Innovations in Coronary Artery Disease Diagnosis and Treatment
Coronary artery disease (CAD) is a narrowing or blockage of the arteries of the heart due to a buildup of cholesterol and fatty deposits (called plaques) in the inner walls of the arteries. Over time, these plaques can clog the artery and restrict blood flow to the heart muscle.
Cleveland Clinic Florida has a tradition of excellence in the care of patients who have coronary artery disease.
"Cleveland Clinic Florida has been named one of the nation’s 50 Top Hospitals® for cardiovascular care by Thomson Reuters,” said Howard Bush, MD, chair of the Department of Cardiology. “In addition, the American Heart Associations has also recognized us for outstanding achievement using evidence-based guidelines to provide the best possible care to patients for coronary artery disease, heart failure and stroke."
The diagnosis of CAD can be made following a careful history and physical examination, complemented with the use of appropriate diagnostic testing.
An electrocardiogram (EKG) looks at the electrical activity of the heart, and may be helpful in the diagnosis of arrhythmias (abnormalities in the rhythm of the heart), prior heart muscle damage (infarction), or ongoing coronary insufficiency (lack of blood flow). Stress tests allow us to increase the work-load on the heart and evaluate if the “supply” can keep up with the “demand”. An "imbalance" of supply/demand is called "ischemia," and this is usually the result of CAD. Echocardiograms (ultrasound of the heart) are non-invasive studies that use sound waves to look at the heart muscle (myocardium), the heart valves (mitral valve and aortic valve), and the sac around the heart (pericardium).
If significant CAD is detected during the cardiac evaluation, the physician may suggest a cardiac catheterization or coronary angiogram. During this procedure (often done as an outpatient), the physician will insert a catheter which is a long tube into a blood vessel (either in the groin or the arm) to get a direct look at the coronary arteries and the heart muscle.
With this definitive study, recommendations can be made regarding treatment options for coronary disease, valvular heart disease, and certain other conditions (congenital anomalies, congestive heart failure, peripheral arterial disease, etc.).
Medications are often the first-line treatment for CAD. Medications will help modify risk factors for coronary artery disease such as high blood pressure, high cholesterol, diabetes as well as thin the blood (anti-platelet drugs). In addition, medications such as beta blockers and nitrates can be helpful to control symptoms (i.e. angina) due to coronary insufficiency.
In addition to lifestyle modifications (diet and exercise, smoking cessation, etc), the physician may discuss revascularization (improving blood supply to the heart) options. Cleveland Clinic Florida has long been a leader in both interventional (coronary stents) and surgical options. The primary goals of these techniques are to either improve the quality of life and/or help insure longevity.
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