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What Is Coronary Artery Disease?

Coronary artery disease (CAD) is a condition in which plaque (plak) builds up inside the

coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

Plaque is made up of fat, cholesterol (ko-LES-ter-ol), calcium, and other substances found in

the blood. When plaque builds up in the arteries, the condition is called atherosclerosis

(ATH-er-o-skler-O-sis).

Atherosclerosis

Figure A shows a normal artery with normal blood flow. Figure B shows an artery withplaque buildup.

Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it

more likely that blood clots will form in your arteries. Blood clots can partially or completely

block blood flow.

Overview

When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your

heart muscle. This can cause angina (an-JI-nuh or AN-juh-nuh) or aheart attack.

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Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing

to an area of your heart muscle. Angina may feel like pressure or squeezing in your chest.

The pain also may occur in your shoulders, arms, neck, jaw, or back.

A heart attack occurs when blood flow to an area of your heart muscle is completely blocked.

This prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die.

Without quick treatment, a heart attack can lead to serious problems and even death.

Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias(ah-

RITH-me-ahs). Heart failure is a condition in which your heart can't pump enough blood

throughout your body. Arrhythmias are problems with the speed or rhythm of your heartbeat.

Outlook

CAD is the most common type of heart disease. It's the leading cause of death in the United

States for both men and women. Lifestyle changes, medicines, and/or medical procedurescan effectively prevent or treat CAD in most people.

Other Names for Coronary Artery Disease

Atherosclerosis

Coronary heart disease

Hardening of the arteries

Heart disease

Ischemic (is-KE-mik) heart disease Narrowing of the arteries

What Causes Coronary Artery Disease?

Research suggests that coronary artery disease (CAD) starts when certain factors damage

the inner layers of the coronary arteries. These factors include:

Smoking

High amounts of certain fats and cholesterol in the blood

High blood pressure High amounts of sugar in the blood due to insulin resistance ordiabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release

compounds that promote this process. This healing causes plaque to build up where the

arteries are damaged.

Over time, the plaque may crack. Blood cells called platelets (PLATE-lets) clump together to

form blood clots where the cracks are. This narrows the arteries more and worsens angina or

causes a heart attack.

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Although age and a family history of early heart disease are risk factors, it doesn't mean that

you will develop CAD if you have one or both.

Making lifestyle changes and/or taking medicines to treat other risk factors can often lessen

genetic influences and prevent CAD from developing, even in older adults.

Emerging Risk Factors

Scientists continue to study other possible risk factors for CAD.

High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for

CAD and heart attack. High levels of CRP are proof of inflammation in the body.

Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls

seems to trigger inflammation and help plaque grow.

Research is under way to find out whether reducing inflammation and lowering CRP levels

also can reduce the risk of developing CAD and having a heart attack.

High levels of fats called triglycerides in the blood also may raise the risk of CAD, particularly

in women.

Other Factors That Affect Coronary Artery Disease

Other factors also may contribute to CAD. These include:

Sleep apnea. Sleep apnea is a disorder in which your breathing stops or gets veryshallow while you're sleeping. Untreated sleep apnea can raise your chances of

having high blood pressure, diabetes, and even a heart attack orstroke.

Stress. Research shows that the most commonly reported "trigger" for a heart attack

is an emotionally upsetting eventparticularly one involving anger.

Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors

for heart disease. Men should have no more than two drinks containing alcohol a day.

Women should have no more than one drink containing alcohol a day.

What Are the Signs and Symptoms of Coronary Artery Disease?

A common symptom of coronary artery disease (CAD) is angina. Angina is chest pain or

discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or a squeezing pain in your chest. You also may feel it in your

shoulders, arms, neck, jaw, or back. This pain tends to get worse with activity and go away

when you rest. Emotional stress also can trigger the pain.

Another common symptom of CAD is shortness of breath. This symptom happens if CAD

causes heart failure. When you have heart failure, your heart can't pump enough blood

throughout your body. Fluid builds up in your lungs, making it hard to breathe.

