Coronary artery disease occurs in the arteries supplying the heart muscle when they become narrowed or blocked with fatty plaque (atheroma), reducing the flow of blood.
The main symptom of coronary artery disease is angina (chest pain/tightness which can spread to the left arm, neck or back) but may also cause shortness of breath, sweating, nausea and an irregular heartbeat. Symptoms are often brought on by exertion.
Our age and family history have a bearing on the health of our hearts, as do other factors, such as smoking, high cholesterol levels, diabetes, high blood pressure and weight gain. These factors increase our risk of developing coronary artery disease.
It would be usual for patients with suspected coronary artery disease to undergo some outpatient investigation. To confirm the diagnosis many patients would have a coronary angiogram which is a dye study using x-ray to visualise the coronary arteries. This will help in planning treatment.
There are medical, interventional and surgical options for the treatment of coronary artery disease. Medications would be prescribed to treat angina, to prevent blood clots and to control high cholesterol and high blood pressure. These medications need to continue long-term, whether or not intervention or surgery is undertaken.
Two common procedures for coronary artery disease are coronary balloon angioplasty now more usually called percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
This non-surgical technique is performed under local anaesthetic, usually as a day case. A fine tube (catheter) with a balloon attached to it is passed down the coronary artery over a thin wire under x-ray guidance to the blockage where it is inflated. This restores blood flow through the artery. The balloon catheter and wire are then removed. A small mesh scaffold (stent) is often placed at the same time to prevent further narrowing.
This is a routine surgical treatment for patients whose disease involves severe narrowing of one or more arteries – in particular if there are a number of narrowed areas in the artery or the narrowing is such that a stent could not be inserted. In this procedure, arteries or veins from elsewhere in the body (such as the internal mammary artery or the radial artery) are used to bypass the narrowed coronary arteries. Usually access to the operative site requires a sternotomy (a split in the breastbone), however in some cases CABG can be performed as a minimally invasive (keyhole) procedure. Conventionally the heartbeat was stopped to enable surgery on the heart arteries but more recently operations are performed with the heart still beating.
Following surgery, patients are normally discharged home in 5-7 days and can return to work in 6-8 weeks.
Patients are followed up in clinic after these procedures and are referred for cardiac rehabilitation.