Coronary Artery Disease
Over time, fatty deposits called atheroma can build up in the arteries anywhere in your body. These can make the artery narrower and eventually reduce the blood supply to that part of the body. When this happens in the coronary arteries – those supplying the heart muscle itself with blood- we call it Coronary Artery Disease.
When oxygen carrying the blood supply to the heart muscle is not enough to cope with demand, it can cause Angina. This is experienced differently by each person but the common symptoms include:
- Chest pain or discomfort in the chest on exertion
- Shortness of breath on exertion
- Pains in the jaw, back or arm (or occasionally elsewhere)
- Feeling faint.
A heart attack (myocardial infarction) happens when part of the fatty deposit in the coronary artery breaks up, causing an inflammatory response resulting in a blood clot in that artery. This blood clot can suddenly stop or greatly reduce the blood supply to the heart muscle, which can cause damage if not restored quickly.
How we treat coronary artery disease (CAD)
Many are available to us, but the common ones are:
- Antiplatelet agents: These include Aspirin and usually another drug. This prevents your blood being too sticky therefore reduces the risk of clots forming after coronary artery treatment or clots reforming after a heart attack. See more information.
- Beta-blockers: These drugs slow down your heart rate which helps to keep your blood pressure low, reduces the workload on your heart and can help to prevent damage to your heart from getting any worse. Read more.
- ACE Inhibitors: These work by making your blood vessels relax and widen which improves blood flow, reduces blood pressure and reduces the workload on your heart. See more.
- Statins or other cholesterol lowering drugs: Statins lower your cholesterol which slows down the process of the fatty deposits furring up your arteries. They also help stabilise the fatty deposits in your arteries to prevent them breaking up and causing a heart attack. Although there was a lot of controversy over statins in the early days, they are now one of the most tested drugs. Lots of reliable studies show that they are very safe and effective – see more information.
- GTN spray and other nitrates: This works very quickly to open up your blood vessels to reduce the workload on your heart and improve blood flow. The spray (or sometimes under-the-tongue tablets) are given to use when you get angina symptoms. Sometimes you may be given a long-acting version of GTN in tablet form to help control your angina symptoms. The “rules” for using your GTN are:
- If you get chest pain or discomfort, sit and rest
- If the symptoms haven’t subsided within one minute, use one pump of the spray under your tongue
- If the symptoms continue after five minutes, take one further spray
- If the symptoms still continue after 10–15 minutes despite using your GTN, phone 999 for an ambulance.
GTN can make you feel lightheaded and give you a headache. Don’t be frightened of using it if you need to but make sure you are sitting down. The side effects will wear off quite quickly.
- Many other drugs can be given for your heart – find out more.
This invasive procedure involves putting a narrow tube into an artery in your arm or groin and feeding it through to your heart. First, an angiogram is performed where dye is injected through the tube directly into your heart arteries. This dye can be seen on x-ray and gives pictures of your arteries.
If there are narrow areas of atheroma in your arteries, the doctor will insert a guide wire through the tube into the narrowed artery and feed a hollow tube over the top. This hollow tube has a deflated balloon at the end which can be blown up in the narrowed artery. This stretches the artery wall and squashes the fatty deposit, widening the inside of the artery.
Some people may be treated with just a balloon, which is usually coated with a special drug to help keep the artery wall open. Some people may receive a metal stent, a thin wire tube wrapped around a balloon. When the balloon is inflated the stent is pushed against the wall of the artery to help keep it open. The balloons and tubes are then deflated and removed.
(Courtesy of British Heart Foundation)
We’re a pioneering centre of new drug-coated balloon angioplasty which is achieving excellent outcomes with less of the risk associated with metal stents.
Coronary artery bypass grafting (CABG) involves taking a healthy artery or vein from elsewhere in the body and “grafting” it to one or more of the coronary arteries above and below a lesion of atheroma to allow the blood flow to bypass the narrowing.
We don’t currently have the facilities for open heart surgery so refer our patients to other centres, usually the Royal Papworth Hospital in Cambridge.