Coronary artery disease (CAD), a narrowing of one or more arteries that supply blood to the heart, is a leading cause of death for men and women in the United States. In this podcast, interventional cardiologist Dr. Laura Mosher explains the risk factors and symptoms for CAD, how it is diagnosed and treatment options.
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What You Need to Know About Coronary Artery Disease (CAD)
Featured Speaker:
Laura Mosher, MD
Dr. Laura Mosher is board certified in interventional cardiology, nuclear cardiology, cardiovascular diseases and adult echocardiography. She has participated in numerous peer groups and written articles on cardiovascular disease. Dr. Mosher’s clinical interests include cardiovascular disease prevention, chronic angina and women’s cardiovascular health. She is a member of the American Heart Association and has served on its board of directors. Transcription:
What You Need to Know About Coronary Artery Disease (CAD)
Intro: Here's another edition of the BayCare Health System's podcast series, BayCare Health Chat with Melanie Cole.
Melanie: Welcome to BayCare HealthChat. I'm Melanie Cole. And today, we're taking a look at what you need to know about coronary artery disease. Joining me is Dr. Laura Mosher. She's an interventional cardiologist with BayCare. Dr. Mosher, it's a pleasure to have you join us again today. Tell us a little bit about coronary artery disease. What is the prevalence? And what's really considered coronary artery disease?
Dr. Laura Mosher: Hi, Melanie. Thanks for having me on your show again. Happy to be here to talk about coronary artery disease. So, coronary artery disease is one form of heart disease. And we know heart disease is very prevalent. It causes one in four deaths in the United States, and it's the leading killer of both men and women. And coronary artery disease happens to be the most common form of heart disease.
And when we speak about coronary artery disease, we're talking about plaque buildup and blockage in the heart arteries. And the heart arteries are small blood vessels that feed blood supply to the heart muscle itself. And when those become blocked, that's what can cause chest pains and, unfortunately, it can cause heart attacks as well. So coronary artery disease is really specifically talking about a blockage in those heart arteries that feed healthy oxygenated blood to the heart muscle.
Melanie: What a great definition. Thank you so much. So let's talk about risk factors. There are some modifiable controllable ones and there are some maybe genetic or uncontrollable ones. Can you tell us about these?
Dr. Laura Mosher: Sure. You're absolutely right. So the risk factors that are modifiable, that we as physicians like to work very carefully with our patients on are diabetes, high cholesterol, high blood pressure and smoking because those are all risk factors, as you said, that we can do something about. We can control those with medications and lifestyle modification and do the best that we can to make those risk factors as optimally controlled as possible.
Now, the other risk factors that we unfortunately don't have much control over would be your family history. So, some people are genetically predispositioned to heart disease and, unfortunately, some people are genetically predispositioned to heart disease or coronary artery disease at a young age as well. So those are issues that we have to work through, but unfortunately you can't modify your family history. And then age as well is another non-modifiable risk factor, whereas the prevalence and the risk for developing coronary artery disease goes up each year of age, but we can't stop the clock. So we have to work on our modifiable risk factors as best as we can.
Melanie: So let's talk a little bit about what would send somebody to the doctor in the first place and how do you diagnose it or how would somebody know, as you're telling us about symptoms, not necessarily symptoms of a heart attack, but of heart disease in general? Are there some warning signs? Are there some impending symptoms, something that would let us know that it's time to go get this checked out? Because many symptoms, Dr. Mosher, crossover between panic attacks or stress-related or obesity, there's a ton of ways that these things crossover. So tell us a little bit about how you diagnose it, when you diagnose it, and some of the symptoms we might notice.
Dr. Laura Mosher: Wow. That's a loaded question. I'll get to all of those as best as I can. But I'm glad that you asked that because I think those types of questions are on everyone's mind. So the typical symptoms that we think of that are warning signs for a heart attack or coronary artery disease would be chest pain, shortness of breath, breaking out in a cold sweat or nauseated or light-headed.
Sometimes coronary artery disease presents as pain in the arms or in the upper back or even as jaw pain. Other potential warning signs could be just unusually fatigued or normal activities such as walking or bike riding, things that someone used to do with ease have become more difficult. That would be a warning sign as well to go get checked out.
