Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease, or CAD, is the buildup of cholesterol rich plaque inside the coronary arteries. These are the vessels that deliver oxygen rich blood to the heart muscle. Plaque forms slowly over decades. As it thickens, the channel narrows. The muscle downstream then receives less blood than it needs during exertion. That shortfall causes angina. Angina is the pressure or tightness people feel when they climb stairs or hurry. A plaque can also rupture. A clot then forms on top of it and blocks the artery completely. The result is a heart attack and permanent muscle damage. CAD is the most common form of heart disease. Heart disease remains the leading cause of death in the United States, according to the Centers for Disease Control and Prevention. The encouraging part is that CAD responds well to treatment. Cholesterol control, blood pressure control and stopping smoking all slow or halt its progression.

Symptoms to watch for

CAD can be present for years without a single symptom. Symptoms usually start with exertion and fade with rest.

Call the office if you have:

• Chest pressure, tightness or burning when you walk uphill, hurry or carry groceries.
• Shortness of breath with activity you used to handle easily.
• Jaw, neck, shoulder or upper back discomfort that comes on with exertion.
• Unusual fatigue, or a drop in what you can do without stopping.
• Nausea or lightheadedness during exercise.

Call 911 immediately for:

• Chest pressure lasting more than a few minutes, or that returns.
• Chest discomfort with sweating, nausea, or shortness of breath.
• Pain radiating into the arm, back, neck or jaw.
• Sudden severe weakness, fainting or a cold sweat.

Women often have less typical symptoms, such as breathlessness or extreme fatigue. The American Heart Association advises calling 911 rather than waiting for classic chest pain.

How Dr. Nanavati diagnoses it

Diagnosis combines your risk profile with testing. The testing shows whether the heart muscle is getting enough blood.

• Electrocardiogram (ECG or EKG) is done in the office. It can reveal prior injury or ongoing strain.
• Treadmill stress testing measures how your heart behaves under controlled exertion.
• Nuclear stress testing shows the specific regions of muscle that are short of blood.
• Advanced stress testing is used when walking is not possible. It also helps when the picture is unclear.
• Echocardiogram measures pumping strength. It also finds wall segments damaged by an earlier event.
• Coronary CT angiography visualizes plaque in the coronary arteries without a catheter.
• Ischemic heart disease evaluation pulls the findings into a single treatment plan.
• Advanced lipid testing goes beyond a routine panel to size up cholesterol risk.
• Carotid ultrasound Doppler and the ankle brachial index check the neck and leg arteries for plaque.

Testing sometimes suggests a significant blockage. A transradial angiogram through the wrist then provides the definitive answer at an affiliated hospital.

Treatment options

Every patient with CAD receives medical therapy. Procedures are added when symptoms or test results call for them.

Lifestyle. Stopping smoking is the highest impact change. Regular activity and a diet low in saturated fat make up the rest. So do weight management, blood sugar control and sleep. The Life's Essential 8 framework organizes these. Your visit also covers the seven risk factors for heart attack.

Medication. Most patients take more than one heart medicine. Each one has a specific job. Statins lower LDL cholesterol and stabilize plaque, following American College of Cardiology guidelines. Aspirin or another antiplatelet reduces clot risk. Beta blockers, nitrates and ACE inhibitors ease symptoms. They also protect the heart muscle. Blood pressure and diabetes medicines are adjusted alongside.

Procedures. Angioplasty, also called PTCA, opens a narrowed artery with a balloon. A coronary stenting procedure props it open with a small mesh tube. Multi vessel disease may be better treated with bypass surgery. These are performed at affiliated hospitals. Cardiac rehabilitation afterward is supervised exercise and education. It measurably improves recovery.

What to expect at your visit

Bring your medications and recent lab results. Also bring any prior stress test, catheterization or hospital records. Expect a conversation about what you can and cannot do physically. Exercise tolerance is a key clue. The visit includes an exam, blood pressure and an ECG. Stress testing, echocardiography and lipid testing are performed in the office. Staff will tell you how to prepare, including any food, caffeine or medication instructions. You leave with your LDL target, a medication plan and a clear next step. The office explains any recommended hospital procedure and arranges the scheduling for you. Common questions are covered on the FAQs page.

When to see a cardiologist

See a cardiologist for exertional chest pain or declining exercise tolerance. An elevated coronary calcium score is another reason. Evaluation is also worthwhile if you have diabetes, high cholesterol or high blood pressure. The same applies if a parent or sibling had early heart disease. Request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He sees patients at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

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