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.
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:
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.
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 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.
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.
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).