Now, unfortunately, for some people, the first sign of coronary artery disease is actually a heart attack. So when they look back on it, they think, you know, they really didn't have any warning signs that something was going on, but I always encourage people to pay attention to their body. And if something doesn't feel right, it's better to err on the side of getting checked out than to stay at home and risk having a heart attack or heart damage, because they were afraid to come to the doctor.
And as you pointed out with other diagnoses, it can be very difficult to figure out if it is heart disease versus something else. Other things or conditions that could mimic heart attack symptoms could be panic attacks or having the flu,. Now in the age of COVID where people are feeling short of breath and unusually fatigued as some symptoms of COVID potentially, it is not easy to differentiate always which is heart and which is not.
So we use stress testing, we use heart catheterization, we use coronary CT scans as an example of tests that can help us differentiate is this a heart issue or is this another issue that is not heart-related causing this similar symptoms. GI issues such as heartburn, hiatal hernia, reflux disease, those types of things can also mimic very similar symptoms as well.
In more specifics about heart testing that can help us differentiate between a heart issue versus a non-cardiac issue, so we typically will use EKGs to help us. We use echocardiograms, that's an ultrasound of the heart to look at the structure and function of the heart muscle, and also to look at the heart valves. And we use stress testing and that can come in different forms. Some are pharmacologic stress tests where you get an injection through the IV that simulates what your heart would do under an exercise test or you can walk on the treadmill. So there's different forms of stress testing, and we tailor this to the needs and specifically what we're looking for in each particular patient.
And other testing that we can also do in terms of looking at the heart arteries, the gold standard is still the heart catheterization or a coronary angiogram. That's done by interventional cardiologists such as myself. And then we also can offer now studies such as a coronary CT scan that also allows us to have a look at the heart arteries in a more non-invasive way. And in some particular patients that can also be a very useful test. And all of these things we use in combination with our clinical assessment and by taking a detailed history from the patient to help us decide, is this a heart issue or is this not a heart issue?
Melanie: That was a very comprehensive answer to what you said was, yes, a difficult question, but just along lines and before we discuss treatment, if people do feel chest pain or these things, does that mean an impending heart attack? Or can you feel those things just because there is restricted blood flow? Or pain in the arms and the jaw, we've always heard, especially as women, you feel that stuff, you assume it's a heart attack and call 911, but can these things also just be part of the developing disease and not really the impending heart attack?
Dr. Laura Mosher: Yes, absolutely. So there can be warning signs that there is coronary artery disease present. And if we catch it early enough, our hope is that it doesn't progress to a heart attack. So that's where it becomes very important for people to pay attention to their bodies and to go get checked out, because what you're feeling may be a warning sign, but our hope is that it does not progress to a heart attack if we can intervene early.
Melanie: Now, tell us a little bit about some of the latest treatments and what's exciting in your field? What are you doing for patients once you discover that they do have developing heart disease?
Dr. Laura Mosher: So once we determined that there is coronary artery disease present, one of the most important things that we do is make sure that the patient is on the right medications. And we know that medical therapy can be very effective at slowing the progression of coronary artery plaquing so that the disease does not become worse. So we institute medical therapies sort of right off the bat is one of the things that we want to do.
In terms of diagnosing it, a lot of times, we're still looking at a heart catheterization to really determine where the blockages are. And a lot of times, while we're in the catheterization lab and we're looking at the heart arteries, a lot of times we can fix it at the same time with a balloon or a stent or both to open up the blood flow in that artery and restore normal blood flow.
Melanie: So these medications that you mentioned, are they something that patients have to be on for the rest of their life, if it's blood pressure or cholesterol-related or even stress-related? Any of these kinds of things to help bring down the heat a little bit, to help calm some of these things and get them under control, is this a lifelong thing? And if so, what other adjuvant things would you like patients to do? Where does exercise come into this picture?
Dr. Laura Mosher: Right. So I think for a lot of patients, these will be medications that they'll be on long-term, but it's really tailored specific to the patient's disease status and their particular needs. So these patients may not have to be on all the medications lifelong. But more often than not, these are medications that we would be looking for the patient to be on longer term.
In particularly, we're thinking about medications such as aspirin, a cholesterol-lowering agent, such as any of the statin medications. We're thinking about medications that are beta-blockers. So similar to medications such as metoprolol or atenolol, those kinds of medications can be very helpful. And those are often medications that we will use longer term, depending on the patient's specific needs.
