Dr. Joanna Ghobrial, 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.

Heart disease is the leading cause of death in the United States for both men and women. This includes coronary artery disease, heart attacks, congestive heart failure, and congenital heart disease. Some conditions, such as genetics, cannot be controlled. But there are many other things one can do to lower their risk for heart disease. Controlling high blood pressure and cholesterol levels, reducing or stopping smoking, exercising more and losing weight if needed, and eating a diet low in sodium can all protect the heart.

Angina is a squeezing type of chest pain that happens when the muscles around the heart don't get enough oxygen. It can be regular or infrequent. Usually, angina is caused by coronary heart disease. However, not all chest pain is angina. Chest pain can also be caused by a lung infection or panic attack, for example, so it is important to have any sudden pain checked.

Arrhythmia is the word for when the heart beats too fast, too slow, or irregularly with skipped beats. It can feel frightening, and depending on the type it can be dangerous, but in most cases arrhythmia is not serious and can be treated. It is very common, especially in older adults.

Heart valve problems can happen in any one of the the heart's four valves that keep blood flowing where it needs to go. Babies can be born with problems in their heart valves, or valves can be damaged by infections. The valves can stiffen and become less mobile, or they can stop closing properly and 'leak' when the heart beats. Valve problems can usually be repaired surgically.

An intra-aortic balloon pump is a small, sausage-shaped balloon at the end of a catheter, or very thin, flexible tube. An incision is made (usually in the groin), and the deflated balloon and catheter are threaded through an artery to the aorta, the large main artery that takes oxygen-filled blood from the heart to the rest of the body. The pump can also be placed during open-heart surgery. If this is the case, it is positioned directly into the aorta. Once in place, the balloon inflates and deflates in rhythm with the heart. When it inflates, it pushes blood back towards the heart to help the heart muscle get enough oxygen and fill correctly. When the IABP deflates, just before the heart contracts, it lowers the pressure in the aorta slightly. This helps move blood away from the heart and into the body.

An IABP is a short-term solution, used for only hours or up to a few weeks at most. The pump is powered and controlled by a computer outside the body, so during treatment patients must remain lying down in their hospital bed. Insertion of the device is performed at a cardiac catheterization lab or operating room, and patients with an intra-aortic balloon pump often stay in the intensive care unit (ICU). While it is not a particularly painful treatment, it is common for patients to hear and feel the balloon inflating and deflating within their chest, which can be unsettling. However, IABP is a safe and effective treatment for supporting the heart.