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PCI And DES Implantation In Nonbifurcation Unprotected LMCA Stenoses
Cite this articlePCI and DES implantation in nonbifurcation unprotected LMCA stenoses. Nat Rev Cardiol 4, 580 (2007). Https://doi.Org/10.1038/ncpcardio0976
Share this article Get shareable linkWhat Is Coronary Artery Disease?
Coronary artery disease (CAD) is the most common type of heart disease. Although it's the top cause of death in the U.S., there is a lot you can do to prevent or treat it.
The trouble starts when a waxy substance called plaque builds up inside the arteries that supply blood to the heart muscle. It can take decades to block the blood flow, but it can eventually cause a heart attack or failure.
How common is coronary artery disease?
An estimated 18.2 million Americans have coronary artery disease, or about one in 20 adults, making it the most common form of heart disease in the country.
The condition is also the leading cause of death in the U.S. In 2021 alone, 375,476 people died of coronary artery disease, and 20% were younger than 65.
Coronary artery disease vs. Heart attack
Coronary artery disease is a form of heart disease, and most heart attacks are caused by coronary artery disease. Some people only discover they have coronary artery disease after they've had a heart attack.
Coronary artery disease isn't just one disease, but several different conditions.
Atherosclerotic coronary artery disease is when plaque builds up along the walls of the arteries to your heart. (Photo credit: iStock/Getty Images)
Starting as early as childhood, plaque – a combination of cholesterol, fat, and other substances – starts to stick to the walls lining your blood vessels.
It builds up over time. That makes arteries harder and narrower, which doctors call "atherosclerosis."
In some cases, plaque can break or rupture. As a result, blood cells called platelets will try to repair the artery, forming a blood clot.
Like gunk in a clogged drainpipe, this buildup prevents a free flow of blood through the arteries. Blood carries oxygen and nutrients to the heart. Myocardial ischemia is when your heart muscle doesn't get enough blood, and it can lead to shortness of breath and chest pain (angina).
Without enough oxygen, the heart can become weaker. This can lead to an irregular heartbeat (arrhythmia). It can also cause heart failure, which means the heart can't pump enough blood throughout the body to meet the body's needs. If you have limited blood flow to your arms or legs, this condition is called peripheral artery disease.
If a plaque grows so large that it stops blood flow to the heart muscle, you could have a heart attack. But most of the time, heart attacks happen from the smaller plaques that rupture.
In the early stages, you may not have any symptoms. But as the plaque continues to build up and curbs blood flow to the heart muscle, you may notice that you're short of breath or fatigued, especially during exercise.
The most common symptom of CAD is angina, or chest pain. Some people mistake it for heartburn or indigestion.
With angina, your chest feels uncomfortable. You may also have that feeling in the shoulders, arms, back, or jaw. You may feel:
Symptoms of CAD for women
Women and those assigned female at birth often have different heart attack symptoms than men or those assigned male at birth. While the most common red flag is still chest pain, women are more likely to have other symptoms, such as shortness of breath, extreme fatigue, nausea, vomiting, and back or jaw pain.
When to call 911
If you have any of the following symptoms, call 911 right away:
Coronary artery disease becomes more likely as you get older or if it runs in your family. Other risk factors include
Men, and people assigned male gender at birth, have a higher risk for CAD after age 45. For women and people who were assigned female gender at birth, the risk goes up after 55.
Some risk factors that affect women (and those assigned female at birth) in particular are:
You're more likely to have coronary artery disease, sometimes called coronary heart disease, if you're over 35 or male.
Black, Hispanic, and Southeast Asian people are more likely to get sick from CAD and to die from it than other ethnic groups. American Indians are 1.5 times more likely to be diagnosed with CAD than White people.
In fact, minorities are at higher risk of all types of heart disease. Among Black people, 47% are diagnosed with some type of cardiovascular (heart and blood vessel) disease. For White people, the rate is 36%. Overall, Black people are more than twice as likely as White people to die from heart disease.
Black, Hispanic, and American Indian people are also more likely to have conditions that contribute to heart disease, like high blood pressure, obesity, and diabetes.
