By Dr. Hiten Patel
Coronary artery disease (CAD) is a common circulatory problem in which cholesterol/fatty deposits build up on the wall of a blood vessel (artery), a process called atherosclerosis. This can narrow the artery lumen and reduce the blood flow to the heart. This may cause chest pain, shortness of breath, or a heart attack. Atherosclerosis can also affect arteries throughout the body, and when it occurs in arteries supplying blood to the limbs, usually the leg, it causes peripheral artery disease (PAD). This may cause leg pain/cramps when walking, numbness, coldness, or leg ulcers. CAD and PAD share common risk factors like increasing age, male gender, a family history of CAD or PAD at an early age, smoking, high blood pressure, high blood cholesterol, diabetes, obesity, physical inactivity and unhealthy diet. Same life style habits used to help treat CAD and PAD can also help prevent it. Tips for healthy life style is to quit smoking, stay physically active, exercise regularly (aim 30-45mins), maintain healthy weight, eat a low-fat, low-salt diet rich in fruits, vegetables, whole grains, and control conditions such as high blood pressure, high cholesterol and diabetes.
CAD is usually diagnosed by stress test which is commonly combined with nuclear imaging. A confirmatory test called angiography is often indicated to look for blockages in arteries, which involves injecting a dye in the artery and viewing it using CT scan or under X-rays via cardiac catheterization (invasive procedure that involves guiding a small hollow tube called catheter through an artery in your groin or wrist to the affected artery). PAD is usually diagnosed with ankle-brachial index (ABI), a test that compares the blood pressure in your ankle with blood pressure in your arm. Additional tests like ultrasound and angiography (using CT scan, or MRI or catheter) is ordered before planning the treatment.
Treatment for both CAD and PAD involves blood thinners, medications to lower blood cholesterol, and medications to relieve chest pain or leg pain. Additionally in PAD patients, supervised exercise program is recommended initially to increase the distance they can walk pain-free. Finally in some cases, angioplasty or bypass surgery may be necessary. Angioplasty is an invasive procedure where a catheter is threaded through blood vessel to the narrowed artery, and later is widen by inserting and inflating balloon. Often times a stent (mesh or spring) is also inserted and left in the artery to keep it open. For bypass surgery, a surgeon creates a path around the narrowed or blocked artery using a graft (either a blood vessel from another part of a body or a synthetic vessel). This technique allows blood to bypass the affected artery. After angioplasty or surgery, patient is referred to cardiac rehabilitation – a program of education, counseling and exercise training that’s designed to help improve health.
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