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The severity of these symptoms varies. The symptoms may get more severe as the buildup

of plaque continues to narrow the coronary arteries.

Signs and Symptoms of Heart Problems Linked to Coronary Artery Disease

Some people who have CAD have no signs or symptoms. This is called silent CAD. It maynot be diagnosed until a person show signs and symptoms of a heart attack, heart failure, or

an arrhythmia(an irregular heartbeat).

Heart Attack

A heart attack happens when an area of plaque in a coronary artery breaks apart, causing a

blood clot to form.

The blood clot cuts off most or all blood to the part of the heart muscle that's fed by that

artery. Cells in the heart muscle die because they don't receive enough oxygen-rich blood.This can cause lasting damage to your heart. For more information, see the animation in

"What Causes a Heart Attack?"

Heart With Muscle Damage and a Blocked Artery

Figure A is an overview of a heart and coronary artery showing damage (dead heart

muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with

plaque buildup and a blood clot.

The most common symptom of heart attack is chest pain or discomfort. Most heart attacks

involve discomfort in the center of the chest that lasts for more than a few minutes or goes

away and comes back. The discomfort can feel like pressure, squeezing, fullness, or pain. It

can be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn.

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Heart attacks also can cause upper body discomfort in one or both arms, the back, neck,

jaw, or stomach. Shortness of breath or fatigue (tiredness) often may occur with or before

chest discomfort. Other symptoms of heart attack are nausea (feeling sick to your stomach),

vomiting, lightheadedness or fainting, and breaking out in a cold sweat.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to your body. Heart

failure doesn't mean that your heart has stopped or is about to stop working. It means that

your heart can't fill with enough blood or pump with enough force, or both.

This causes you to have shortness of breath and fatigue that tends to increase with activity.

Heart failure also can cause swelling in your feet, ankles, legs, and abdomen.

Arrhythmia

An arrhythmia is a problem with the speed or rhythm of the heartbeat. When you have an

arrhythmia, you may notice that your heart is skipping beats or beating too fast. Some people

describe arrhythmias as a fluttering feeling in their chests. These feelings are called

palpitations.

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called

sudden cardiac arrest (SCA). SCA can make you faint and it can cause death if its not

treated right away.

For more information, see the animations in "Types of Arrhythmia."

How Is Coronary Artery Disease Diagnosed?

Your doctor will diagnose coronary artery disease (CAD) based on:

Your medical and family histories

Your risk factors

The results of a physical exam and diagnostic tests and procedures

Diagnostic Tests and Procedures

No single test can diagnose CAD. If your doctor thinks you have CAD, he or she will probably

do one or more of the following tests.

EKG (Electrocardiogram)

AnEKG is a simple test that detects and records the electrical activity of your heart. An EKG

shows how fast your heart is beating and whether it has a regular rhythm. It also shows the

strength and timing of electrical signals as they pass through each part of your heart.

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Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG

also can show signs of a previous or currentheart attack.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart

tests are performed. If you can't exercise, you're given medicine to speed up your heart rate.

When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries

narrowed by plaque can't supply enough oxygen-rich blood to meet your heart's needs. A

stress test can show possible signs of CAD, such as:

Abnormal changes in your heart rate or blood pressure

Symptoms such as shortness of breath or chest pain

Abnormal changes in your heart rhythm or your heart's electrical activity

During the stress test, if you can't exercise for as long as what's considered normal for

someone your age, it may be a sign that not enough blood is flowing to your heart. But other

factors besides CAD can prevent you from exercising long enough (for example, lung

diseases, anemia, or poor general fitness).

Some stress tests use a radioactive dye, sound waves, positron emission tomography (PET),

orcardiac magnetic resonance imaging (MRI) to take pictures of your heart when it's working

hard and when it's at rest.

These imaging stress tests can show how well blood is flowing in the different parts of your

heart. They also can show how well your heart pumps blood when it beats.

