Diagnosis
Your healthcare provider diagnoses coronary artery disease (atherosclerosis) based on your medical and family histories, a physical exam, and results from tests.
Specialists Involved
If you have coronary artery disease, your healthcare provider may recommend other healthcare specialists. These may include:
- A cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. You may see a cardiologist if you have coronary heart disease (CHD).
- A vascular specialist. This is a doctor who specializes in diagnosing and treating blood vessel problems. You may see a vascular specialist if you have peripheral arterial disease (P.A.D.).
- A neurologist. This is a doctor who specializes in diagnosing and treating nervous system disorders. You may see a neurologist if you've had a stroke due to carotid artery disease.
Methods of Diagnosis
- Physical Exam: During a physical exam, your health professional may use a stethoscope to check your arteries for an abnormal whooshing sound called a bruit, which may indicate poor blood flow due to plaque buildup. He or she also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent, which can be a sign of a blocked artery.
- Diagnostic Tests: Your healthcare provider may recommend one or more tests to diagnose atherosclerosis. These tests can help define the extent of your disease and the best treatment plan.
- Blood Tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may put you at risk for atherosclerosis.
- Ankle/Brachial Index compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. Used to help diagnose P.A.D.
- EKG (Electrocardiogram) detects and records the heart's electrical activity. It shows how fast the heart is beating and its rhythm (steady or irregular).
- Echocardiography uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart, how well your heart chambers and valves are working, and areas of poor blood flow.
- Computed Tomography Scan creates computer-generated pictures and can show hardening and narrowing of large arteries.
- Stress Testing You exercise (or are given medicine if you are unable to exercise) to make your heart work hard and beat fast while heart tests are done. A stress test can show possible signs of CAD.
- Angiography: Angiography uses dye and special X-rays to reveal the insides of your arteries. It can show whether plaque is blocking your arteries and how severe the blockage is.
Treatment
Latest NIH Research
- Recent gene-mapping research has found the largest set of genes yet discovered underlying high cholesterol and high triglycerides—the major risk factors for coronary heart disease. The new findings point to specific genetic signposts that help scientists understand why many people from all walks of life have abnormal levels of cholesterol and other blood lipids that lead to heart disease. The research was funded by the National Heart, Lung, and Blood Institute and several other NIH Institutes.
- New research from the Women's Health Initiative (WHI) confirm that combination hormone therapy (HT) increases the risk of heart disease in healthy postmenopausal women. Researchers report a trend toward an increased risk of heart disease during the first two years of hormone therapy among women who began therapy within 10 years of menopause, and a more marked elevation of risk among women who began hormone therapy more than 10 years after menopause. Analyses indicate that overall a woman's risk of heart disease more than doubles within the first two years of taking combination HT.
- Cholesterol screening rates for young adults who have at least one of the common risk factors for bad cholesterol are low and need to be increased, according to the Centers for Disease Control and Prevention (CDC). Young men and women have a high burden of risk factors for heart disease, the study indicates.
Ask Your Health Professional
- Is my cholesterol level currently under control?
- How often should I have my cholesterol checked?
- What type of exercises would you recommend that I do to safely help lower my bad cholesterol and raise my good cholesterol?
- Do I have any other risk factors that could affect my heart health?
- What, if any, medications do I need to take? What are their side effects?
Lifestyle changes
- Follow a Healthy Diet. This can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.
- Exercise Regularly. Regular physical activity can lower many atherosclerosis risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. It also can lower the risk of diabetes and raise your HDL ("good") cholesterol, which helps prevent atherosclerosis. Talk to your healthcare provider before you start a new exercise plan.
- Maintain a Healthy Weight. Maintaining a healthy weight can lower your risk of atherosclerosis. A general goal is a body mass index (BMI) of less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your healthcare provider can help you. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating atherosclerosis. Your healthcare provider can help you set an appropriate goal.
- Quit Smoking. If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels, raising the risk of atherosclerosis. Talk to your healthcare provider about programs and products to help you quit.
- Manage Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger. Also, drinking, smoking, or overeating to cope with stress is not healthy.
Medicines
To slow the buildup of plaque, your health professional may prescribe medicines to help lower your cholesterol level or blood pressure or to prevent blood clots from forming.
Medical Procedures and Surgery
In the event of severe atherosclerosis, your doctor may recommend one of several procedures or surgeries.
Angioplasty is a procedure to open blocked or narrowed coronary (heart) arteries. It can improve blood flow, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube, called a stent, is placed in the artery to keep it open after angioplasty.
Coronary artery bypass grafting (CABG) is a type of surgery that uses arteries or veins from other areas in your body to bypass your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent heart attack.
Bypass grafting also can be used for leg arteries. In this surgery, a healthy blood vessel is used to bypass a narrowed or blocked artery in one of your legs. The healthy blood vessel redirects blood around the artery, improving blood flow to the leg.
Carotid endarterectomy, or carotid artery surgery, removes plaque buildup from the carotid arteries in the neck. This procedure opens the arteries and improves blood flow to the brain, helping prevent a stroke.