Coronary Artery Disease; How To Keep You And Your Heart Healthy
Coronary artery disease is the most common type of heart disease in the United States so what is the best way to keep your heart health in mind? Dr. Arturo Cardounel discusses the answer to this question and more about how to keep your heart healthy.
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Learn more about Arturo Cardounel, MD, PhD
Arturo Cardounel, MD, PhD
In joining VCU Health, Dr. Cardounel has returned to Richmond after completing his cardiothoracic surgery residency at the esteemed University of Pittsburgh Medical Center. The local terrain is very familiar: He earned his undergraduate degree at the University of Richmond, and he earned his Ph.D. in VCU’s Department of Physiology and Biophysics.Learn more about Arturo Cardounel, MD, PhD
Transcription:
Coronary Artery Disease; How To Keep You And Your Heart Healthy
Caitlin Whyte: Coronary artery disease is the most common type of heart disease in the United States. So how can we keep you and your heart healthy? To answer that question and more, we are joined today by Dr. Arturo Cardounel. He is a cardiothoracic surgeon as well as an Assistant Professor of Surgery.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health. I'm your host, Caitlin Whyte. Doctor, to start us out on this conversation, what is a coronary artery and why are they so important?
Arturo Cardounel, MD, PhD: Sure. So coronary arteries are basically the blood vessels that supply oxygen and blood to your heart. There are two main coronary arteries. There's one called the left main, which supplies about two-thirds of the heart. And then there's one called the right coronary artery and that supplies about a third of your heart. So when we talk about coronary artery disease, what we're talking about is narrowing of those blood vessels that supply the heart muscle over time, which eventually can lead to things like heart attack and angina, the typical symptoms that we think of when we think of coronary disease.
Caitlin Whyte: So that actually leads me into my next question, what is coronary artery disease?
Arturo Cardounel, MD, PhD: Sure. So coronary disease is basically the formation of plaques. These fatty deposits gradually happen over a person's lifetime. It begins typically when we're teenagers. It begins with just these little fatty streaks on the blood vessels. But over time, those fatty streaks will become plaques, which are cholesterol-filled plaques that triggers an inflammatory response in the blood vessels, white cells come in, and we've all heard about inflammation and heart disease. Inflammation is really key to lots of different types of diseases, and that's no different than with coronary artery disease. So that inflammation leads to further changes in the vessel wall, progressive narrowing. Eventually, the narrowing will become enough that you actually limit the blood supply to the heart. And that's when patients will typically start getting symptoms of coronary artery disease.
So what do we mean by symptoms? Things like angina, which is that tightness or pressure, aching burning feeling in people's chest that they describe. They can also get things like radiating pain up to their neck, up to their shoulder, even sometimes up into the jaw. Those are what we call agina and angina equivalents. And that would be a good indicator that a patient has significant coronary artery disease.
Caitlin Whyte: And can you dig into that a bit more for us? Just what is the cause of coronary artery disease?
Arturo Cardounel, MD, PhD: Sure. So the cause is multifaceted. So we don't know exactly why these processes happen, but ultimately, it's that fat deposition, that cholesterol deposition in the artery wall that causes this progressive narrowing. What prevents it from being an issue from the beginning is that there's still what's called a cap or a thin layer of normal healthy tissue that overlays these deposits. However, over time as the plaque gets larger and larger, what can happen is that cap can actually tear or break. When that cap breaks, now all of a sudden the blood vessel wall, the inside parts of the wall are in direct contact with the blood. And within the blood, there's things called platelets. And we probably heard of platelets because those are what cause blood clotting. So when those platelets interact with the deeper layers of the blood vessel wall, what you get is you get the formation of a blood clot and that's what causes an acute myocardial infarction. That's that sudden onset of this deep chest pain that ultimately leads to a heart attack. At that point, you know, you need an intervention to help prevent permanent injury to the heart muscle.
Caitlin Whyte: So now that we know the background a little bit, what are some symptoms of this?
Arturo Cardounel, MD, PhD: So symptoms can vary, but there are, you know, a series or a constellation of symptoms that we call typical. The typical symptom of coronary disease is angina. And angina can vary in its presentation, but usually people describe it as a heaviness, a tightness, a pressure, an ache, or a burning in your chest. That discomfort can spread. It can spread up into your shoulder, your left or your right. It can radiate down your arms. It can move up your neck. Some patients even feel it up in their jaw.