Echocardiography

This test uses sound waves to create a moving picture of your heart. Echocardiography

provides information about the size and shape of your heart and how well your heart

chambers and valves are working.

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that

aren't contracting normally, and previous injury to the heart muscle caused by poor blood

flow.

Chest X Ray

A chest x ray takes a picture of the organs and structures inside the chest, including your

heart, lungs, and blood vessels.

A chest x ray can reveal signs ofheart failure, as well as lung disorders and other causes of

symptoms that aren't due to CAD.

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Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood.

Abnormal levels may show that you have risk factors for CAD.

Electron-Beam Computed Tomography

Your doctor may recommendelectron-beam computed tomography (EBCT). This test finds

and measures calcium deposits (called calcifications) in and around the coronary arteries.

The more calcium detected, the more likely you are to have CAD.

EBCT isn't used routinely to diagnose CAD, because its accuracy isn't yet known.

Coronary Angiography and Cardiac Catheterization

Your doctor may ask you to have coronary angiography(an-jee-OG-ra-fee) if other tests orfactors show that you're likely to have CAD. This test uses dye and special x rays to show

the insides of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac

catheterization (KATH-e-ter-i-ZA-shun). A long, thin, flexible tube called a catheter is put into

a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your

coronary arteries, and the dye is released into your bloodstream. Special x rays are taken

while the dye is flowing through your coronary arteries.

Cardiac catheterization is usually done in a hospital. You're awake during the procedure. Itusually causes little to no pain, although you may feel some soreness in the blood vessel

where your doctor put the catheter.

How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines, and

medical procedures. The goals of treatments are to:

Relieve symptoms

Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque

Lower the risk of blood clots forming, which can cause aheart attack

Widen or bypass clogged arteries

Prevent complications of CAD

Lifestyle Changes

Making lifestyle changes can often help prevent or treat CAD. For some people, these

changes may be the only treatment needed:

Follow a heart healthy eating plan to prevent or reduce high blood pressureand high

blood cholesterol and to maintain a healthy weight

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Try to limit alcoholic drinks. Too much alcohol will raise your blood pressure and triglyceride

level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories,

which will cause weight gain. Men should have no more than two alcoholic drinks a day.

Women should have no more than one alcoholic drink a day.

See the NHLBI's "Your Guide to Lowering Your Cholesterol With TLC" for more information.

Dietary Approaches to Stop Hypertension (DASH) eating plan.

Your doctor may recommend the DASH eating plan if you have high blood pressure. The

DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart

healthy and lower in salt/sodium.

This eating plan is low in fat and cholesterol. It also focuses on fat-free or low-fat milk and

dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meat

(including lean red meat), sweets, added sugars, and sugar-containing beverages. It's rich in

nutrients, protein, and fiber.

The DASH eating plan is a good heart healthy eating plan, even for those who don't have

high blood pressure. See the NHLBI's "Your Guide to Lowering Your Blood Pressure With

DASH"for more information.

Increase Physical Activity

Regular physical activity can lower many CAD risk factors, including LDL ("bad") cholesterol,

high blood pressure, and excess weight. Physical activity also can lower your risk fordiabetes and raise your levels of HDL cholesterol (the "good" cholesterol that helps prevent

CAD).

Check with your doctor about how much and what kinds of physical activity are safe for you.

Unless your doctor tells you otherwise, try to get at least 30 minutes of moderate-intensity

activity on most or all days of the week. You can do the activity all at once or break it up into

shorter periods of at least 10 minutes each.

Moderate-intensity activities include brisk walking, dancing, bowling, bicycling, gardening,

and housecleaning.

More intense activities, such as jogging, swimming, and various sports, also may be

appropriate for shorter periods. See the NHLBI's "Your Guide to Physical Activity and Your

Heart" for more information.

Maintain a Healthy Weight

Maintaining a healthy weight can decrease risk factors for CAD. If you're overweight, aim to

reduce your weight by 7 to 10 percent during your first year of treatment. This amount of

weight loss can lower your risk for CAD and other health problems.

