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Understanding Coronary Artery Disease
Table of contents
Introduction....................................................................................................1
You and your doctor: A heart-healthy partnership...........................................1
Signs and symptoms of coronary artery disease...............................................2
Risk factors of coronary artery disease ............................................................2
What is blood pressure?..................................................................................2
Understanding cholesterol..............................................................................3
Smoking and heart disease.............................................................................3
Being overweight and heart disease................................................................3
Know your numbers.......................................................................................3
Prevention and control of risk factors..............................................................4
w Exercise......................................................................................................4
w Heart-healthy diet.......................................................................................5
w How to read a nutrition label......................................................................6
w Quit smoking..............................................................................................7
Managing depression......................................................................................7
How is coronary artery disease diagnosed?.....................................................8
How is coronary artery disease treated?..........................................................8
Complications of coronary artery disease........................................................8
Stroke.............................................................................................................9
Important points to remember........................................................................9
Resources.......................................................................................................9
Type of medication........................................................................................10
Body mass index chart..................................................................................11
Personal Medication List................................................................................13
Introduction
Coronary artery disease is a disease of the blood vessels of the heart. It is the
most common type of heart disease. The heart needs a constant supply of
oxygen and nutrients to work properly. These are carried by the blood through
the arteries. A buildup of plaque, which is made of cholesterol deposits, can
cause the arteries to narrow. A narrow or blocked artery prevents oxygen and
nutrients from getting to the heart.
You and your doctor: A heart-healthy partnership
Heart disease is a lifelong illness. Despite that fact, people are able to live
a long, full life with proper care. The first step in determining your risk for
heart disease is to see your doctor for a thorough checkup. Your doctor is an
important partner in helping you set and reach your goals for a healthy heart.
Here are some tips for good, clear communication between you and your
doctor:
w Speak up – Tell your doctor that you want to keep your heart healthy and
would like help in achieving that goal. You should ask questions about your
heart disease and how to lower the risks of complications.
w Monitor your treatment – If you are already being treated for heart
disease or have risk factors, regularly review your treatment plan with your
doctor.
w Be open – When your doctor asks you questions, answer them honestly
and as fully as you can.
w Keep it simple – If you do not understand something your doctor says,
ask for an explanation in simple language.
Follow-up visits to your doctor’s office are needed to help you and your doctor
know if your medications, diet and exercise are working for you.
1
Signs and symptoms of coronary artery disease
Some people who have coronary artery disease may have very noticeable symptoms. Others may have
no signs or symptoms at all.
Some of the most common signs and symptoms:
Chest discomfort, also called angina – This may feel like a squeezing pain
in your chest. You may also feel it in your shoulders, arm, neck, jaw or back.
Shortness of breath – This happens when your heart cannot pump enough
blood throughout your body. This could happen with regular activity.
Fatigue with activity – This results in being unable to perform your work as
you used to. Exercise may also become difficult.
Arrhythmia – This is a sudden problem with the speed or the rhythm of your
heart. You may notice your heart is skipping beats or beating too fast.
It is important to treat symptoms early to prevent permanent damage to your
heart. If you have any of these symptoms, call your doctor.
Risk factors of coronary
artery disease
Anyone can develop heart disease.
Some risk factors can be controlled;
others cannot. For example, you can
take measures to control high blood
pressure and high cholesterol. You
cannot control a family history of
heart disease, race, normal aging and
gender. In women, menopause may
also be a risk factor.
Major risk factors
• High blood pressure
• High cholesterol
• Lack of exercise
• Cigarette smoking
• Poor dietary habits
Many people do not know they have
high blood pressure.
Blood pressure is the force of
blood against your artery walls as
it circulates through your body.
High blood pressure is when the
systolic and diastolic numbers are
greater than 140 over 90. High blood
pressure is also called hypertension.
Blood pressure is measured using
two numbers:
• The first number is the systolic.
It represents the pressure in
your blood vessels when your
heart beats.
