Coronary Artery Disease and the Use of Stents

Am Fam Physician. 2009;80(11):1252-1253

See related article on coronary artery stents.

What is coronary artery disease?

Coronary artery disease, or CAD, is the buildup of fatty deposits (also called plaque) inside the small arteries that supply blood to your heart. This buildup narrows your arteries, decreasing the flow of blood and oxygen to your heart.

What are the symptoms?

Some symptoms of CAD are:

Pain, tightness, or pressure in your chest
Shortness of breath
Fatigue
Sweating

These often start or get worse when you are physically active.

Who is at risk?

You're at risk for CAD if you have high cholesterol, diabetes, or high blood pressure; if you smoke; or if an immediate family member has a history of CAD, especially if he or she is younger than 50 years. But, some patients with CAD have none of these risk factors.

How do I know if I have a blocked artery?

Sometimes, telling your doctor about your symptoms is enough. Often, though, your doctor will have you take a stress test. This usually involves walking on a treadmill while your doctor monitors the electrical activity in your heart. Sometimes another test is added to take pictures of the blood flow to your heart. You should tell your doctor if you can't walk on a treadmill, because there are medicines that can be used instead to mimic what happens to your heart during exercise. By checking your heart when it's under stress, your doctor can see if you have a blockage.

If your symptoms are severe, if they happen while you are at rest, or if your stress test is abnormal, your doctor may want you to have a coronary angiogram. For this test, the doctor will inject dye into your coronary arteries and then take pictures of them to see how blocked they are.

What's the best treatment for a blocked artery?

Eating a healthy diet and getting regular exercise are important no matter what treatment your doctor chooses. Also, taking a low dose (81 mg) of aspirin in addition to other medicines prescribed to lower cholesterol, treat high blood pressure, and manage diabetes is helpful.

Sometimes, medicines can work well enough to control your symptoms. If medicines are not enough, the artery can be opened up by putting in a stent at the site of the blockage. A stent is a small metal tube that your doctor can inflate with a small balloon to prop open your artery where it is blocked.

If all of your heart arteries are blocked, and especially if your heart isn't working normally, heart bypass surgery may be the best option.

What medicines will I need to take after getting a stent?

After you get a stent, it is very important that you take two medicines—aspirin and either clopidogrel (Plavix) or prasugrel (Effient). You need to take both of them every day and never stop without talking to your doctor. Stopping either of the medicines without your doctor's advice may put you at higher risk of a heart attack.