Other symptoms are less obvious. Sometimes people can just present with increasing fatigue. Activities that they used to tolerate, now they become very tired, that could be an indicator of coronary disease. Other symptoms that are atypical are things like dizziness, lightheadedness, nausea. Women can present with slightly different symptoms. Sometimes they'll present with heartburn or indigestion-type of symptoms, anxiety. Even a cold sweat can sometimes be an indicator of coronary disease.
Caitlin Whyte: You know, this is often known as a silent disease. So just how threatening is it if it can be so undetectable?
Arturo Cardounel, MD, PhD: So it's very threatening. So heart disease is actually the leading cause of death for both men and women in the United States. It's called the silent killer because you can have coronary disease and not have any symptoms at all. People could sometimes even have a heart attack and not know they had one. So we call it silent myocardial infarction or a silent heart attack. And it accounts for about half of all heart attacks. So the question is, you know, what can we do about it? Well, the key to managing coronary disease is really knowing what's your individual risk and then knowing what the symptoms are when they happen. Risk factors, these are things like smoking, obesity, diabetes, high cholesterol and, of course, family history. But we need to also be aware of the symptoms, which we talked about, that anginal-type of symptom, that tightness or pressure in your chest. If you have any of these symptoms or you have a family history, it's critical that you talk to your healthcare provider so they can assess what your actual risk is. Once you get diagnosed with coronary disease, there's lots of different options.
Caitlin Whyte: Well, doctor, I'd love to know what your personal connection is to this disease.
Arturo Cardounel, MD, PhD: Sure. So I have a very strong personal connection. So I have a strong family history of coronary disease. My father had his first heart attack in his 40s and he had bypass surgery. Both my brother and I had bypass surgery at 48. So coronary disease is definitely something that hits close to home. You know, I thought I was a healthy person. I maintained a healthy weight. I lived an active lifestyle. But over a period of a couple of months, I noticed that I was getting this mild chest tightness with exertion. And like everybody else, initially, I minimized the symptoms. I chalked it up to maybe some asthma or some indigestion. But I do have a strong family history. So I reached out to my primary care provider who ordered a stress test, which was positive. So I saw the cardiologist at the Pauley Heart Center and they diagnosed me with a severe multivessel coronary disease.
So at that time, I discussed the options with my cardiologist and we decided that that bypass surgery would be the best option for me. As a cardiac surgeon myself, you know, I kind of knew what the disease burden that I had was. And I thought that bypass surgery would give me the best options at a long-term success.
Caitlin Whyte: Wow. So it's like you've been on both sides.
Arturo Cardounel, MD, PhD: Yeah, absolutely. So, you know, it's always interesting to play the role of the patient as opposed to the physician. But, you know, I knew I was in excellent hands. The guys here at the Pauley Heart Center really are, you know, leading this therapy in terms of personalized heart care. They have this individualized approach to heart disease that's really leading the charge in cardiac care.
Caitlin Whyte: Well, on that topic, what are the treatment options?
Arturo Cardounel, MD, PhD: Different treatment options. So it can be anything from medications. There are lots of anti-anginal medications. These are medications that decrease the work your heart has to do. So it minimizes the symptoms and kind of the stress on your heart. There's vasodilator medications. These are pills that you can take that help open up the blood vessels, increasing the blood supply. Lipid-lowering, so your cholesterol-lowering medications. All of these things can help limit the disease burden. But ultimately, once you have advanced coronary disease, your options are going to be things like stents, bypass surgery.
Caitlin Whyte: Well, doctor, wrapping up here, are there any final thoughts? Anything else we didn't touch on that you find important when it comes to this conversation?
Arturo Cardounel, MD, PhD: The message that I want to send is that coronary disease can happen to anybody. It's the leading cause again of death in patients in the United States. And it's not a disease of just, you know, old people. So there are 18 million adults in the United States that are 20 or older that have coronary disease. And about 20% of deaths from coronary artery disease actually happen in patients under the age of 65. So if you have risk factors, if you have concerns, if you have a strong family history, I really implore you to reach out to your primary care physician and have them assess your risk.
