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What Is Obstructive Coronary Artery Disease?
Obstructive CAD is a major risk factor for severe, potentially fatal heart difficulties. Early diagnosis and treatment can preserve your heart health and quality of life.
Having obstructive coronary artery disease (CAD) means there's significant blockage in the arteries that supply blood to your heart muscle. Significant blockage or stenosis of a coronary artery means that more than 50% of the artery is blocked. This can lead to a heart attack and other serious health difficulties.
Obstructive CAD is the most common type of heart disease, affecting an estimated 1 out of every 20 adults in the United States.
Obstructive CAD can be treated with surgery and other procedures. You may also be able to manage this condition through healthy lifestyle choices and following the advice of a healthcare team.
Obstructive CAD may not have any noticeable symptoms because it tends to progress gradually. Severely restricted blood flow in the heart may lead to angina. Angina is chest pain caused by a reduction in oxygenated blood reaching the heart muscle.
Physical exertion may bring on episodes of angina, though in cases of "unstable angina," chest pain may come on without an obvious trigger.
When CAD leads to a heart attack, symptoms may include:
Obstructive coronary artery disease (CAD) is usually the result of atherosclerosis. Atherosclerosis is the buildup of plaque in the walls of your arteries. Plaque is made up of cholesterol, fats, and other substances, and it can gradually form in any artery of the body.
When there's considerable plaque buildup in the coronary arteries, circulation to the heart becomes restricted, as the opening for blood to flow, known as the "lumen," grows narrower.
Obstructive CAD differs from nonobstructive coronary artery disease (CAD) in terms of how narrow the coronary arteries are and what's causing the arteries to narrow. Narrowed arteries indicate a condition known as "stenosis."
Obstructive CAD means there's a significant amount of plaque buildup in one or more coronary arteries, causing reduced circulation through a narrowed lumen.
In nonobstructive CAD there may be plaque present, but there's not enough to significantly restrict blood flow. Instead, other conditions may cause the arteries to narrow in people who have nonobstructive CAD.
Possible causes of nonobstructive CAD include:
Although nonobstructive CAD is less dangerous than obstructive CAD, both conditions may lead to angina, heart attack, and heart failure.
To diagnose obstructive CAD, a doctor will review your symptoms, if any, as well as your medical history and your family's medical history. Heart disease can run in families.
Then, various tests may be administered to confirm or rule out the presence of obstructive CAD. These tests may include:
If obstructive CAD is diagnosed, the goal of treatment will be to improve blood flow to the heart. There are two main treatment options: coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
With CABG, a heart surgeon will use blood vessels taken from elsewhere in the body to create a detour for blood to flow around the blockage. During this procedure, a heart surgeon attaches (or grafts) a blood vessel to the affected artery to reroute the blood.
With PCI, a doctor uses a catheter to insert a stent in the area of the blockage, pushing the plaque against the artery wall and restoring better blood flow. A stent is a flexible mesh tube.
Engaging in heart-healthy behaviors and taking medications to manage your blood pressure, cholesterol, and blood glucose levels are also important to complement these procedures.
Obstructive CAD is an avoidable condition for many people. The strategies to preventing it are the same as those recommended to prevent atherosclerosis.
Some of the more effective preventive strategies include:
Obstructive CAD may lead to a heart attack and subsequent heart difficulties when left untreated. The earlier you respond to symptoms, the more likely you are to avoid a heart attack. Bypass surgery and stenting can be done as preventive measures or in response to a heart attack.
100 Heart-surgeries In Ten Months: New OR Highlights Need For More Care In West Michigan
WYOMING, Mich. — An open heart surgery center in Wyoming just passed a major milestone. It has hosted 100 surgeries in less than a year.
While a success in efficiency for the University of Michigan Health-West, it highlights a need for corrective care for patients with heart disease, a leading cause of death.
In anticipation of the 100th surgery last week, FOX 17 gained exclusive access to an open heart surgery procedure to see how a new partnership in West Michigan is impacting people who live here.
Dr. Alphonse DeLucia, the lead cardiac surgeon at UMH-West, likens the operation to piloting an airplane.
"Obviously in the back of their mind, they know that they've got so many souls on the plane with them," he explained. "And in the back of my mind, I have a person down here. But when you're in the zone, or in the moment, you're focusing on the task at hand."
And the flight plan ahead of takeoff early one Friday morning in August: coronary artery bypass surgery.
What they call a widow maker will be bypassed in part with a radial artery from the patient's arm over the course of four hours.
This procedure is one of 100 that have been completed inside the new state of the art operating room in its first ten months. That more than doubled the initial goal of 50 in a year. Leaders expect that by the end of the first year, they will have completed 140 operations.
Dr. Ronald Grifka, Chief Medical Officer at UMH-West, says that for the last 25 years, there's only been one open heart surgery program in Grand Rapids.
"Because of that, and the growth we've had in with Michigan, this really was the largest community in the country that just had one open heart surgery program," said Dr. Grifka.
Inside an open heart surgery procedure
Born out of that need, the Cardiovascular Center at the University of Michigan, UMH-West, Trinity Health Grand Rapids, and Trinity Health Muskegon partnered together to create the Cardiovascular Network of West Michigan.