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After the first year, you may have to continue to lose weight so you can lower your body

mass index (BMI) to less than 25.

BMI measures your weight in relation to your height and gives an estimate of your total body

fat. A BMI between 25 and 29 is considered overweight. A BMI of 30 or more is considered

obese. A BMI of less than 25 is the goal for preventing and treating CAD.

You can calculate your BMI using the NHLBI's online calculator, or your health care provider

can calculate your BMI.

For more information on losing weight and maintaining your weight, see the Diseases and

Conditions Index Overweight and Obesityarticle.

Quit Smoking

If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise

your risk for CAD.

The U.S. Department of Health and Human Services has information on how to quit smoking.

Reduce Stress

Research shows that the most commonly reported "trigger" for a heart attack is an

emotionally upsetting eventparticularly one involving anger. Also, some of the ways people

cope with stress, such as drinking, smoking, or overeating, aren't heart healthy.

Physical activity can help relieve stress and reduce other CAD risk factors. Many people also

find that meditation or relaxation therapy helps them reduce stress.

Medicines

You may need medicines to treat CAD if lifestyle changes aren't enough. Medicines can:

Decrease the workload on your heart and relieve CAD symptoms

Decrease your chance of having a heart attack or dying suddenly

Lower your cholesterol and blood pressure

Prevent blood clots

Prevent or delay the need for a special procedure (for example, angioplasty or

coronary artery bypass grafting (CABG))

Medicines used to treat CAD include anticoagulants (AN-te-ko-AG-u-lants), aspirin and other

antiplatelet (an-ty-PLAYT-lit) medicines, ACE inhibitors, beta blockers, calcium channel

blockers, nitroglycerin, glycoprotein IIb-IIIa, statins, and fish oil and other supplements high in

omega-3 fatty acids.

Medical Procedures

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You may need a medical procedure to treat CAD. Both angioplasty and CABG are used as

treatments.

Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube

with a balloon or other device on the end is threaded through a blood vessel to the narrowed

or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward

against the wall of the artery. This widens the artery and restores the flow of blood.

Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a

heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it

open after the procedure.

In CABG, arteries or veins from other areas in your body are used to bypass (that is, go

around) your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve

chest pain, and possibly prevent a heart attack.

You and your doctor can discuss which treatment is right for you.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG,

angioplasty, or a heart attack. Cardiac rehab, when combined with medicine and surgical

treatments, can help you recover faster, feel better, and develop a healthier lifestyle. Almost

everyone with CAD can benefit from cardiac rehab.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical andoccupational therapists, dietitians, and psychologists or other behavioral therapists.

Rehab has two parts:

Exercise training. This part helps you learn how to exercise safely, strengthen your

muscles, and improve your stamina. Your exercise plan will be based on your

individual abilities, needs, and interests.

Education, counseling, and training. This part of rehab helps you understand your

heart condition and find ways to reduce your risk for future heart problems. The

cardiac rehab team will help you learn how to cope with the stress of adjusting to anew lifestyle and with your fears about the future.

For more information on cardiac rehab, see the Diseases and Conditions Index Cardiac

Rehabilitation article.

How Can Coronary Artery Disease Be Prevented or Delayed?

Taking action to control your risk factors can help prevent or delay coronary artery disease

(CAD). Your chance of developing CAD goes up with the number of risk factors you have.

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Making lifestyle changes and taking prescribed medicines are important steps. See "How Is

Coronary Artery Disease Treated?" for information on heart healthy eating plans, physical

activity, maintaining a healthy weight, and medicines.

Know your family history of health problems related to CAD. If you or someone in your family

has CAD, be sure to tell your doctor. Also, let your doctor know if you smoke.

Living With Coronary Artery Disease

Coronary artery disease (CAD) can cause serious complications. However, if you follow your

doctor's advice and change your habits, you can prevent or reduce the chances of:

Dying suddenly from heart problems

Having a heart attack and permanently damaging your heart muscle

Damaging your heart because of reduced oxygen supply

Having arrhythmias (irregular heartbeats)

Ongoing Health Care Needs

Doing physical activity regularly, taking prescribed medicines, following a heart healthy

eating plan, and watching your weight can help control CAD. (See "How Is Coronary Artery

Disease Treated?" for more information).