Caitlin Whyte: Well, thank you so much for sharing with us today, doctor. You can find more about us by calling (804) 628-4327. That's (804) 628-4327. Or check out our website at vcuhealth.org/heart and give us a follow at facebook.com/vcuhealthheart. This has been Healthy With VCU Health. I'm Caitlin Whyte. We'll see you next time.
Coronary Artery Disease; How To Keep You And Your Heart Healthy
Caitlin Whyte: Coronary artery disease is the most common type of heart disease in the United States. So how can we keep you and your heart healthy? To answer that question and more, we are joined today by Dr. Arturo Cardounel. He is a cardiothoracic surgeon as well as an Assistant Professor of Surgery.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health. I'm your host, Caitlin Whyte. Doctor, to start us out on this conversation, what is a coronary artery and why are they so important?
Arturo Cardounel, MD, PhD: Sure. So coronary arteries are basically the blood vessels that supply oxygen and blood to your heart. There are two main coronary arteries. There's one called the left main, which supplies about two-thirds of the heart. And then there's one called the right coronary artery and that supplies about a third of your heart. So when we talk about coronary artery disease, what we're talking about is narrowing of those blood vessels that supply the heart muscle over time, which eventually can lead to things like heart attack and angina, the typical symptoms that we think of when we think of coronary disease.
Caitlin Whyte: So that actually leads me into my next question, what is coronary artery disease?
Arturo Cardounel, MD, PhD: Sure. So coronary disease is basically the formation of plaques. These fatty deposits gradually happen over a person's lifetime. It begins typically when we're teenagers. It begins with just these little fatty streaks on the blood vessels. But over time, those fatty streaks will become plaques, which are cholesterol-filled plaques that triggers an inflammatory response in the blood vessels, white cells come in, and we've all heard about inflammation and heart disease. Inflammation is really key to lots of different types of diseases, and that's no different than with coronary artery disease. So that inflammation leads to further changes in the vessel wall, progressive narrowing. Eventually, the narrowing will become enough that you actually limit the blood supply to the heart. And that's when patients will typically start getting symptoms of coronary artery disease.
So what do we mean by symptoms? Things like angina, which is that tightness or pressure, aching burning feeling in people's chest that they describe. They can also get things like radiating pain up to their neck, up to their shoulder, even sometimes up into the jaw. Those are what we call agina and angina equivalents. And that would be a good indicator that a patient has significant coronary artery disease.
Caitlin Whyte: And can you dig into that a bit more for us? Just what is the cause of coronary artery disease?
Arturo Cardounel, MD, PhD: Sure. So the cause is multifaceted. So we don't know exactly why these processes happen, but ultimately, it's that fat deposition, that cholesterol deposition in the artery wall that causes this progressive narrowing. What prevents it from being an issue from the beginning is that there's still what's called a cap or a thin layer of normal healthy tissue that overlays these deposits. However, over time as the plaque gets larger and larger, what can happen is that cap can actually tear or break. When that cap breaks, now all of a sudden the blood vessel wall, the inside parts of the wall are in direct contact with the blood. And within the blood, there's things called platelets. And we probably heard of platelets because those are what cause blood clotting. So when those platelets interact with the deeper layers of the blood vessel wall, what you get is you get the formation of a blood clot and that's what causes an acute myocardial infarction. That's that sudden onset of this deep chest pain that ultimately leads to a heart attack. At that point, you know, you need an intervention to help prevent permanent injury to the heart muscle.
Caitlin Whyte: So now that we know the background a little bit, what are some symptoms of this?
Arturo Cardounel, MD, PhD: So symptoms can vary, but there are, you know, a series or a constellation of symptoms that we call typical. The typical symptom of coronary disease is angina. And angina can vary in its presentation, but usually people describe it as a heaviness, a tightness, a pressure, an ache, or a burning in your chest. That discomfort can spread. It can spread up into your shoulder, your left or your right. It can radiate down your arms. It can move up your neck. Some patients even feel it up in their jaw.