In terms of exercise, once we have stabilized the patient's disease process, if we've opened the heart artery or say we've even had to send a patient to bypass surgery, because there were so many blockages or in a dangerous location, and stenting was not feasible, once the patient has been stabilized and recovered from their therapeutic intervention, then exercise becomes very important. And we are sending a lot of patients to cardiac rehab, which has very well-proven outcomes to be helpful in patients who are recovering from stenting procedures and bypass surgery and from heart attack as well.
Melanie: This is such an informative episode, Dr. Mosher. As we wrap up and you're such a great guest, please reiterate lifestyle modifications that you encourage patients to adhere to so that maybe they don't have to do any of the interventions that we've discussed here today.
Dr. Laura Mosher: Oh, that's a great way to end the segment, really to drive home the idea that it doesn't have to come to a heart attack or a catheterization or bypass surgery. What can people do to prevent things from getting to that standpoint? So my best advice is to be aware of your risk factors. What is your cholesterol? What is your blood pressure? If you're smoking, please quit. Are you diabetic? Have you been checked for diabetes?
So those things you can work with your doctor to assess and start any therapies needed as directed by your doctor to control those risk factors. Other things would be including, and that would be eating a heart-healthy diet, diets low in sodium and low in trans fat and saturated fat, lots of whole grains, fruits, and vegetables, and then making sure that you're getting enough sleep. We know now that sleep is very important in healing the body and decreasing inflammation.
We also know that patients should be exercising. It doesn't have to be any vigorous exercise, but even going for a walk 30 minutes a day, five days a week is really where we want to get people to. and that way they can decrease their blood pressure, decrease blood sugars and control cholesterol and maintain a healthier body weight.
The other thing that's super important is to reduce alcohol intake. The recommended daily allotment of alcoholic beverages for men is two drinks or less a day. And for women it's one drink or less a day.
I would want to emphasize to the audience that they should pay attention to their body. And if they feel symptoms that are unusual or worrisome, don't hesitate to get checked out and make sure that you have routine visits with your primary physician so that you know what your risk factors are for developing coronary artery disease. And your physician can work with you to make sure you're maintaining a healthy lifestyle to prevent the development of coronary artery disease.
Melanie: So well said, Dr. Mosher. Thank you so much for coming on and sharing your incredible expertise. You are such an excellent guest.
To learn more about BayCare's heart and vascular services, please visit our website at BayCareHeart.org for more information and to get connected with one of our providers.
That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. I'm Melanie Cole,
What You Need to Know About Coronary Artery Disease (CAD)
Intro: Here's another edition of the BayCare Health System's podcast series, BayCare Health Chat with Melanie Cole.
Melanie: Welcome to BayCare HealthChat. I'm Melanie Cole. And today, we're taking a look at what you need to know about coronary artery disease. Joining me is Dr. Laura Mosher. She's an interventional cardiologist with BayCare. Dr. Mosher, it's a pleasure to have you join us again today. Tell us a little bit about coronary artery disease. What is the prevalence? And what's really considered coronary artery disease?
Dr. Laura Mosher: Hi, Melanie. Thanks for having me on your show again. Happy to be here to talk about coronary artery disease. So, coronary artery disease is one form of heart disease. And we know heart disease is very prevalent. It causes one in four deaths in the United States, and it's the leading killer of both men and women. And coronary artery disease happens to be the most common form of heart disease.
And when we speak about coronary artery disease, we're talking about plaque buildup and blockage in the heart arteries. And the heart arteries are small blood vessels that feed blood supply to the heart muscle itself. And when those become blocked, that's what can cause chest pains and, unfortunately, it can cause heart attacks as well. So coronary artery disease is really specifically talking about a blockage in those heart arteries that feed healthy oxygenated blood to the heart muscle.
Melanie: What a great definition. Thank you so much. So let's talk about risk factors. There are some modifiable controllable ones and there are some maybe genetic or uncontrollable ones. Can you tell us about these?
Dr. Laura Mosher: Sure. You're absolutely right. So the risk factors that are modifiable, that we as physicians like to work very carefully with our patients on are diabetes, high cholesterol, high blood pressure and smoking because those are all risk factors, as you said, that we can do something about. We can control those with medications and lifestyle modification and do the best that we can to make those risk factors as optimally controlled as possible.