See your doctor regularly to keep track of your blood pressure and blood cholesterol and

blood sugar levels. A cholesterol blood test will show your levels of LDL ("bad") cholesterol,

HDL ("good") cholesterol, and triglycerides. A fasting blood glucose test will check your blood

sugar level and show if you're at risk for or have diabetes. These tests will show whether you

need more treatments for your CAD.

Talk to your doctor about how often you should schedule office visits or blood tests. Between

those visits, call your doctor if you develop any new symptoms or if your symptoms worsen.

CAD raises your risk for heart attack. Learn the symptoms ofheart attack and arrhythmia.

Call 911 if you have any of these symptoms for more than 5 minutes:

Chest discomfort or painuncomfortable pressure, squeezing, fullness, or pain in the

center of the chest that can be mild or strong. This discomfort or pain lasts more than

a few minutes or goes away and comes back.

Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.

Shortness of breath, which may occur with or before chest discomfort.

It's important to know the difference between angina and a heart attack. During a heart

attack, the pain is usually more severe than angina, and it doesn't go away when you rest or

take medicine. If you don't know whether your chest pain is angina or a heart attack, call 9

11.

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Let the people you see regularly know you're at risk for a heart attack. They can seek

emergency care if you suddenly faint, collapse, or develop other severe symptoms.

You may feel depressed or anxious if you've been diagnosed with CAD and/or had a heart

attack. You may worry about heart problems or making lifestyle changes that are necessary

for your health. Your doctor may recommend medicine, professional counseling, or relaxation

therapy if you have depression or anxiety.

Physical activity can improve mental well-being, but you should talk to your doctor before

starting any fitness activities. It's important to treat any anxiety or depression that develops

because it raises your risk of having a heart attack.

What To Expect During Coronary Angioplasty

Coronary angioplasty is performed in a special part of the hospital called the cardiac

catheterization (kath-eh-ter-ih-ZA-shun) laboratory. The "cath lab" has special video screens

and x-ray machines. Your doctor uses this equipment to see enlarged pictures of the blocked

areas in your coronary arteries.

Preparation

In the cath lab, you will lie on a table. An intravenous (IV) line will be placed in your arm to

give you fluids and medicines. The medicines will relax you and prevent blood clots from

forming. These medicines may make you feel sleepy or as though you're floating or numb.

To prepare for the procedure:

The area where the catheter will be inserted, usually the arm or groin (upper thigh),

will be shaved.

The shaved area will be cleaned to make it germ free and then numbed. The

numbing medicine may sting as it's going in.

Steps in Angioplasty

When you're comfortable, the doctor will begin the procedure. You will be awake but sleepy.

A small cut is made in your arm or groin into which a tube called a sheath is put. The doctor

then threads a very thin guide wire through the artery in your arm or groin toward the area of

the coronary artery that's blocked.

Your doctor puts a long, thin, flexible tube called a catheter through the sheath and slides it

over the guide wire and up to the heart. Your doctor moves the catheter into the coronary

artery to the blockage. He or she takes out the guide wire once the catheter is in the right

spot.

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The animation shows how a doctor inserts a tube called a balloon catheter into a coronary

artery narrowed by plaque. The balloon catheter compresses the plaque and widens the

artery to restore blood flow.

If your doctor needs to put a stent (small mesh tube) in your artery, another tube with a

balloon will be threaded through your artery. A stent is wrapped around the balloon. Your

doctor will inflate the balloon, which will cause the stent to expand against the wall of the

artery. The balloon is then deflated and pulled out of the artery with the tube. The stent stays

in the artery.

After the angioplasty is done, your doctor pulls back the catheter and removes it and the

sheath. The hole in the artery is either sealed with a special device, or pressure is put on it

until the blood vessel seals.

