Coronary Artery Disease

UT Southwestern Medical Center’s heart team brings the latest scientific insights and most advanced therapies to the care of people with or at risk for coronary artery disease. Our team of experts works closely with patients and their families to choose the most appropriate treatment to prolong and improve quality of life. 

Our physicians, clinical teams, and biomedical scientists are continually pursuing and pioneering innovative treatments that not only extend and enhance the lives of our patients but also advance the care of people with coronary artery disease throughout the world.

Expert Care for a Common Cardiovascular Condition

The heart supplies the body – and itself – with blood through a network of vessels called coronary arteries. The coronary arteries can narrow and become blocked from a buildup of cholesterol and fat called plaque (atherosclerosis). 

When that happens, the heart muscle might not get enough blood to continue working properly. This condition is coronary artery disease (CAD). 

If a portion of the plaque buildup in the coronary arteries ruptures, a blood clot forms that can block the artery entirely, starving the heart of oxygen. This situation leads to the emergency known as myocardial infarction (heart attack). Even when a heart attack is not fatal, it can seriously damage heart muscle. 

Over time, CAD also can weaken the heart and lead to heart rhythm abnormalities (cardiac arrhythmias) or heart failure. 

The UT Southwestern Preventive Cardiology team helps patients understand their risk for coronary artery disease through detailed assessments and tests, as well as an evaluation of hereditary risk factors and other conditions that could impact their heart health. Our team then works with patients to reduce risk through interventions such as lifestyle modifications and medications to lower blood pressure and reduce plaque within coronary arteries. 

For patients who have more advanced disease requiring more aggressive treatment, our Interventional Cardiology team provides expertise in evaluating and clearing clogged arteries with catheter-based techniques such as:

• Coronary angiogram to visualize blood vessel blockages
  
• Angioplasty to open up clogged coronary arteries to restore blood flow
  
• Placement of a stent – a small, cage-like structure – to hold a cleared artery open 

When severe coronary artery disease affects multiple blood vessels, open-heart bypass surgery, known as coronary artery bypass graft, or CABG, might be the most appropriate treatment. UT Southwestern’s Department of Cardiovascular and Thoracic Surgery is one of the nation’s leading programs, with fellowship-trained surgeons performing more than 600 open-heart procedures each year. 

Whatever a patient’s degree of coronary artery disease or risk for developing it, our multidisciplinary team of cardiologists and cardiothoracic surgeons will discuss options and tailor a treatment plan to the patient’s condition, goals, and lifestyle. 

What People Should Know About Coronary Artery Blockages

The heart’s intricate system of chambers, valves, and blood vessels recycles, replenishes, and recirculates about 2,000 gallons of blood per day. The heart obtains its own blood supply from two arteries that originate just above the aortic valve: the left main coronary artery and the right coronary artery. These arteries branch off into smaller arteries that supply the heart’s chambers and tissues with nutrient-rich blood. 

As people age, fat can build up in the walls of the coronary arteries. Calcium, protein, and other materials moving through the blood vessels stick to the fat, forming a material called plaque. This buildup of plaque – a condition called atherosclerosis – occurs more rapidly in some people than others. 

As the plaque layer thickens, blood flow to the heart can be reduced, damaging the heart muscle. If coronary artery disease goes undiagnosed and untreated for an extended period of time, the heart will weaken and pump blood less efficiently. This condition is known as heart failure. Should the flow of blood become completely blocked in one or more arteries, a heart attack can result, sometimes with deadly consequences. 

Though treatment of heart attacks has improved dramatically in recent decades, coronary artery disease remains the leading cause of death for both men and women in the U.S. 

Causes of Coronary Artery Disease

Understanding the risk factors for coronary artery disease can help people reverse, reduce, or even prevent its harmful effects.

CAD risk factors that cannot be controlled are:

• Gender: Males are at higher risk.
  
• Age: Older people, including postmenopausal women, are more likely to have heart disease.
  
• Race and ethnicity: African-Americans, for example, have a higher incidence than Caucasians.
  