• The second number is the diastolic.
It represents the pressure in your
blood vessels when your heart rests
between beats.
High blood pressure has no warning
signs or symptoms. The only way to
know if you have high blood pressure
is to have it checked.
Talk with your doctor about how
often you should have your blood
pressure checked.
• If the measurement reads 120
systolic and 80 diastolic, you would
say “120 over 80”.
ategory
C
Top Number
(Systolic)
Bottom Number (Diastolic)
• Diabetes
Normal Blood Pressure
Less then 120
Less then 80
It is important to check with your
doctor about which risk factors may
apply to you.
Prehypertension
120 - 139 80 - 89
140 and above
90 and above
• High levels of alcohol intake
• Being overweight
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What is blood pressure?
Hypertension
Understanding
cholesterol
Smoking and heart
disease
Cholesterol is a waxy, fat-like
substance that your body needs. If
you have too much in your blood, it
can stick to the walls of your arteries.
Over time, this “plaque” can narrow
your arteries and allow less blood to
pass through. This can lead to heart
disease and stroke.
Quitting smoking is the most
important thing you can do to
improve your health.
There are no symptoms of high
cholesterol. A simple blood test can
tell you if your cholesterol is too high.
This test measures several kinds of
cholesterol as well as triglycerides.
LDL – Low density lipoproteins –
“Lousy” or “Bad” cholesterol that can
clog the arteries. Lower LDL numbers
are best.
HDL – High density lipoproteins –
“Healthy” or “Good“ cholesterol
helps keep cholesterol from building
up in the arteries. High levels of HDL
can reduce the risk of heart disease
and stroke.
Triglycerides – another form of fat
in the blood that can raise the risk of
heart disease.
Desirable Cholesterol Levels
Total
Cholesterol
under 200 mg/dL
LDL under 100 mg/dL
HDL above 40 mg/dL
Triglycerides under 150 mg/dL
Your individual goals may vary. Discuss
your goals with your doctor.
Overall, it is important to keep your:
• HDL or “healthy cholesterol” high.
• LDL or “lousy cholesterol” low.
Facts:
• Smoking increases blood pressure
and the risk of blood clots.
Know your numbers
It is important to see your doctor
regularly. This helps your doctor
keep track of you and how you
are responding to your treatment
plan. This is the time to review
your:
• Smoking increases the risk of heart
attack and stroke.
• Blood pressure
• Smoking decreases HDL (healthy)
cholesterol.
• Triglycerides
• Women who smoke and use birth
control pills dramatically increase
their risk of heart disease.
• HDL
• There is no safe amount of
smoking.
It is never too late to quit smoking.
Being overweight and
heart disease
Maintaining a healthy weight can
also help decrease your risk for heart
disease.
Try to keep your waist circumference
less than 35 inches if female; and less
than 40 inches if male. A larger waist
circumference puts you at a higher
risk for health problems.
• Cholesterol
• LDL
• Weight (refer to Body Mass
Index Table for Adults)
• Waist circumference
It is important to talk to your
doctor about what your blood
pressure and cholesterol numbers
should be and what steps you
need to take to reach your
goals. It is helpful to write your
numbers down to keep track of
your progress.
Body mass index is a measurement of
your weight in relation to your height.
It also gives an estimate of your total
body fat. A BMI between 25 and 29
is considered overweight. A BMI of
less than 25 is the goal for treating
heart disease.
To figure out your BMI, see the “Body
Mass Index Table for Adults.” If
your BMI is 25 or above, talk to your
doctor about diet and activity changes
that may help you lose weight.
See BMI Chart on page 11.
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Prevention and control
of risk factors
A good start would be living a healthy
lifestyle (this should include the
whole family) by exercising, quitting
smoking, eating the proper diet and
managing stress. Lowering your
cholesterol and your blood pressure
are also very important.