The animation below shows the process of coronary angioplasty and stent placement. Click

the "start" button to play the animation. Written and spoken explanations are provided with

each frame. Use the buttons in the lower right corner to pause, restart, or replay the

animation, or use the scroll bar below the buttons to move through the frames.

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The animation shows how a doctor inserts a tube called a balloon catheter into a coronary

artery narrowed by plaque. The balloon catheter compresses the plaque, widens the artery,

and restores blood flow. Through the catheter, a stent is placed in the artery to help

maintain the restored blood flow.

During angioplasty, strong antiplatelet medicines are given through the IV to prevent blood

clots from forming in the artery or on the stent. These medicines help thin your blood. They'reusually started just before the angioplasty and may continue for 1224 hours afterward.

What To Expect After Coronary Angioplasty

After coronary angioplasty, you will be moved to a special care unit, where you will stay for a

few hours or overnight. While you recover in this area, you must lie still for a few hours to

allow the blood vessels in your arm or groin (upper thigh) to seal completely.

While you recover, nurses will check your heart rate and blood pressure. They also will check

your arm or groin for bleeding. After a few hours, you will be able to walk with help.

The place where the tube was inserted may feel sore or tender for about a week.

Going Home

Most people go home 1 to 2 days after the procedure. When your doctor thinks you're ready

to leave the hospital, you will get instructions to follow at home, including:

How much activity or exercise you can do.

When you should follow up with your doctor. What medicines you should take.

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What you should look for daily when checking for signs of infection around the area

where the tube was inserted. Signs of infection may include redness, swelling, or

drainage.

When you should call your doctor. For example, you may need to call if you have a

fever or signs of infection, pain or bleeding where the catheter was inserted, or

shortness of breath.

When you should call 911 (for example, if you have any chest pain).

Your doctor will prescribe medicine to prevent blood clots from forming. Taking your

medicine as directed is very important. If a stent was inserted, the medicine reduces the risk

that blood clots will form in the stent. Blood clots in the stent can block blood flow and cause

a heart attack.

Recovery and Recuperation

Most people recover from angioplasty and return to work about 1 week after being sent

home. Your doctor will want to check your progress after you leave the hospital. During the

followup visit, your doctor will examine you, make changes to your medicines if needed, do

any necessary tests, and check your overall recovery. Use this time to ask questions you

may have about activities, medicines, or lifestyle changes, or to talk about any other issues

that concern you.

Lifestyle Changes

Although angioplasty can reduce the symptoms ofcoronary artery disease (CAD), it isn't a

cure for CAD or the risk factors that led to it. Making healthy lifestyle changes can help treat

CAD and maintain the good results from angioplasty.

Talk with your doctor about your risk factors for CAD and the lifestyle changes you'll need to

make. For some people, these changes may be the only treatment needed.

Follow a healthy diet to prevent or reduce high blood pressure and high blood

cholesterol and to maintain a healthy weight.

Quit smoking if you smoke.

Be physically active. Lose weight if you're overweight or obese.

Reduce stress.

Take medicines as your doctor directs to lower high blood pressure or high blood

cholesterol.

"Your Guide to Living Well With Heart Disease," from the National Heart, Lung, and Blood

Institute, will give you more detailed information about making healthy lifestyle changes.

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Cardiac Rehabilitation

Your doctor may want you to take part in a cardiac rehabilitation (rehab) program. Cardiac

rehab helps people with heart disease recover faster and return to work or daily activities.

Cardiac rehab includes supervised physical activity, education on heart healthy living, and

counseling to cut down on stress and help you return to an active life. Your doctor can tell

you where to find a cardiac rehab program near your home. "Your Guide to Living Well With

Heart Disease," will give you more information on cardiac rehab.

What Are the Risks of Coronary Angioplasty?

Coronary angioplasty is a common medical procedure. Although angioplasty is normally

safe, there is a small risk of serious complications, such as:

Bleeding from the blood vessel where the catheter was placed.