Now, the other risk factors that we unfortunately don't have much control over would be your family history. So, some people are genetically predispositioned to heart disease and, unfortunately, some people are genetically predispositioned to heart disease or coronary artery disease at a young age as well. So those are issues that we have to work through, but unfortunately you can't modify your family history. And then age as well is another non-modifiable risk factor, whereas the prevalence and the risk for developing coronary artery disease goes up each year of age, but we can't stop the clock. So we have to work on our modifiable risk factors as best as we can.
Melanie: So let's talk a little bit about what would send somebody to the doctor in the first place and how do you diagnose it or how would somebody know, as you're telling us about symptoms, not necessarily symptoms of a heart attack, but of heart disease in general? Are there some warning signs? Are there some impending symptoms, something that would let us know that it's time to go get this checked out? Because many symptoms, Dr. Mosher, crossover between panic attacks or stress-related or obesity, there's a ton of ways that these things crossover. So tell us a little bit about how you diagnose it, when you diagnose it, and some of the symptoms we might notice.
Dr. Laura Mosher: Wow. That's a loaded question. I'll get to all of those as best as I can. But I'm glad that you asked that because I think those types of questions are on everyone's mind. So the typical symptoms that we think of that are warning signs for a heart attack or coronary artery disease would be chest pain, shortness of breath, breaking out in a cold sweat or nauseated or light-headed.
Sometimes coronary artery disease presents as pain in the arms or in the upper back or even as jaw pain. Other potential warning signs could be just unusually fatigued or normal activities such as walking or bike riding, things that someone used to do with ease have become more difficult. That would be a warning sign as well to go get checked out.
Now, unfortunately, for some people, the first sign of coronary artery disease is actually a heart attack. So when they look back on it, they think, you know, they really didn't have any warning signs that something was going on, but I always encourage people to pay attention to their body. And if something doesn't feel right, it's better to err on the side of getting checked out than to stay at home and risk having a heart attack or heart damage, because they were afraid to come to the doctor.
And as you pointed out with other diagnoses, it can be very difficult to figure out if it is heart disease versus something else. Other things or conditions that could mimic heart attack symptoms could be panic attacks or having the flu,. Now in the age of COVID where people are feeling short of breath and unusually fatigued as some symptoms of COVID potentially, it is not easy to differentiate always which is heart and which is not.
So we use stress testing, we use heart catheterization, we use coronary CT scans as an example of tests that can help us differentiate is this a heart issue or is this another issue that is not heart-related causing this similar symptoms. GI issues such as heartburn, hiatal hernia, reflux disease, those types of things can also mimic very similar symptoms as well.
In more specifics about heart testing that can help us differentiate between a heart issue versus a non-cardiac issue, so we typically will use EKGs to help us. We use echocardiograms, that's an ultrasound of the heart to look at the structure and function of the heart muscle, and also to look at the heart valves. And we use stress testing and that can come in different forms. Some are pharmacologic stress tests where you get an injection through the IV that simulates what your heart would do under an exercise test or you can walk on the treadmill. So there's different forms of stress testing, and we tailor this to the needs and specifically what we're looking for in each particular patient.
And other testing that we can also do in terms of looking at the heart arteries, the gold standard is still the heart catheterization or a coronary angiogram. That's done by interventional cardiologists such as myself. And then we also can offer now studies such as a coronary CT scan that also allows us to have a look at the heart arteries in a more non-invasive way. And in some particular patients that can also be a very useful test. And all of these things we use in combination with our clinical assessment and by taking a detailed history from the patient to help us decide, is this a heart issue or is this not a heart issue?
Melanie: That was a very comprehensive answer to what you said was, yes, a difficult question, but just along lines and before we discuss treatment, if people do feel chest pain or these things, does that mean an impending heart attack? Or can you feel those things just because there is restricted blood flow? Or pain in the arms and the jaw, we've always heard, especially as women, you feel that stuff, you assume it's a heart attack and call 911, but can these things also just be part of the developing disease and not really the impending heart attack?
Dr. Laura Mosher: Yes, absolutely. So there can be warning signs that there is coronary artery disease present. And if we catch it early enough, our hope is that it doesn't progress to a heart attack. So that's where it becomes very important for people to pay attention to their bodies and to go get checked out, because what you're feeling may be a warning sign, but our hope is that it does not progress to a heart attack if we can intervene early.