Exercise
When you have heart disease, it is
very important to exercise. Exercising
should become part of your daily
routine. Even if you can only do
a small amount of exercise, it is
better than doing none at all. Talk
to your doctor about exercising. If
your doctor says its okay, try to do
at least 30 minutes of exercise a day
most days of the week. Begin your
exercise program at a low level and
increase the amount of exertion
gradually. Avoid overexertion on days
of extreme temperatures. Always
be alert for signs of heart problems.
These signs include chest pain, tiring
easily, shortness of breath, dizziness,
lightheadedness and palpitations.
Some good ways to get exercise
are to:
• Take a brisk walk outside or mall
walk on very hot or cold days.
Here are some other ideas for
being more active every day:
• Park the car farther away from your
destination.
• Get on or off the bus several blocks
away from your stop.
• Take the stairs instead of the
elevator or escalator.
• Exercise while watching TV.
• Walk around while you talk on
the phone.
• Play with the kids.
• Go dancing.
• Take the dog for a walk.
• Take a low-impact aerobics class.
• Get up to change the TV channel
instead of using the remote
control.
• Swim or do water aerobic exercises.
• Ice-skate or roller-skate.
• Ride a bicycle outdoors or a
stationary bicycle indoors.
• Work in the garden or rake leaves.
• Clean the house.
• Wash the car.
• Stretch out your chores. For
example, make two trips to take
the laundry downstairs instead
of one.
• Park at the far end of the grocery
store lot and walk to the store.
• At work, walk over to see a
co-worker instead of calling or
e-mailing.
• Stretch or walk around instead of
taking a coffee break and eating.
Always talk to your doctor before starting an
exercise program. Younger adults who smoke,
are overweight, have diabetes, high blood
pressure and/or high cholesterol should get a
pre-exercise physical exam.
4
Heart-healthy diet
Most people know that to maintain heart health, they need to
eat healthy. It is not always clear how to translate that into our
daily eating habits. To prevent heart disease, a diet that is high in
fiber and low in saturated fat and cholesterol is the best. Talk to
your doctor to discuss the best diet for you.
Fats
Fiber
Fats in our food affect our cholesterol
level. There are good fats and
bad fats.
Fiber is the part of the plant that
cannot be digested. It is known as
bulk or roughage. Fiber helps the
body by lowering your risk of heart
disease. It also helps in digestion. It
makes you feel full longer, which can
help in weight loss.
Good fats are unsaturated
fats, polyunsaturated fats and
monosaturated fats. These fats lower
the risk of heart disease.
Bad fats are saturated fats and
trans fats. These fats increase your
cholesterol level.
Cholesterol
It is a waxy, fat-like substance made
in the liver and found in all cells of
the body. Cholesterol is important
for good health. However, too much
cholesterol in the body may build up
in the blood vessel walls and increase
the risk of developing heart disease
and stroke.
Sodium (Salt)
Using less sodium in your food can
help lower your blood pressure.
Some low-fat foods contain a large
amount of salt. Most packaged and
canned foods, especially soups, are
high in sodium.
Potassium
vegetables. Do not take potassium
supplements or use salt substitutes
without talking to your doctor.
Alcohol
If you do drink alcohol, moderation is
the key. Too much alcohol can lead to
high blood pressure and can increase
your triglyceride level. Having one
or two drinks a day for a man, and
one drink a day for a women may
be acceptable.
What is considered a drink?
• 12 ounces of beer
• 4 ounces of wine
• 1.5 ounces of 80-proof liquor
If you don’t drink alcohol, don’t start.