Damage to blood vessels from the catheter.

An allergic reaction to the dye given during the angioplasty.

An arrhythmia (irregular heartbeat).

The need for emergency coronary artery bypass grafting during the procedure (24

percent of people). This may occur when an artery closes down, instead of opening

up.

Damage to the kidneys caused by the dye used.

Heart attack (35 percent of people).

Stroke (less than 1 percent of people).

As with any procedure involving the heart, complications can sometimes, though rarely,

cause death. Less than 2 percent of people die during angioplasty.

Sometimes chest pain can occur during angioplasty because the balloon briefly blocks off the

blood supply to the heart.

The risk of complications is higher in:

People aged 75 and older

People who have kidney disease or diabetes

Women

People who have poor pumping function in their hearts

People who have extensive heart disease and blockages

Research on angioplasty is ongoing to make it safer and more effective, to prevent treated

arteries from closing again, and to make the procedure an option for more people.

Complications From Stents

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Restenosis

There is a chance that the artery will become narrowed or blocked again in time, often within

6 months of angioplasty. This is called restenosis.

Stent Restenosis

The illustration shows the restenosis of a stent-widened coronary artery. The coronary

artery is located on the surface of the heart. In figure A, the expanded stent compressesplaque, allowing normal blood flow. The inset image on figure A shows a cross-section of

the compressed plaque and stent-widened artery. In figure B, the plaque grows (over time)

through and around the stent, causing a partial blockage and abnormal blood flow. The inset

image on figure B shows a cross-section of the growth of the plaque around the stent.

When astent isn't used, 4 out of 10 people have restenosis. When a nonmedicine-coated

stent is used, 2 out of 10 people have restenosis.

The growth of scar tissue in and around the stent also can cause restenosis. Medicine-

coated stents reduce the growth of scar tissue around the stent and lower the chance of

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restenosis. When medicine-coated stents are used, the chance of restenosis is lowered even

more, to around 1 in 10 people.

Other treatments, such as radiation, can help prevent tissue growth within a stent. For this

procedure, the doctor puts a wire through a catheter to where the stent is placed. The wire

releases radiation to stop any tissue growth that may block the artery.

Blood Clots

Recent studies suggest that there is a higher risk of blood clots forming in medicine-coated

stents compared to bare metal stents (nonmedicine-coated). The Food and Drug

Administration (FDA) reports that medicine-coated stents usually don't cause complications

due to blood clots when used as recommended.

When medicine-coated stents are used in people with advanced CAD, there is a higher risk

of blood clots, heart attack, and death. The FDA is working with researchers to study

medicine-coated stents, including their use in people with advanced CAD.

Taking medicine as prescribed by your doctor can lower the risk of blood clots. People with

medicine-coated stents are usually advised to take an anticlotting drug, such as clopidogrel

and aspirin, for months to years to lower the risk of blood clots.

As with all procedures, it's important to talk to your doctor about your treatment options,

including the risks and benefits to you.

Key Points

Coronary angioplasty is a medical procedure in which a balloon is used to open a

blockage in a coronary (heart) artery narrowed by atherosclerosis. This procedure

improves blood flow to the heart.

Atherosclerosis is a condition in which a material called plaque builds up on the inner

walls of the arteries. When atherosclerosis affects the coronary arteries, the condition

is called coronary artery disease (CAD).

Angioplasty can improve some of the symptoms of CAD, such as angina(chest pain)

and shortness of breath. It also can reduce damage to the heart muscle from a heart

attackand reduce the risk of death in some patients.

You may need angioplasty if medicines and lifestyle changes haven't improved your

symptoms of CAD. You also may need angioplasty as emergency treatment during a

heart attack.

Angioplasty is less invasive than surgery. General anesthesia isn't needed. You will

be given medicines to help you relax, but you will be awake during the procedure.

Angioplasty is performed in a special part of the hospital called the cardiac

catheterization laboratory.

