Coronary Artery Disease (CAD)

Coronary artery disease (CAD), also called coronary heart disease or ischemic heart disease, happens when the arteries that supply the heart with blood become blocked or narrowed. Left untreated, the disease can lead to serious complications, such as heart attack and heart failure.

At Baystate Health, our cardiology team has deep expertise managing and treating coronary artery disease. We’re here to give you the expert care and support you need every step of the way.

What Is Coronary Artery Disease?

Coronary artery disease is caused by atherosclerosis, or the buildup of cholesterol, calcium, and other substances (called plaque) in the arteries. When this plaque buildup occurs in coronary arteries, it causes coronary artery disease.

Over time, atherosclerosis narrows arteries, restricting blood flow to the heart and raising the risk of chest pain (angina) and heart attack.

Why Choose Baystate Health for Coronary Artery Disease Treatment?

We provide top-quality coronary artery disease and heart attack care for the region, including:

• Some of the nation’s best outcomes: Baystate performs approximately 1,400 percutaneous coronary interventions (PCI) each year and is one of only about 120 high volume centers in the whole country. Our experience gives us the expertise to offer excellent care with excellent outcomes. We rank in the top 10 percent of hospitals nationwide for door-to-balloon time, or how fast we unblock coronary arteries in acute heart attack. Our cardiac surgery program also has a prestigious three-star ranking from the Society of Thoracic Surgeons.
• Lifesaving heart attack treatment: We are the only medical center in western Massachusetts with the ability to stop a heart attack instantly by unblocking an artery with angioplasty and stents to reestablish blood flow.
• 24/7 cardiac catheterization laboratory: Our cardiac catheterization laboratory is open 24 hours a day, 7 days a week to provide fast, lifesaving treatment when you need it most.
• Highly specialized providers: Our interventional and non-invasive cardiologists, cardiovascular surgeons, heart failure experts, nurses, and technicians have specialized training in coronary artery disease. In complex cases, our providers collaborate in heart team meetings to determine the best possible treatment plan.
• Latest innovations: As an academic medical center, we participate in clinical trials that can give our patients access to the most recent advancement in cardiac therapies, devices, and surgeries.
• Certified rehabilitation support: Our Cardiovascular Rehabilitation Program is one of the largest in New England. We help you recover from heart procedures and prevent future hospitalizations with exercise, nutrition, and stress reduction guidance. We’re certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) for upholding the highest standards of cardiac rehabilitation care.

Types of Coronary Artery Disease

There are two main types of coronary artery disease: obstructive and nonobstructive. Both types can increase the risk of serious complications.

Obstructive Coronary Artery Disease

This is the most common form of CAD. In these cases, plaque buildup narrows or closes the arteries.

Non-Obstructive Coronary Artery Disease

This less common form of CAD occurs when poor artery function blocks blood flow. Plaque may build up in the artery, but it doesn’t cause major blockages. Instead, artery problems are the main reason for restricted blood flow. These issues can include:

• Damaged artery lining (endothelial dysfunction)
• Sudden tightening of arteries (coronary vasospasm)
• Malfunctioning blood vessels (microvascular dysfunction)

Non-obstructive CAD can still lead to chest pain, reduced blood flow, and heart attack.

Symptoms of Coronary Artery Disease

Symptoms for both types of coronary artery disease include:

• Chest pain and discomfort (called angina), especially during exercise or emotional distress
• Indigestion or burning in chest, especially in women
• Shortness of breath

For some people, the first symptom of coronary artery disease is a heart attack.

Causes and Risk Factors for Coronary Artery Disease

Risk factors for both types of coronary artery disease include:

• Chronic health conditions including diabetes, high blood pressure, high cholesterol, and obesity
• Family history of coronary artery disease
• Lifestyle factors such as smoking, not exercising, and having high stress

Diagnosing Coronary Artery Disease

Your doctor may use a variety of tests to assess your heart health and diagnose CAD. These include:

• Blood tests: Tests that assess risk factors such as cholesterol, blood sugar, and blood pressure help doctors assess your heart health.
• Cardiac catheterization (angiography): A doctor inserts a thin tube called a catheter into a blood vessel near the wrist or groin and guides it to the coronary arteries. They then inject dye into the arteries to help see any blockages.
• Electrocardiogram (ECG or EKG): This quick, noninvasive test records electrical signals in the heart. Your doctor will place sensors (electrodes) on your skin to record electrical activity and assess your heart rhythm and conditions.
• Echocardiogram (echo): This imaging test uses ultrasound (sound waves) to create moving pictures of your heart as it beats. It helps identify heart defects and narrowing or leaking heart valves.
• Exercise stress test: This test measures heart rate and rhythm while you walk on a treadmill or ride an exercise bike. It checks for blockages in the arteries by seeing how hard the heart is working to pump blood during exercise.

Treating Coronary Artery Disease

Coronary artery disease can’t be reversed, but it can be managed. Our teams work with you to restore blood flow, prevent further plaque buildup, and lower your risk of serious complications. We create personalized treatment plans to protect your heart and help you live a healthy life.

Lifestyle Changes

Lifestyle changes can make a big difference in managing CAD. If you have less plaque buildup, these healthy habits may be enough to manage the disease. Otherwise, these changes help supplement other CAD treatments.

Lifestyle changes may include:

• Exercise
• Nutritious diet
• Physical therapy
• Smoking and alcohol cessation

At Baystate Health, your doctor will work with you to create a tailored exercise and nutrition plan. Our cardiac rehabilitation team also offers guided programs to help you quit smoking or alcohol.

Medications

Medications help manage coronary artery disease by treating CAD symptoms and underlying risk factors and reducing the amount of plaque in your arteries. Medications may include:

• Angiotensin converting enzyme (ACE) inhibitors, which lower blood pressure and improve blood flow
• Anticoagulants (blood thinners), which reduce your risk of blood clots
• Beta blockers, which lower blood pressure and regulate your heart rate and rhythm
• Calcium channel blockers, which lower blood pressure by relaxing your blood vessels
• Nitrates, which relieve angina and reduce heart strain
• Statins, which lower bad cholesterol

Angioplasty and Stenting

If your symptoms can’t be managed by medication or your arteries are too narrow, your doctor may recommend a coronary angioplasty and stenting.

During this minimally invasive procedure, your doctor inserts a wire with a balloon on the end into the blocked artery. They inflate the balloon, pushing plaque against the artery wall to restore blood flow. They may also place a stent, or a metal mesh tube, to help the artery stay open.

Many patients spend a few days in the hospital after angioplasty and stenting following a heart attack. Full recovery can take two to three months.

Coronary Artery Bypass Graft (CABG) Surgery (Heart Bypass)

You may need heart bypass surgery if you have multiple blocked blood vessels. During this open-heart surgery, a surgeon uses a healthy artery or vein from the chest, arm, or leg to create a new path for blood to flow around the blocked vessels.

Afterward, you will recover in the cardiac intensive care unit (ICU) under the specialized care of critical care cardiologists and cardiac surgeons. Full recovery can take up to four months.

Managing Coronary Artery Disease

If you have coronary artery disease, our team is here to provide ongoing support and keep you safe. You will have regular cardiology appointments to check your heart health, discuss medications, and complete follow-up testing that informs the most appropriate treatment.

We also help you stick with your care plan and adopt new habits. Our cardiac rehabilitation team includes cardiologists, dietitian nutritionists, and nurses who can teach you safe exercise, proper nutrition, and ways to reduce stress. Whether you’re recovering from a procedure or managing the disease, you can lean on us to keep your heart strong.