Melanie: Now, tell us a little bit about some of the latest treatments and what's exciting in your field? What are you doing for patients once you discover that they do have developing heart disease?
Dr. Laura Mosher: So once we determined that there is coronary artery disease present, one of the most important things that we do is make sure that the patient is on the right medications. And we know that medical therapy can be very effective at slowing the progression of coronary artery plaquing so that the disease does not become worse. So we institute medical therapies sort of right off the bat is one of the things that we want to do.
In terms of diagnosing it, a lot of times, we're still looking at a heart catheterization to really determine where the blockages are. And a lot of times, while we're in the catheterization lab and we're looking at the heart arteries, a lot of times we can fix it at the same time with a balloon or a stent or both to open up the blood flow in that artery and restore normal blood flow.
Melanie: So these medications that you mentioned, are they something that patients have to be on for the rest of their life, if it's blood pressure or cholesterol-related or even stress-related? Any of these kinds of things to help bring down the heat a little bit, to help calm some of these things and get them under control, is this a lifelong thing? And if so, what other adjuvant things would you like patients to do? Where does exercise come into this picture?
Dr. Laura Mosher: Right. So I think for a lot of patients, these will be medications that they'll be on long-term, but it's really tailored specific to the patient's disease status and their particular needs. So these patients may not have to be on all the medications lifelong. But more often than not, these are medications that we would be looking for the patient to be on longer term.
In particularly, we're thinking about medications such as aspirin, a cholesterol-lowering agent, such as any of the statin medications. We're thinking about medications that are beta-blockers. So similar to medications such as metoprolol or atenolol, those kinds of medications can be very helpful. And those are often medications that we will use longer term, depending on the patient's specific needs.
In terms of exercise, once we have stabilized the patient's disease process, if we've opened the heart artery or say we've even had to send a patient to bypass surgery, because there were so many blockages or in a dangerous location, and stenting was not feasible, once the patient has been stabilized and recovered from their therapeutic intervention, then exercise becomes very important. And we are sending a lot of patients to cardiac rehab, which has very well-proven outcomes to be helpful in patients who are recovering from stenting procedures and bypass surgery and from heart attack as well.
Melanie: This is such an informative episode, Dr. Mosher. As we wrap up and you're such a great guest, please reiterate lifestyle modifications that you encourage patients to adhere to so that maybe they don't have to do any of the interventions that we've discussed here today.
Dr. Laura Mosher: Oh, that's a great way to end the segment, really to drive home the idea that it doesn't have to come to a heart attack or a catheterization or bypass surgery. What can people do to prevent things from getting to that standpoint? So my best advice is to be aware of your risk factors. What is your cholesterol? What is your blood pressure? If you're smoking, please quit. Are you diabetic? Have you been checked for diabetes?
So those things you can work with your doctor to assess and start any therapies needed as directed by your doctor to control those risk factors. Other things would be including, and that would be eating a heart-healthy diet, diets low in sodium and low in trans fat and saturated fat, lots of whole grains, fruits, and vegetables, and then making sure that you're getting enough sleep. We know now that sleep is very important in healing the body and decreasing inflammation.
We also know that patients should be exercising. It doesn't have to be any vigorous exercise, but even going for a walk 30 minutes a day, five days a week is really where we want to get people to. and that way they can decrease their blood pressure, decrease blood sugars and control cholesterol and maintain a healthier body weight.
The other thing that's super important is to reduce alcohol intake. The recommended daily allotment of alcoholic beverages for men is two drinks or less a day. And for women it's one drink or less a day.
I would want to emphasize to the audience that they should pay attention to their body. And if they feel symptoms that are unusual or worrisome, don't hesitate to get checked out and make sure that you have routine visits with your primary physician so that you know what your risk factors are for developing coronary artery disease. And your physician can work with you to make sure you're maintaining a healthy lifestyle to prevent the development of coronary artery disease.
Melanie: So well said, Dr. Mosher. Thank you so much for coming on and sharing your incredible expertise. You are such an excellent guest.
To learn more about BayCare's heart and vascular services, please visit our website at BayCareHeart.org for more information and to get connected with one of our providers.
That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. I'm Melanie Cole,