Potassium is important in controlling
high blood pressure. The main
sources of potassium are fruits and
Cholesterol is found in:
• Dairy products
• Egg yolks
Examples of good fats
Examples of bad fats
• Fatty meats
Plants
Peanut oil
Fatty meats
Margarine
• Liver
Nuts
Olive oil
Shortenings
• Shrimp
Seeds
Omega-3 fatty
acids such as
salmon and
walnuts
Whole milk
products
Sunflower oil
Corn oil
Soybean oil
Chicken skin
Sweets (cakes,
cookies)
Coconut oil
Butter
Palm oil
Fast food
Canola oil
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How to read a nutrition label
Serving size
First look at the serving size and the
number of servings in the package. All
the information on this label is based
on this serving or portion size. So, if
you eat double the serving, you will
consume double the calories, carbohydrate, fat and other nutrients.
Calories
Calories provide a measure of how
much energy you get from a serving of
this food. This gives the total calories
per serving. The portion of the total
calories that comes from fat is also
given. A good rule of thumb is to
look for foods that show one-third or
fewer of the total calories coming
from fat.
Total carbohydrate
and sugars
This shows the amount of
Carbohydrate per serving that
comes from sugar. This includes
both natural sugar and
added sugar.
Vitamins and minerals
Eating enough of these nutrients
can improve your health and help
reduce the risk of some diseases
and conditions.
Nutrition Facts
Serving Size 1 cup (228g)
Servings Per Container 2
Amount per Serving
Calories from Fat 118
Calories 250
% Daily Value*
18%
Total Fat 12g
Saturated Fat 3g
15%
Trans Fat 3g
10%
Cholesterol 30mg
20%
Sodium 470mg
10%
Total Carbohydrate 31
Dietary Fiber 0g
0%
Sugars 5g
Protein 5g
Vitamin A
4%
Vitamin C
2%
Calcium
20%
Iron
4%
* Percent Daily Values are based on a 2,000
calorie diet. Your Daily Values may be higher
or lower depending on your calorie needs.
Calories2,000 2,500
Total Fat
Less than 65g
65g
Sat Fat
Less than 20g
25g
Cholesterol
Less than 300mg 300mg
Sodium
Less then 1,500mg
Potassium
3.500mg
Total Carbohydrate
300g
375g
Dietary Fiber
25g
30g
Limit these nutrients
Sodium
This shows the amount of sodium
(salt) in one serving. This is
important if you are on a lowsodium diet or if you have high
blood pressure.
Dietary fiber
This shows the portion of the total
carbohydrate per serving that is
fiber. Eating a diet high in dietary
fiber promotes healthy bowel
function.
Protein
This shows the total grams of
protein in one serving. Protein is
an essential nutrient for growth
and health.
Total fat
This gives the total grams of fat in one serving of that food.
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Saturated, trans fat and cholesterol
Unsaturated fat
Eating too much fat may increase your risk of certain
chronic diseases, such as stroke, and some types
of cancers.
You can find the amount of unsaturated fat by
subtracting the amount of saturated and trans fats
from the total fat. Eating more unsaturated fats than
saturated fats can help lower blood cholesterol levels.
Most unsaturated fats come from plant sources and
include canola, vegetable and olive oil.
Quit smoking
Shortly after you quit smoking, your
circulation begins to improve and
your blood pressure starts to return
to normal. Your sense of smell
and taste improve and breathing
will become easier. There may be
increased coughing at first, but this
will go away shortly.
Quitting is not easy. You may
experience weight gain, irritability
and anxiety. This will also go away
after a short time. Most people try
several times before succeeding. Do
not stop trying.
How to stop smoking:
• Some people stop “cold turkey.”
Pick a day. Get rid of all tobacco.
Don’t let anyone smoke in your
home. Change your routine.
Spend time in places where
smoking is not allowed.
• Talk to your doctor about
medicines, nicotine patches, gum
or lozenges to help decrease
cravings.
The more help you have, the
better your chance of quitting.
• Support groups and counseling
can also be helpful. Call your
local health department about
available programs.
• Talk to your doctor about the
best way for you to quit.
• Tell people you want to quit. Ask
them not to smoke around you or
leave tobacco products in sight.