There are many possible reasons for these disparities. They include:
Your doctor will give you a checkup and talk with you about your symptoms, risks, and family history. You may also get tests such as:
How to check for heart blockage at home
There's no home test that can determine whether you have coronary artery disease. But if you're concerned about your heart health in general, there are steps you can take to keep tabs on it:
Heart rate measurement. Check your pulse to figure out how fast your heartbeat is:
A healthy rate is between 60 and 100 beats per minute. If yours is much higher or lower than that, tell your doctor.
Blood pressure cuff. Because high blood pressure raises your risk for heart disease, it's important to keep blood pressure in a healthy range. For most people, that's less than 120/80. But ask your doctor what your numbers should be. Some monitors let you upload your readings into an app or website for easy tracking. You can also print them out to share with your doctor.
The stair test. If you can't climb four flights of stairs within 90 seconds, that may be a sign that your heart isn't as healthy as it should be. Talk to your doctor about your concerns.
Your doctor can order many tests to get a better sense of your heart health. That can include:
Blood tests.
A sample of your blood can be checked for issues that raise your risk of coronary artery disease. Among them are high cholesterol, high triglycerides (a type of blood fat), and high-sensitivity CRP, a special protein that signals heart inflammation.
Computed tomography (CT) coronary angiogram
Sometimes, doctors want a close-up look of your arteries. If so, a special dye is put into your vein before a CT scan.
Coronary calcium scan
Also called a heart calcium scan or cardiac calcium scan, this test looks for calcium deposits that are blocking your arteries and making it hard for blood to get through.
Echocardiogram (echo)
Sound waves can be used to show how well blood flows to and from your heart.
Electrocardiogram (EKG)
Small painless devices called electrodes can be put on your skin to check how well your heart is working. If this test is done in your doctor's office, it will give a snapshot of your heart health. To get more info about your heart patterns, you may be given a special device to wear for up to a week.
Exercise stress test
Sometimes, CAD symptoms only show up when you're active. For this type of test, you'll be asked to walk or run on a treadmill or pedal a stationary bike during an EKG.
Cardiac catheterization
If your doctor chooses to do this more complex procedure, a very thin tube called a catheter is put into one of your blood vessels and guided to your heart. Then dye is put into the tube so your doctor can see your blood vessels better and check for blockages.
Coronary artery disease can lead to other serious – and sometimes life-threatening – conditions, such as:
Depending on your case, your treatment plan may include one or a combination of the following treatments:
Medications
You may need to take medicines to help your heart be healthier. They can include blood thinners (anticoagulants), aspirin and other anti-clotting medicines, ACE inhibitors, beta-blockers, nitroglycerin, calcium channel blockers, certain immunosuppressants, statins, or PCSK9s.
Invasive procedures
Part of your treatment plan may involve surgery. Some of the most commonly performed procedures for coronary artery disease include:
Cardiac rehabilitation and recovery
If you've had a heart attack or cardiac surgery, your doctor will likely recommend that you complete a cardiac rehab program to help you recover. Cardiac rehab will start while you're in the hospital, then you can attend outpatient appointments once you go home. Most insurance companies will cover 12 weeks of cardiac rehab. Typically, these programs include the following:
Studies have shown that cardiac rehab can help lower your future risk of stroke, heart attack, depression, and cardiac-related death.
Lifestyle changes
These time-tested methods sound familiar for a reason -- they work!
Fortunately, there are a number of things you can do to reduce your chances of getting CAD.
Get wise to your risk. Speak to your doctor about getting your cholesterol, blood pressure, and blood sugar checked. If you have high cholesterol, high blood pressure, or diabetes, it's important to manage those conditions.
Aim for a healthy weight. If you're not sure what your target weight should be, ask your doctor. And if you have a lot of weight to lose, remember that even a modest amount of weight loss helps.
Avoid cigarette smoke. If you smoke, quit. Steer clear of secondhand smoke.
Limit your alcohol. One or two drinks may have some heart benefits, but too much is risky. Men should have no more than two alcoholic drinks a day, and women should have no more than one per day.
Eat smart. Eat whole foods and avoid trans fats, which can be found in many baked goods and deep-fried and processed foods. Get plenty of fiber-rich foods, such as fruits and veggies, whole grains, and beans. Limit salt and aim to have two servings of fatty fish, such as salmon, tuna, or mackerel, a week. They're high in heart-healthy omega-3 fats.
