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Restricted Blood Flow

Over many years, fatty material and cholesterol (plaque) can stick to the walls of the arteries, including the blood vessels of the heart (coronary arteries). This disease process is called atherosclerosis.

When blockages develop in the coronary arteries, the restricted blood flow results in a lack of oxygen to the heart muscle. This condition is known as coronary artery disease. Insufficient blood flow to the heart muscle can lead to symptoms of chest pain (angina). If the coronary artery becomes completely blocked, it will cause a heart attack. During a heart attack, some of the heart muscle can die from a lack of oxygen.

Risk factors

Risk factors for atherosclerosis include:

  • high blood pressure
  • high blood cholesterol
  • diabetes
  • obesity (increased BMI or waist circumference)
  • a high fat diet
  • a family history of heart disease.
Symptoms

Early warning signs of coronary artery disease may include fatigue, pain and dizziness. They can also include the symptoms associated with angina: a squeezing, suffocating or burning feeling in your chest that tends to start in the centre of your chest but may move to your arm, neck, back, throat or jaw. Women are more likely to experience less typical symptoms such as vague chest discomfort. If left untreated, coronary artery disease can lead to other serious problems such as heart attack, stroke or even death.

Coronary artery disease is a serious heart condition. If you notice any of the symptoms of coronary artery disease, get immediate medical attention. If you think you may be experiencing a heart attack, call 9-1-1 right away. Read about the signs of heart attack.

Treatment

Diagnosis

In addition to taking a medical history, doing a physical exam and ordering a chest X-ray, your doctor may also order an electrocardiogram (ECG or EKG) or echocardiogram.

You may also be referred for a coronary angiogram, an X-ray image of your coronary arteries and blood vessels. This procedure is done using diagnostic cardiac catheterization​. Performed in hospital under local anesthetic, diagnostic cardiac catheterization involves inserting a hollow plastic tube (catheter) through the skin into an artery and guiding it towards the heart. The catheter releases a special dye makes the heart's arteries and blood vessels visible to the X-ray.  

Treatment

If you have atherosclerosis or coronary artery disease, your primary care physician or heart specialist will determine the best treatment options for you. This could include:

Reducing risk factors

There are diet and lifestyle changes you can make to reduce certain risk factors for coronary artery disease. It is also important to work with your doctor to manage health conditions such as high blood pressure, high blood cholesterol and diabetes.

Medical management

In some cases, medical management is the preferred treatment option. Depending on your personal needs, you doctor may prescribe one or more medications to treat your coronary artery disease.

Coronary revascularization

Coronary revascularization is a treatment that restores blood flow and reduces the risk of damage to the heart. It may be recommended when blockages in one or more coronary arteries cause symptoms and/or serious complications, or if these blockages have already caused a heart attack. The procedure may be scheduled as an elective procedure or performed on an urgent basis.

Typically, your doctors will determine your need for revascularization treatment with a diagnostic cardiac catheterization. This procedure involves inserting a hollow plastic tube (catheter) through the skin into an artery and guiding it towards the heart to evaluate coronary arteries, heart valves and heart function. A coronary angiogram is a cardiac catheterization that uses x-ray dye to take pictures of the coronary arteries.

There are two types of coronary revascularization procedure.

Percutaneous coronary intervention (PCI or coronary angioplasty)

PCI is a minimally invasive, non-surgical procedure used to restore coronary blood flow. A hollow flexible tube (catheter) is inserted through the skin into an artery in the leg or arm, where it is guided up to the heart vessels. A small balloon is inflated, stretching the artery and flattening the blockage (plaque) against the artery wall. A permanent wire scaffold (stent) may be placed to prevent the artery from narrowing again.

Coronary artery bypass graft (CABG)

CABG is the most commonly-performed heart surgery. A healthy segment of an artery or vein from elsewhere in the body (e.g., chest wall artery, leg vein) is removed and connected (grafted) to a section of the coronary artery. This creates a new path for blood flow to the heart that bypasses the blockage. In a single surgery, a patient may undergo multiple bypass grafts (e.g., double, triple or quadruple bypass).

Both PCI and CABG increase coronary blood flow. Choosing the most suitable option for a patient depends on a number of factors, including medical history (especially diabetes), risk factors and how many coronary arteries are affected. Generally, CABG tends to be reserved for patients with significant narrowing in two or more coronary arteries (multi-vessel disease) and PCI tends to be used to treat narrowing in a single coronary artery (single-vessel disease).

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