Coronary Artery Disease

General Information

Coronary artery disease occurs with the development of hardening of the arteries that feed blood to the heart muscle. The deposits of cholesterol that harden these arteries also narrow the artery and limit the amount of blood that can flow through it. Exercise increases the heart rate. Normally this results in an increase in blood flow through the coronary arteries to provide oxygen for the exercising heart’s muscle. When this increase in blood flow fails to occur because of the narrowed arteries, pain in the chest, heart pain, is one result. This pain is called angina pectoris. The occurrence of artery narrowing rises with age. Coronary artery disease is a phenomenon of aging.

Typical anginal pain comes on with exercise and abates with rest. Emotional upset or a large meal, if it causes the heart rate to increase, counts as exercise. The pain is most often felt in the left side of the chest in the front. It can spread to or occur in the neck, jaw, shoulder (usually left shoulder), and left arm. Cold weather seems to be associated with increased frequency and attacks of anginal pain.

Generally patients with angina learn how much exercise they can tolerate without development of painful discomfort in the chest. Angina can mimic pain caused by musculoskeletal abnormalities, arthritis, or muscle and joint strain in the muscles and bones, particularly of the chest. Conversely, pain from these sources can mimic angina. Angina-like pain can also be a result of heartburn or esophageal inflammation or gallstone attacks and, on rare occasions, peptic ulcer discomfort. Because anginal pain implies a risk of sudden death, it is wise to have your physician evaluate new or recurrent chest pain.

Chest pain is not an inevitable accompaniment of decrease in blood flow to the heart muscle. This is particularly true in the elderly in whom heart attacks in the absence of chest pain are common. In these patients, shortness of breath or heart failure may be the presenting problem.

Important Points in Treatment
If angina pectoris is the diagnosis, a decision concerning its control depends on the extent of involvement of the coronary arteries in the narrowing process. Many patients receive treatment with medicines alone. Drugs called vasodilators help the arteries remain open as widely as possible. Nitroglycerin and its derivatives are most often used to dilate the coronary arteries, but a wide selection of other drug preparations (calcium channel blockers) is available for this purpose as well. In addition, drugs, usually beta blockers, are given to regulate the heartbeat. Low doses of aspirin may be given to act as a blood thinner and prevent the possible progression of the angina to a heart attack.

Much can be done to prevent anginal pain. Exercise and activity, which are important to maintain physical condition, should continue but should be kept to a level below that which triggers the anginal pain. Many tasks can be done without precipitating anginal attacks if approached in a measured and thoughtful manner. Your physician can counsel you about the appropriateness of some forms of work or exercise.

Patients with angina have good and bad days. Exploit the good days and respect the bad ones. Be cautious when the weather adds to stress levels.

Notify Our Office If

• You experience pain in the chest. New pain or recurring pain is a real risk and a warning for urgent evaluation.
• You experience a change in pain in the chest. Pain that changes and becomes unstable often precedes a heart attack. Unstable pain may come on with less than the usual amount of exercise, sometimes without any exercise at all while you are at rest or in bed. Its relief is less predictable, and it may persist for a longer interval.