For help in quitting smoking, contact: New York State Quitline 1 (866) NY-QUITS, 1 (866) 697-8487
Serving size
First look at the serving size and the number of servings in the package. All
the information on this label is based on this serving or portion size. So, if you
eat double the serving, you will consume double the calories, carbohydrate,
fat and other nutrients.
Calories
Calories provide a measure of how much energy you get from a serving of
this food. This gives the total calories per serving. The portion of the total
calories that comes from fat is also given. A good rule of thumb is to look for
foods that show
one-third or fewer of the
total calories coming from fat.
Total carbohydrate
and sugars
This shows the amount of
Carbohydrate per serving that comes from sugar. This includes both natural
sugar and added sugar.
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How is coronary artery
disease diagnosed?
How is coronary artery
disease treated?
Along with checking your blood
pressure and cholesterol, your doctor
will diagnose you with the following:
1. Lifestyle changes (See section on
prevention).
1. Medical and family histories
• Angioplasty – A thin tube with
a balloon on the end is inserted
into the artery. Once in place, the
balloon is inflated and blood flow is
restored.
Complications of
coronary artery
disease
• Stent – a small mesh tube placed
in the artery to keep it open.
A heart attack happens when an
artery becomes totally blocked. This
blockage prevents oxygen and
nutrients from getting to the heart.
A heart attack can cause permanent
damage to the heart muscle. The
more time that passes without
treatment to restore blood flow,
the greater the damage to the heart.
High blood pressure, high cholesterol
or diabetes may increase the chance
of a heart attack. A previous heart
attack and smoking are also risks.
2. Review of risk factors
3. Physical exam
4. Diagnostic tests
• Blood tests
• Chest X-ray – Creates a picture of
the heart, lungs and other organs
in the chest.
• ECG or EKG (electrocardiogram)
– this test measures the electrical
activity of the heart. An EKG can
also show signs of an old or new
heart attack.
2. Medical procedures such as:
• Coronary artery bypass grafts –
Arteries or veins from other areas
of the body are used to go around
(bypass) the narrowed artery.
• Echocardiogram – uses sound
waves to create a moving picture of
the heart.
3.Cardiac rehabilitation – A
team of doctors, nurses, physical
therapists and dieticians works
together to help develop a
treatment plan to modify unhealthy
behaviors.
• Exercise stress test – measures
the EKG when exercising to look
for changes consistent with heart
disease that are not seen at rest.
• The first part of cardiac
rehabilitation is exercise training.
This will help you learn how to
exercise safely.
• Nuclear cardiac imaging (also
known as Spect MPI) – may
be performed at rest or under
the stress of exercise or drug
stimulation.
• The second part of cardiac
rehabilitation is education. This
helps you understand your heart
condition and find ways to reduce
your risk of future heart problems.
• Cardiac catheterization – uses
dye and special X-rays to check
the inside of your arteries for
a blockage. It can monitor the
blockage and flow of blood
through the heart.
4. Medication is also used .
See page 10 for type of
medication and page 13 for
personal medication records.
• The list below includes some of
the heart medications that may be
prescribed by your doctor. Not all
heart medications are included in
this list.
• Take your medications the way
your doctor instructs you to.
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• You may also discuss questions
about your medications with your
pharmacist as well as your doctor.
• Do not stop medication without
talking to your doctor.
Heart attack
The five major symptoms of a heart
attack are:
• Pain or discomfort in the jaw, neck
or back.
• Feeling weak, light-headed or faint.
• Chest pain or discomfort.
• Pain or discomfort in the arms
or shoulder.
• Shortness of breath.
Other symptoms may include
breaking out in a cold sweat, nausea
or lightheadedness.
Do not wait for an emergency to happen. Talk to your doctor about having a plan in place. If an emergency
does occur and you think that you
or someone is having a heart attack,
call 911 or your emergency response
number right away.
Stroke
A stroke, sometimes called a “brain
attack,” occurs when a blood clot
blocks the blood supply to the brain.