Other symptoms are less obvious. Sometimes people can just present with increasing fatigue. Activities that they used to tolerate, now they become very tired, that could be an indicator of coronary disease. Other symptoms that are atypical are things like dizziness, lightheadedness, nausea. Women can present with slightly different symptoms. Sometimes they'll present with heartburn or indigestion-type of symptoms, anxiety. Even a cold sweat can sometimes be an indicator of coronary disease.
Caitlin Whyte: You know, this is often known as a silent disease. So just how threatening is it if it can be so undetectable?
Arturo Cardounel, MD, PhD: So it's very threatening. So heart disease is actually the leading cause of death for both men and women in the United States. It's called the silent killer because you can have coronary disease and not have any symptoms at all. People could sometimes even have a heart attack and not know they had one. So we call it silent myocardial infarction or a silent heart attack. And it accounts for about half of all heart attacks. So the question is, you know, what can we do about it? Well, the key to managing coronary disease is really knowing what's your individual risk and then knowing what the symptoms are when they happen. Risk factors, these are things like smoking, obesity, diabetes, high cholesterol and, of course, family history. But we need to also be aware of the symptoms, which we talked about, that anginal-type of symptom, that tightness or pressure in your chest. If you have any of these symptoms or you have a family history, it's critical that you talk to your healthcare provider so they can assess what your actual risk is. Once you get diagnosed with coronary disease, there's lots of different options.
Caitlin Whyte: Well, doctor, I'd love to know what your personal connection is to this disease.
Arturo Cardounel, MD, PhD: Sure. So I have a very strong personal connection. So I have a strong family history of coronary disease. My father had his first heart attack in his 40s and he had bypass surgery. Both my brother and I had bypass surgery at 48. So coronary disease is definitely something that hits close to home. You know, I thought I was a healthy person. I maintained a healthy weight. I lived an active lifestyle. But over a period of a couple of months, I noticed that I was getting this mild chest tightness with exertion. And like everybody else, initially, I minimized the symptoms. I chalked it up to maybe some asthma or some indigestion. But I do have a strong family history. So I reached out to my primary care provider who ordered a stress test, which was positive. So I saw the cardiologist at the Pauley Heart Center and they diagnosed me with a severe multivessel coronary disease.
So at that time, I discussed the options with my cardiologist and we decided that that bypass surgery would be the best option for me. As a cardiac surgeon myself, you know, I kind of knew what the disease burden that I had was. And I thought that bypass surgery would give me the best options at a long-term success.
Caitlin Whyte: Wow. So it's like you've been on both sides.
Arturo Cardounel, MD, PhD: Yeah, absolutely. So, you know, it's always interesting to play the role of the patient as opposed to the physician. But, you know, I knew I was in excellent hands. The guys here at the Pauley Heart Center really are, you know, leading this therapy in terms of personalized heart care. They have this individualized approach to heart disease that's really leading the charge in cardiac care.
Caitlin Whyte: Well, on that topic, what are the treatment options?
Arturo Cardounel, MD, PhD: Different treatment options. So it can be anything from medications. There are lots of anti-anginal medications. These are medications that decrease the work your heart has to do. So it minimizes the symptoms and kind of the stress on your heart. There's vasodilator medications. These are pills that you can take that help open up the blood vessels, increasing the blood supply. Lipid-lowering, so your cholesterol-lowering medications. All of these things can help limit the disease burden. But ultimately, once you have advanced coronary disease, your options are going to be things like stents, bypass surgery.
Caitlin Whyte: Well, doctor, wrapping up here, are there any final thoughts? Anything else we didn't touch on that you find important when it comes to this conversation?
Arturo Cardounel, MD, PhD: The message that I want to send is that coronary disease can happen to anybody. It's the leading cause again of death in patients in the United States. And it's not a disease of just, you know, old people. So there are 18 million adults in the United States that are 20 or older that have coronary disease. And about 20% of deaths from coronary artery disease actually happen in patients under the age of 65. So if you have risk factors, if you have concerns, if you have a strong family history, I really implore you to reach out to your primary care physician and have them assess your risk.
Caitlin Whyte: Well, thank you so much for sharing with us today, doctor. You can find more about us by calling (804) 628-4327. That's (804) 628-4327. Or check out our website at vcuhealth.org/heart and give us a follow at facebook.com/vcuhealthheart. This has been Healthy With VCU Health. I'm Caitlin Whyte. We'll see you next time.