There are many risk factors that contribute to coronary artery disease and result in angina. As discussed above, the most common reason individuals develop coronary artery disease and subsequently chest pain is high blood cholesterol. Other risk factors include: tobacco use (smoking, chewing, long-term exposure to second-hand smoke), diabetes, hypertension, high triglyceride levels, men greater than the age of 45, women greater than the age of 55, family history of heart disease, obesity, stress and Inactivity or lack of exercise.
All of these risk factors point to the buildup of cholesterol within the coronary arteries and contribute to the development of coronary artery disease. Advanced coronary artery disease becomes a life-threatening medical condition when there is greater than or equal to 70% blockage of the artery. This means that even at rest only 30% of blood is able to freely move through the artery. When an individual becomes active, or even at rest with these other risk factors, the lumen of the artery can constrict resulting in complete obstruction of the coronary artery. When there is complete obstruction of the coronary artery, then there is not any blood supply to that specific area of the heart. The difference between Angina “chest pain” and Infarction “heart attack, is that in angina the ischemia is reversible as long as the lumen blockage is removed, but in infarction the heart cells in that region die.
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As with any form of chest pain, it is essential to determine the underlying medical problem. Therefore, if you or someone you know has been experiencing chest pain, please speak with your healthcare provider so that further evaluation and possible intervention can occur. Having a full evaluation and physical examination by your healthcare provider will help you gain a better understanding of the necessary interventions that may be required to prevent devastating, life-threatening, irreversible damage to the heart. After your physician evaluates your symptoms, it may be clinically indicated to undergo a variety of diagnostic testing and/or procedures. The first diagnostic testing is known as an EKG (Electrocardiogram). An EKG is a non-invasive diagnostic test that will provide information on the rate of the heart as well as the rhythm of the heart. There are also specific changes that can be seen on the EKG that can indicate a Myocardial Infarction (Heart Attack) has occurred in the past or is currently happening.
If the patient is being evaluated in the outpatient setting, after the EKG, a stress test is the next appropriate diagnostic tool. There are two different types of stress tests; chemical and treadmill. Chemical stress tests are for those individuals who are unable to physically walk on the treadmill. The most common form of stress test is the treadmill stress test. The patient will walk until their heart rate reaches a certain rate and/or they experience symptoms such as angina. If the patient does experience symptoms associated with angina during the stress test, then it is defined as a positive stress test.
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If the stress test is positive, then there is a possibility the cardiologist will recommend a Nuclear Stress Test. Nuclear test evaluates the perfusion of the heart under controlled exercise and provide information about which area of the heart is not receiving enough blood flow. If the Nuclear Stress Test is positive, then the next step may be Cardiac Catheterization. Cardiac Catheterization is a minimally invasive technique in which the coronary arteries are accessed through the femoral artery. Catheterization allows for direct visualization of the coronary arteries and can identity if and where any blockages are within the vessels. If there is greater than 70% stenosis of the coronary arteries, then a stent is clinically indicated to create an opportunity for the heart to pump more blood in an easier manner. If there is greater than 3 main vessels that appear diseased, then the patient may not be clinically indicated to undergo stent placement, but may require open heart surgery; otherwise known as CABG.
Other forms of imaging studies that may help determine if there is any cardiac pathology include a CCTA otherwise known as Coronary Computed Tomography Angiography. This utilizes dye to highlight the coronary arteries. While this test can be beneficial, it can have a high rate of false positivity because as individuals age the normal physiology of the coronary vessels begin to develop calcifications and cholesterol build up.