Exercise regularly. You'll want to get at least 30 minutes of moderate-intensity exercise (like hiking or going for a bike ride that makes your heart beat faster but not race) on 5 or more days a week. Speak with your doctor before you begin a new exercise routine.
Manage your stress level. Use strategies such as exercise, meditation, and other healthy activities that relax you.
There is no cure for coronary artery disease. Your prognosis will depend on your age, symptoms, and other health conditions and risk factors you have.
But you may be able to improve your prognosis or slow the progression of the disease by changing your lifestyle and following your doctor's treatment plan. Take any medications your doctor prescribes to treat your coronary artery disease as consistently as possible.
If you have coronary artery disease, you will have regular check-ups with your doctor and any specialists they refer you to, like a cardiologist.
But if you notice any changes in your symptoms or if you have side effects related to your medications between those visits, reach out to your doctor. They can also discuss any questions or concerns you have about your treatment plan.
If you are having symptoms of a heart attack or stroke, call 911 right away. Both are medical emergencies that require medical attention as quickly as possible.
Coronary artery disease is the most common form of heart disease in the U.S. If you've been diagnosed with the condition, your doctor will help you find the treatment plan that's right for you. Coronary artery disease can lead to serious complications, including heart attack and arrhythmia, but quitting smoking, eating a low-sodium diet, and maintaining a healthy weight are steps you can take right away to help lower your risk. Always talk with your doctor if your symptoms change, and ask them before making any major changes to your exercise routine.
What is the life expectancy of someone with coronary artery disease?
The life expectancy of someone with CAD will vary, depending on their age, medical history, and lifestyle choices. If you've been diagnosed with coronary artery disease, talk with your doctor about your prognosis.
What are the coronary arteries?
There are two main coronary arteries. The left main coronary artery supplies blood to the left ventricle and left atrium, while the right coronary artery sends blood to the right ventricle, right atrium, and the sinoatrial and atrioventricular nodes. Both sides divide into smaller branches to supply blood to all parts of the heart.
EXCLUSIVE: Teen's Heart Stopped 400 Times In A Week. Doctors Were Stunned To Find Out The Cause
When Amy Simpson was 11, she started experiencing dizzy spells and stomach pain. At the time, she was going through a lot of changes and thought stress caused her symptoms. Still, her sister encouraged her to see a doctor.
"My sister brought it to my attention, like, 'Hey, it's not normal that this is happening. We should really get you checked out,'" Amy, 17, from Brownsville, Texas, tells TODAY.Com. "It was nerve-wracking."Doctors found tumors in Amy's stomach and eventually diagnosed her with Carney-Stratakis syndrome. It's a rare, inherited condition that causes tumors in the stomach, neck, head and torso, according to the National Cancer Institute. For many patients, the tumors are harmless, though they are sometimes cancerous.
Since having the large tumor removed from her heart, Amy Simpson, 17, has enjoyed being active and embracing life.Courtesy Ashely Meshioye 400 cardiac arrests in one week While Amy's tumors were not cancerous, she had them removed surgically and did fine until, at age 14, when she started having chest pain and fainting.
Doctors performed a scan and found something stunning: there was a large tumor crushing her coronary artery, which supplies blood to the heart muscle. Surgery to remove it carried a high risk because of Amy's age and the tumor's placement, and many doctors balked at doing it.
The teen wondered if she might die.
"I felt very defeated," she recalls. "It was like, 'Oh man, here we go again. I thought I was done with this.'"
At the time, Amy was living in Colorado, but she moved to Texas for care. At first, she took a medication that doctors hoped would shrink the tumors. But it only made her feel worse.
"It didn't really work," she says. "Taking that medicine put me in a whole loop of dizzy spells and passing out almost every day."
Amy's health declined. "I started having really bad chest pains," she says. "My heart started doing really weird things."
Doctors had her wear a heart monitor for a week. During that time, she experienced 400 episodes where her heart stopped anywhere from five to 25 seconds, Dr. Avichal Aggarwal, pediatric cardiologist with Children's Memorial Hermann Hospital and one of Amy's doctors, tells TODAY.Com.
"Anything over three seconds is dangerous," Aggarwal explains. "She was having chest pain. She would feel it, but she wasn't exactly sure what was going on."
