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What is Coronary Artery Disease by Brendan Nahn

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Coronary artery disease, commonly abbreviated as CAD, is when the arteries of the heart have partial or complete blockage of blood flow to the muscles of the heart. How this happens is from a series of contributing factors that start the build of plaque along the walls of the arteries which is called arteriosclerosis. Plaque starts from cholesterol, specifically, LDL (Low-density lipoproteins), and a white blood cell called a monocyte. When you have elevated cholesterol levels, meaning more LDL, monocytes will begin eating or removing them from the blood. Eventually, they become so filled with this lipoprotein that they become foam cells, which is basically big ball of lipid droplets, and attach to the wall of your arteries. Once a foam cell attaches it starts a chain reaction, releasing cytokines (chemicals) that stimulate the smooth muscles around the vessel to divide, thickening the wall. As this happens more monocytes invade the area and try to remove these lipids.  If this continues the cells lining the vessel will start to swell and form gaps, exposing collagen fibers. When collagen fibers come into contact with blood this stimulates platelets to begin sticking to that area and form a clot which restricts blood flow even further. If this clot breaks off and blocks that vessel completely, you have a heart attack or if it travels up to the brain a stroke. When all that happens in your coronary arteries, that’s CAD. This can also happen in your other blood vessels as well which is called peripheral arterial disease (PAD). Now let’s say you have the beginning stages of arteriosclerosis; one thing that may start is angina or chest pain and there are two different types of this, stable and unstable. Stable occurs during exercise, physical activity, or mental and emotional stress. Unstable is when you have chest pain at rest which is very severe and should be checked out immediately. Other symptoms of a heart attack include:

  • Pain or discomfort in the neck, jaw or back
  • Feeling weak, light-headed, or faint
  • Chest pain or discomfort
  • Pain or discomfort in the arms or shoulder (More commonly or frequent in the left arm, but not always)
  • Shortness of breath

Recognizing these symptoms is very important because you could potentially stop a heart attack before it happens or CAD at an earlier stage and get proper treatment.

Some treatments a doctor might suggest for you will vary and depend on how severe the blockage is and how much blood the heart is not getting. The main thing he’ll recommend is lifestyle changes meaning diet, exercise, not smoking, and limiting alcohol. There are general “rules” such as no fast food, eating plenty of fresh fruits and vegetables, eating foods low in cholesterol, saturated fats, sodium, trans fatty acids, and fatty meats such as beef, lamb, and pork. You want to increase HDLs (high-density lipoproteins) in your diet because HDL’s job is to carry LDLs back to the liver. Orange juice and soy products have been studied and shown to increase HDL levels as well as replace saturated fat foods with unsaturated. To get what is best for you, see a dietician so you can get the best food plan specifically for you.

What you eat greatly affects your blood pressure. A doctor might say you have hypertension which is high blood pressure, and high blood pressure is a huge factor in health risks and problems. Hypertension affects the heart in how hard the heart works, so if you have CAD and more than likely hypertension, your heart has to work extremely hard to try and get blood to itself, not to mention the rest of your body. This is what causes fatigue, shortness of breath, or even chest pain. If your BP (blood pressure) is high, the doctor might also prescribe drugs to help lower it. It’s important to note though, a pill cannot cure everything, it simply helps. The best ways to lower it are exercise and eating healthy but if your levels are dangerously high it is important to get them under control immediately. If you are already on drugs for various things like BP or chest pain, think about if you started to make lifestyle changes and begin eating right, exercising, and quitting smoking. Not only are you becoming healthier, you feel better, and if continue to do so you save money by not eating at fast food restaurants or buying cigarettes. Maybe even the next time you go to the doctor you might be able to get off certain medications if he notices these changes in your health, which can save you even more money!

If medications are ineffective and/or your condition is extreme, non-invasive or invasive surgery might be your best option. Non-invasive means they don’t make a relatively large incision and use tools to help with the blockage. They can insert a long, slender catheter into the coronary artery and use other surgical tools to remove soft plaque. Balloon angioplasty is when the tip of the catheter has an inflatable “balloon”, and once it is placed it is inflated and pushes the plaque against arterial walls. Balloon angioplasty often involves the use of stents to help keep it open and from reforming, and also to help support the vessel. An invasive surgery, more commonly known as bypass surgery, is another procedure. Relatively large incisions are made to get to the heart and a graft taken from small peripheral veins or arteries is used to create vessels that go around the blockage. The number of vessels repaired can be up to four and is spoken as a single, double, triple, or quadruple bypass surgery. Although this is termed as invasive, with rapidly advancing technology this procedure is on the verge of becoming non-invasive.

Now that you have a basic idea of how CAD starts, what it is, and some of the terminology, the doctor’s visit might not be so overwhelming and you can better understand what he is talking about. Listening to your doctor’s advice along with educating yourself is the best combination for a healthier lifestyle.




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“Coronary Artery Disease (CAD).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 07 Dec. 2009. Web. 06 Oct. 2013.

“How to Boost Your ‘Good’ Cholesterol.” WebMD. WebMD, 03 Jan. 2005. Web. 06 Oct. 2013.

Martini, Frederic H., Ph.D, Judi L. Nath, Ph.D, and Edwin F. Bartholomew, M.S. Fundamentals of Anatomy & Physiology. Ninth ed. San Francisco: Pearson Benjamin Cummings, 2012. Print



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