Some strokes are called mini-strokes
or transient ischemic attacks. A TIA
produces stroke-like symptoms but
no lasting damage. Recognizing and
treating TIAs reduce your risk
of having a major stroke. Symptoms
of stroke appear suddenly and
without warning.
The symptoms of a stroke include:
Important things to remember:
• Sudden numbness or weakness,
especially on one side of the body.
• Check the time your symptoms
develop; your doctor will ask.
• Confusion or trouble speaking
or understanding speech.
• Seek treatment right away. DO
NOT WAIT!
• Trouble seeing in one or both eyes.
• Call an ambulance. Do not drive
yourself to the hospital.
• Trouble walking or loss of balance.
• Feeling dizzy.
• Severe headache with no known
cause.
The most common symptoms of a stroke can be remembered by
the word FAST:
F = Face:
Is one side of your face drooping down?
A = Arm: Can you raise both arms, or is one arm weak?
S = Speech:
Is speech slurred or confusing?
T = Time:
Is critical!!! Call 911 immediately!
10 Important Points to Remember
• Do not ignore any stroke symptom.
You need to call your doctor or
call 911.
Resources
American Heart Association
Centers for Disease Control and
Prevention
National Heart, Lung, Blood
Institute (NHLBI)
WomenHeart: The National
Coalition for Women with Heart
Disease
National Institute of Health (NIH)
1. Stay active.
2. Make healthy food choices.
3. Maintain a healthy weight.
4. Take medication as directed by your
doctor.
5. Have your blood pressure and
cholesterol levels checked regularly.
6. Do not smoke.
7. Avoid excessive alcohol intake.
8. See your doctor regularly.
9. Find healthy ways to cope with stress.
10. Be aware of the warning signs of a
heart attack or stroke.
9
10
Type of
medication
Why it is used
Things to remember
Beta Blockers
• Used for most types of heart problems.
• Lower heart rate and blood pressure.
• Relieve and prevent chest pain.
• Diabetics should report low blood
sugars to their doctor.
• Report dizziness.
Calcium Channel
Blockers
• Lower heart rate and blood pressure.
• Control an irregular heartbeat.
• Help the heart muscle function better.
• Relieve and prevent chest pain.
• Report any swelling in your ankles,
feet or legs, weight gain, shortness of
breath or constipation to your doctor.
Angiotensin II
receptor blockers
(ARBs)
• Reduce blood pressure.
• Do not take NSAIDs, (arthritis pain
medications), antacids, potassium
supplements, diuretics, and lithium
without talking to your doctor.
Angiotensin
converting
enzyme (ACE)
inhibitor
• Reduce blood pressure.
• A cough is a commom side effect. If
coughing is severe, talk to the doctor.
Statins (cholesterol
pills)
• Lower bad cholesterol (LDL) levels.
• Tell your doctor if you have severe
muscle aches.
• Do not drink grapefruit juice.
• See your doctor regularly for
blood work.
Diuretics
(Water pills)
• Reduce blood pressure.
• Treat heart failure.
• A high-potassium diet may be
recommended.
• Tell your doctor if you are allergic to
sulfa medications.
Aspirin
• Reduce the risk of heart attack.
• Reduce the severity of a heart attack if
chewed immediately when symptoms
begin.
• Coated aspirin helps prevent
stomach upset.
• Do not take pain relievers without
talking to your doctor.
Anticoagulant
• Blood thinner.
• Prevent blood clots.
• Avoid activities that have a high risk for
injury or bleeding.
• Immediately tell your doctor if you have
any bruising or bleeding.
• Talk to your doctor before taking any
pain relievers, vitamins, supplements or
any natural products.
• Do not make any sudden changes in
how much vitamin K rich foods you eat.
When you have blood work, contact your
doctor for medication instructions.
Digoxin
• Slow and strengthen heart contractions.
• If you take too much medication,
get emergency medical attention.
• Drink fluids to avoid becoming
dehydrated in hot weather or
during activity.
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