Coronary Artery Disease
At Yale Cardiac Surgery, we have extensive experience in treating patients with coronary artery disease. Our world-renowned surgeons can help you better understand and offer you the most advanced surgical treatments, including off-pump and minimally invasive robot-assisted coronary artery bypass grafting. We also specialize in all-arterial coronary revascularization.
Coronary artery disease is associated with several risk factors, including:
- High blood pressure
- High cholesterol
- Radiation therapy to the chest
- Injury to the inner wall of the artery
- Chest pain (angina): Angina can be triggered by physical and emotional stress. You might compare the tightness or pressure to someone standing on your chest. In women, this type of chest pain may also include fleeting pain in the abdomen, back, or arm.
- Shortness of breath: When blood flow is restricted, the heart cannot pump enough blood to meet the body’s needs, leading to shortness of breath and extreme fatigue.
- Heart attack: A heart attack may occur when a coronary artery becomes completely blocked, completely shutting off blood to the heart muscle it supplies. Classic signs of a heart attack include crushing pressure in the chest and pain down the left shoulder or arm.
- Age: As age increases, the risk of developing coronary artery disease also increases.
- Sex: Men are at greater risk than women for developing coronary artery disease. The risk for women increases after menopause.
- Family history: A family history of heart disease, including coronary artery disease is a risk factor. The risk of developing coronary artery disease is higher if a close relative developed the disease at an early age. Men are at an increased risk if their father or a brother was diagnosed before the age of 55. Women are at an increased risk if their mother or a sister was diagnosed before the age of 65.
- Smoking: The incidence of heart attack is higher in men and women who are smokers. Nicotine and carbon monoxide constrict blood vessels and causes damage to the inner lining, increasing the risk of coronary artery disease.
- High blood pressure: High blood pressure, or hypertension, is a recognized risk factor for coronary artery disease.
- High blood cholesterol: High blood cholesterol, or hypercholesterolemia, can increase the risk of plaque buildup in the coronary arteries.
- Diabetes: Diabetes is a very strong coronary risk factor.
Chest X-Ray: A plain chest X-ray is almost always obtained as a screening test to confirm that there are no significant chest masses, fluid collections, pneumonias, or major anatomic malformations in the chest.
Electrocardiogram (ECG): An ECG detects electrical patterns that run through your heart and is particularly useful in identifying an ongoing heart attack or one that occurred in the distant past. It is also an important tool to identify any rhythm disturbances as well.
Echocardiogram: An echocardiogram is a non-invasive test that uses ultrasonic sound waves to display moving images of the heart. It usually provides an excellent assessment of heart pumping function and heart valve competence. For patients with coronary artery disease, it can provide clues as to which areas of heart muscle are suffering from a lack of blood flow.
Stress test: Stress tests are generally used to determine deficiencies in coronary blood flow during cardiac exertion. There are several types of stress tests in which the heart is stimulated by actual exercise (i.e., walking on a treadmill) or with medicines and then imaged with echocardiography or radioactive imaging techniques. These tests are usually performed in the presence of a cardiologist to interpret them and to make sure that the patient is not over-stressed.
Cardiac catheterization (coronary angiogram): A cardiac catheterization, or coronary angiogram, is performed by threading a thin catheter into the heart via an artery in your leg or arm and injecting dye directly into the coronary arteries. These studies map out the coronary anatomy and detect narrowing within the arteries.
Computerized tomography (CT) scan: Coronary CT angiography is a relatively new imaging technique that, like cardiac catheterization, displays the coronary anatomy and identifies narrowing or blockages in the coronary arteries. Its potential advantage over the older, more traditional coronary angiogram is that it’s non-invasiveness, as a catheter does not need to be threaded into the heart.
Magnetic resonance angiogram (MRI): MRI studies are not usually obtained prior to coronary artery bypass surgery, but are most often useful for determining the functional potential, or “viability,” of heart muscle. It is also quite accurate in measuring overall heart function, assessing aortic diseases, and characterizing rare cardiac tumors.
Coronary angioplasty and stent placement: This procedure is generally performed by interventional cardiologists. This procedure begins with placement of a special catheter into the heart via an arm or leg artery. A wire specially fitted with a balloon is guided through this catheter into the diseased coronary artery. The balloon is inflated at the point of vessel narrowing, plastering the atherosclerotic plaque against the side of the vessel wall, thereby opening up the vessel and improving blood flow through it. This allows enough room for to the cardiologist to place a metal stent in the artery that will help keep it open.
We understand that the thought of undergoing heart surgery can feel overwhelming. Our surgeons will review your surgical plan, in detail, so that you will know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their innovative treatment strategies.