"It's one seamless process, whether the patient is seen in any of those three facilities, they're all part of the same network," Dr. Grifka said. "So, it takes the guesswork for the patient out of, 'Am I getting the best option or getting the best care?'"
One year ago, Victor Cerbins asked himself those questions, but the brand new heart surgery network made his decision easier. Though, it didn't hurt that he already had connections to the University of Michigan.
"So I knew U of M was involved," he remarked. "And I said, 'Well, I have a lot of faith in the procedure from them. My daughter graduated from the nursing school there, and I have two granddaughters graduated from nursing school there. So I had some pretty good faith there."
Cerbins was case number one for the new center. By no means though was he a guinea pig.
"You are the first patient here, but you're not the first patient to have this done," he assured himself. "And so, I felt comfortable"
Victor Cerbins
Victor Cerbins, a patient at the University of Michigan Health West, prepares for heart surgery. He was the first patient to receive care in the facility's new operating room.While faced with an impending procedure that would have his chest cut open, exposing his beating heart, Cerbins considered what it may have been like for his wife had they not had service so close to their home.
"My option at that point would have been Ann Arbor possibly. And that's several hours away driving, and then my wife would stay there. Whereas here, she could just back and forth, because we're in Holland," said Cerbins.
It's that accessibility those involved with the network pride themselves on.
Dr. Theodore Boeve, another cardiac surgeon, lives and works on the lake-shore with Trinity Health Muskegon. He touts their own brand-new hospital and being fortunate to have great facilities in West Michigan that contribute to quality care.
"Our goal is 100% access for every community member to come in and get world class care. And I think that's what this network is going to help us do," said Dr. Boeve.
He says there's more to be done on the community scale however, and the cardiovascular network can make a difference.
"Until there's perfect access at great value, I think there's there's plenty of work to do and there's always ways to do it better," he added.
The responsibility of quality care doesn't just rest on the shoulders of surgeons like Dr. Boeve and Dr. DeLucia.
Dr. Grifka explained, "Cardiac surgery is really the ultimate specialty because it requires every specialty in the hospital to work at the top of its level between the respiratory therapist and the intensive care unit to nursing, radiology, laboratory anesthesia, on top of the cardiac surgeons."
The operation we attended, nearly 100 away from Cerbins' operation last fall, showcases the intricacy of the work in progress.
What's clear is that Cerbins is not the only patient benefiting from proximity and the need in the fight against heart disease, as the growing number of cases pushes the hospital far beyond initial expectations.
The American Heart Association of West Michigan provided insight to the latest heart disease trends in the US.
When we asked for specifics on first year heart surgery results at UMH-West, we were told it's well above the recommended standards from the Societies of Cardiac Surgery.UMH-West says it is delivering on another of its objectives: reducing costs. They hesitated to provide specifics, but expect the first-year data to show significant cost reductions.
The patient receiving care when FOX 17 was present signed off on our cameras being there. He was discharged four days after surgery and says he is doing "incredibly well."
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Life-saving Heart Surgery Carried Out On 87 Year Old At KLE
Doctors at KLE Dr. Prabhakar Kore hospital with the Rajashekhar Kalburgi, 87, who underwent open heart surgery in Belagavi recently.Photo Credit: SPECIAL ARRANGEMENT
Doctors from KLE Society's Dr. Prabhakar Kore Hospital conduced a rare, life-saving open heart surgery on an 87 year old.
A team of doctors headed by cardiothoracic surgeon Richard Saldanha successfully carried out a Coronary Artery Bypass Graft (open heart surgery) on an 87-year-old patient recently.
The surgery was carried out on Rajashekhar Kalburgi. The team operated on him with three grafts. The patient recovered and was discharged within a week. "Operating on an octogenarian is a challenging task as the muscles, arteries, and bones all have become weak. It was a high-risk surgery in view of his old age and the vulnerable cardiac condition,'' the doctors said.
"Till now, we have carried out over 27, 270 heart surgeries performed at the Department of Cardiothoracic Surgery. Of them, Mr. Kalburgi is the oldest patient to have undergone heart surgery. The team had surgeons, anesthesiologists, perfusionists, nurses, and physiotherapists. Their successful teamwork has kindled hope among the aged patients. This surgery also proved that age is no bar for an open heart surgery," Dr. Saldanha said in a release. This is the oldest ever patient operated on by me in my four-decade long career," he said.
The other members of the team were Anand Wagharali, Mohan Gan and Sharangouda Patil.
The patient is a retired teacher, a resident of Bhagya Nagar in Belagavi. He was advised the procedure at the hospital after an angiography report. He went to see doctors after he was facing difficulty walking and had chest pain, discomfort, and breathlessness. The angiography report showed that the octogenarian's major arteries were totally blocked.
Following support from anaesthesia experts, the surgery was carried out successfully.
The blocked arteries were freed by bypass. On the third day of the operation, the patient was out of bed and was able to walk. Prabhakar Kore, Chairman KLES and colonel Dr Dayananda, Medical Director of the hospital have congratulated the team.
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