Dr. Mubadda A. Salim, MD

• Angina, which is chest pain that occurs when the heart does not receive enough blood flow.
• Heart attack, which happens if the arteries leading to the heart are completely blocked.
• Arrhythmia, or irregular heartbeat, which can develop if the heart does not have enough blood supply.
• Heart failure, which may occur if a heart attack damages the heart and it becomes too weak to pump enough blood to the rest of the body.

Certain factors may increase risk for the disease, like smoking, lack of exercise, being overweight, high cholesterol, high blood pressure, and diabetes. CAD tends to develop over decades, so it can go undetected until it has become quite severe. A diagnosis may be established using such tests as:

• Electrocardiogram (ECG), which records the heart's electrical activity over a period of time. ECGs can detect whether there is enough blood flow to the heart or if a heart attack has occurred.
• Echocardiogram (echo), which creates images of the heart using sound waves. Echos can show whether the heart is able to pump blood normally.
• Stress tests, where an ECG or echo is combined with exercise, like riding a stationary bike or walking on a treadmill. This test is done to find out if the heart can function properly while performing a strenuous activity.

Treatments for the disease include medications such as vasodilators, like nitroglycerin, which dilates (widens) the coronary arteries. CAD may also be treated by a procedure called angioplasty with stent placement, where a balloon is inflated inside a diseased artery to flatten the plaque deposits against the artery walls, creating more room for blood to flow.

In some severe cases of the disease, multiple arteries may be blocked, and an open heart surgery called coronary artery bypass surgery may be necessary. This operation transplants a vessel from another part of the body to form a graft that goes past the narrowed arteries, thus enabling blood to flow around those arteries.

Placement of an ICD is similar to the placement of a standard pacemaker. An incision is made near the shoulder, and two insulated wires or leads are threaded through a vein and placed in the heart. The battery pack, a small metal device, is inserted beneath the skin of the chest just under the collarbone. Once everything is in place, the wires are connected to the battery, and the ICD is functional.

Patients may have swelling and discomfort after surgery as their incisions heal.The heart needs several weeks to adjust to the ICD, so it is best for them to avoid strenuous activity at first. Strong magnetic fields may affect the function of the ICD, so doctors tell patients to avoid certain activities, such as having an MRI or even keeping their cell phones too close to their ICD. Within a few weeks patients' hearts should be beating more safely and effectively.