and severity of coronary artery disease tends to increase with age and risk factors such as the following:

• Diabetes
• Family history of heart attack, bypass surgery, coronary artery angioplasty or stent placement, especially first-degree relatives (parents and siblings)
• High blood pressure
• High cholesterol
• Smoking

The typical individual at risk for coronary artery disease is older than 40 years in age and has one of more of the risk factors listed above. When plaque in the coronary arteries becomes severe enough to interfere with blood flow to the heart muscle, the affected person can feel symptoms such as chest pain, chest pressure, jaw pain or breathlessness. 

In some cases, plaque in the coronary artery suddenly break and trigger a blood clot to form inside the artery, which can then completely block the artery and cause a heart attack. In people who develop problems from coronary artery disease, approximately 50% experience heart attack as their first symptom. Click here to view the risk factors and symptoms of heart attack.

Low-dose CT (computerized tomography) calcium scoring can identify the early stages of heart disease in patients without symptoms. Talk to your primary care doctor about scheduling an appointment.

Peripheral artery disease

Peripheral artery disease (PAD) is a disease of the blood vessels outside the heart and brain. This condition is caused by a narrowing of vessels that carry blood to the legs and feet, arms, brain, stomach or kidneys. PAD stems from structural changes in the blood vessels resulting from fatty buildup (atherosclerosis) in the inner walls of the arteries. These deposits hinder and block normal blood flow, especially to the lower- and upper- extremities.

Left untreated, PAD can lead to gangrene and limb amputation. Additionally, patients with PAD are at heightened risk for death from both heart attack and stroke. PAD can result in poor kidney circulation, leading to high blood pressure, or blood pressure that is difficult to control with lifestyle changes and medications. In some cases, blockage of the kidney arteries may progress to loss of kidney function or kidney failure.

The most common symptoms of PAD, especially in the early stages, include cramping, fatigue, heaviness, pain or discomfort in the legs and buttocks, due to poor leg circulation. The symptoms occur during activity and usually go away with rest. This can often decrease the distance you can walk, and can negatively affect your ability to function at home and at work. Other symptoms include skin problems or discoloration on your legs and feet, and poor nail growth.

Risk factors for developing PAD include:

• A family history of PAD
• A history of smoking
• Diabetes
• Excess weight
• High blood pressure
• High cholesterol
• Older age

Diagnosing PAD begins with a medical history and physical exam. Your healthcare provider also may perform a simple noninvasive test called an ankle brachial index (ABI) which compares the blood pressure in your arms and in your legs to look for a decrease in circulation. Treatment for PAD may include medication and heart-healthy lifestyle modifications. Medications that are often used include antiplatelet agents to prevent blood clots, cholesterol-lowering medications and high blood pressure drugs.

Lifestyle changes include smoking cessation, controlling diabetes and high blood pressure, managing your weight and eating a heart-healthy diet. Regular exercise is particularly important to reduce pain and other symptoms.

Peripheral artery disease treatment

When medications, lifestyle changes and exercise are not effective in treating PAD, an invasive procedure to widen arteries may be needed. This is called “revascularization.” Less invasive procedures to relieve PAD include angioplasty that widens narrowed or blocked arteries. A thin tube or catheter with a deflated balloon on its tip is passed into the narrowed artery to the location of the blockage. The balloon is inflated, which pushes open the narrowed segment. Other procedures that can help open a narrowed artery use a stent or wire mesh tube.

The stent is placed at the affected artery segment and expanded until opened. It stays in place, keeping the diseased artery open. If the narrowed artery segment is unable to be treated with angioplasty or stent placement, bypass surgery may be considered. A vein from another part of the body or a synthetic blood vessel is attached above and below the blocked area to detour blood around the blocked area.

Talk with your physician for more information.

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