• Family history of heart disease

Many risk factors for CAD can be addressed with medical care, preventive treatments, and healthy lifestyle choices. These include:

• Smoking
  
• High blood pressure
  
• High cholesterol
  
• Diabetes
  
• Sedentary lifestyle
  
• Being overweight, especially with excess abdominal fat
  
• Diet high in saturated fat and cholesterol 
  

Symptoms of Coronary Artery Disease

People with asymptomatic (“silent”) CAD might not experience any symptoms until a blockage is severe enough to cause a heart attack. This is why it’s important for people to get regular medical checkups and talk with their doctors if they experience symptoms of coronary artery disease. 

Those symptoms can include:

• Angina: Chest pain or pressure that gets worse with activity
  
• Shortness of breath
  
• Irregular heartbeat
  
• Heart attack 

Diagnosing Coronary Artery Disease

UT Southwestern cardiologists might perform several tests to reveal specific, important information about a patient’s heart health and diagnose CAD. Common diagnostic tests include:

• Electrocardiogram (ECG or EKG): This test provides a visual record of the heart’s rate and rhythm.
  
• Echocardiography (echo or cardiac ultrasound): This noninvasive diagnostic tool uses sound waves to create images of the heart’s structures to evaluate the heart’s size, shape, tissues, pumping capacity, and other useful data.
  
• Cardiac calcium scoring: An imaging test can measure how much calcium has accumulated in the coronary arteries, which is correlated with plaque formation.
  
• Exercise stress test: This study can determine if the heart is not getting enough blood with exercise.
  
• Cardiac catheterization: This procedure involves the insertion of a long, thin, flexible tube into an artery at the groin or wrist, which is then guided to the heart and its arteries. A contrast agent is injected into the coronary arteries, allowing the cardiologist to see plaque buildup in the artery walls. 

Coronary Artery Disease Treatments

There are three levels of treatment for coronary artery disease:

• Medical intervention (lifestyle and drug therapy)
  
• Interventional procedures
  
• Surgical interventions 

For people with any degree of coronary artery disease, lifestyle modifications such as a healthy diet, regular exercise, and smoking cessation will help foster a longer, more vigorous life. 

Medical Therapy

Patients with coronary artery disease that has been caught early and people with one or more elevated risk factor for developing it can often be treated effectively with lifestyle changes and medications. 

Medications to prevent and treat coronary artery disease include:

• ACE inhibitors, such as beta blockers or calcium channel blockers to lower blood pressure
  
• Statins to lower cholesterol levels, which decreases the risk for heart attacks in people with high cholesterol, established coronary disease, or other risk factors
  
• Aspirin or other anticoagulants to reduce the risk of blood clots by thinning the blood 

Interventional and Surgical Procedures

For patients with more severe coronary artery disease, interventional cardiologists and cardiac surgeons offer more aggressive therapies. 

UT Southwestern’s interventional cardiologists have extensive experience in the latest minimally invasive approaches to percutaneous coronary intervention (PCI). A catheter is inserted into an artery at the groin or wrist to access and open blocked coronary arteries, increasing blood flow and reducing symptoms. A small, cage-like structure called a stent is often placed within a cleared artery to keep it open. Facilitating rapid recovery with minimal pain and complications, these minimally invasive procedures require only a brief hospital stay. 

For patients with severe coronary artery disease that cannot be successfully managed with less invasive treatments, coronary artery bypass grafting (CABG, or heart bypass surgery) might be recommended. In CABG, a healthy artery or vein is harvested from another part of the body and joined to the obstructed coronary artery, past the blockage, creating a detour route for oxygen-rich blood to reach the heart muscle. 

Since CABG was first performed more than 65 years ago, numerous advances in technologies and techniques have steadily improved patient outcomes. 

Rehabilitation and Follow-Up Care

People who have been treated for or are at risk for serious coronary artery disease can reduce their likelihood of future heart problems with the assistance of UT Southwestern’s collaborative cardiac rehabilitation team. 

Customized diet, exercise, and smoking cessation programs provide patients with the understanding, support, and motivation they need to make the lifestyle choices and changes that will pave the way to improved health. 

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease. 

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.