Soon after the monitor results were analyzed, Amy was transported to Children's Memorial Hermann Hospital in Houston, where doctors tried to come up with a plan.
Aggarwal and his colleague Dr. Jorge Salazar believed surgery was Amy's only option. But others worried about how dangerous it was.
"Dr. Salazar and Dr. Aggarwal kept pushing for the surgery, asking for it," Amy says. "They had their work cut out for them."
In May 2023, she underwent an open-heart procedure to have the tumor removed.
"When I woke up, it was so crazy how much I felt like a new person," she says. "Right away, I could tell the difference."
Removing a tumor emmeshed in the heartPatients with Carney-Stratakis syndrome "can have tumors almost anywhere in the body, but mostly in the (gastrointestinal) tract, chest, head and neck," says Aggarwal.
"She had this huge tumor in the chest that was compressing some key components of the heart, causing other symptoms, which made her such a huge high-risk patient," he explains.
The biggest danger with Carney-Stratakis syndrom normally occurs when tumors compress any vital structure in the body. That's exactly what Amy experienced.
"She was having these episodes of chest pain, dizziness and passing out," Aggarwal says, adding that the tumor compressed the left main coronary artery "to almost 10-15% of its normal size." That restriction caused the episodes where her heart stopped.
"The coronary arteries are like the gas lines to the heart," Salazar, a pediatric cardiothoracic surgeon at Children's Memorial Hermann Hospital, tells TODAY.Com. "When the left main coronary artery is pinched or kinked or obstructed, it's like having a heart attack. … She was having multiple episodes, really death spells, every day."
While the pair knew they surgery was risky, they thought of their own teen daughters and how they'd do anything to save their lives. They believed Amy deserved that, too.
"She'd been turned down by a lot of other surgeons," Salazar says. "We told the family that without surgery she was definitely going to die soon. … We were just very determined (to help)."
In the six-hour open heart surgery, Salazar hoped to free the tumor from her coronary artery while preserving the structure of the heart and arteries.
"We exposed the heart and saw the tumor. It was pretty jaw-dropping to see how vascular the tumor was," he says. "The tumor had basically caused all these blood vessels to grow into it and feed it."
Because the tumor was so intertwined with the blood vessels, Salazar knew he needed to take a different approach to removing the tumor.
"We cut out part of her aorta, part of her pulmonary artery," he says. "We found the part of the tumor that was pinching the left main artery, and we shaved it off."
The tumor had thinned out part of the artery in one spot, and when they removed it, it left a tiny hole. After removing everything, Salazar repaired the hole and reconstructed her aorta and pulmonary artery like he would in patients with congenital heart defects.
"At the end of the surgery, she not only had a normal heart, but also had a coronary artery that was normal," he says. "She's had just an amazingly fast recovery. We've done multiple scans and visits for her after surgery, and she literally has a normal heart. Now all those death spells went away."
'I felt really free'After spending about two weeks in the hospital, Amy went home.
"I pretty much bounced back," she says. "Mentally I was very, very drained. But physically I felt really great, and it felt amazing … to feel that sense of normalcy."
Amy Simpson immediately noticed a difference when she woke from surgery to remove a large tumor crushing her aorta. She sadly has one growing in her neck compressing her nerves.Courtesy Ashely Meshioye Over last summer, she spent long days at the pool and time with friends being active.
"I remember racing with my friends because running all of a sudden felt so great," she says. "I felt really free."
Sadly, Amy has another tumor growing in her neck and compressing nerves. "I can feel it," she says. "My vision is (blurrier) in my left eye because of it."
The doctors she visited thinks if they remove it, she will lose feeling in her face. "I wouldn't be able to talk," she says. "I wouldn't be able to sing and singing is my life. … I would probably have a feeding tube."
A doctor predicted that she has five to 10 years before the tumor becomes a serious issue, possibly life-threatening. She's currently back on the medication to try to shrink the tumor.
While it feels overwhelming to have another mass, she is trying to enjoy life as much as she can. Amy graduated from high school early and is pursuing music at college in Utah next year.
Undergoing so many surgeries at such a young age has inspired Amy to embrace life and chase her dreams, like one day performing on Broadway. She hopes her story encourages people to advocate for their health, even when it seems dire.
"There are doctors that can do the impossible," Amy says. "I should say my story and share my piece and help out how I can."
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