Before angioplasty is done, your doctor will need to know whether your coronary

arteries are blocked. To find out, he or she will do an angiogram and take an x-ray

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picture of your arteries to show any blockages and where they're located. Once your

doctor has this information, the angioplasty can proceed.

During angioplasty, your doctor will use a small tube called a catheter with a balloon

at the end. He or she will thread the balloon through an artery to the blockage. The

balloon is blown up (inflated), pushing the plaque outward against the artery wall.

This opens the artery more and improves blood flow through it.

During angioplasty, a stent (mesh tube) is often placed in the artery that has been

opened. The stent reduces the chance that the artery will become blocked again in

the future. The stent remains in place after the procedure.

Most people go home 1 to 2 days after having angioplasty. Full recovery from the

procedure is usually 1 week or less.

Lifestyles changes are recommended after angioplasty to improve CAD and to

prevent the arteries from becoming narrowed or blocked again. Lifestyle changes

include a healthy diet, weight control, medicines to lower high blood pressure and

high blood cholesterol, regular physical activity, and quitting smoking.

Angioplasty is a common medical procedure and is generally safe, but there is a

small risk of serious complications.

Renarrowing of the treated artery and growth of scar tissue within a stent can occur.

The use of medicine-coated stents can lower the chance of this happening, but these

stents aren't without risk. In some cases, blood clots can form in the medicine-coated

stents.

Research on angioplasty is ongoing to make it safer and more effective, to prevent

treated arteries from closing again, and to make the procedure an option for more

people.

Risk of a Repeat Heart Attack

Once youve had a heart attack, youre at higher risk for another one. Its important to know

the difference between angina and a heart attack. The pain of angina usually occurs after

exertion and goes away in a few minutes when you rest or take medicine as directed. During

a heart attack, the pain is usually more severe than angina, and it doesnt go away when you

rest or take medicine. If you dont know whether your chest pain is angina or a heart attack,

call 911.

Remember, the symptoms of a second heart attack may not be the same as those of a first

heart attack. Dont take a chance if youre in doubt. Always call 911 within 5 minutes if you

or someone youre with has symptoms of a heart attack.

Unfortunately, most heart attack victims wait 2 hours or more after their symptoms begin

before they seek medical help. This delay can result in lasting heart damage or death.

Key Points

A heart attack occurs when blood flow to a section of heart muscle becomes blocked.

If the flow of blood isnt restored quickly, the section of heart muscle becomesdamaged from lack of oxygen and begins to die.

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Heart attack is a leading killer of both men and women in the United States.

Today there are excellent treatments for heart attack that can save lives and prevent

disabilities. Treatment is most effective when started within 1 hour of the beginning of

symptoms.

Unfortunately, many heart attack victims wait 2 hours or more after their symptomsbegin before they seek medical help. This delay can result in lasting heart damage or

death.

If you think you or someone with you is having a heart attack, call 911 right away.

Heart attacks occur most often as a result of a condition called coronary artery

disease (CAD).

Heart attack also can be caused by a condition called microvascular disease, which

involves the microscopic blood vessels of the heart. Less commonly, a spasm

(tightening) of a coronary artery can cause a heart attack.

Certain risk factors increase the changes of developing CAD and having a heart

attack (for example, age, a family history of CAD, smoking, and being overweight or

obese). Some risk factors cant be controlled, while others can.

The warning signs of heart attack arent the same for everyone. However, common

signs and symptoms of a heart attack are:

o Chest discomfort or painuncomfortable pressure, squeezing, fullness, or

pain in the center or the chest that can be mild or strong. This discomfort or

pain lasts more than a few minutes or goes away and comes back.

o Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.

o Shortness of breath may occur with or before chest discomfort.

o Other signs include nausea (feeling sick to your stomach), vomiting,

lightheadedness or fainting, or breaking out in a cold sweat.

Treatments for heart attack include medicines and procedures to open blocked

arteries (such as angioplasty).

Lowering your risk for CAD can decrease your chances of having a heart attack (or

second heart attack). This usually involves making healthy lifestyle choices and

treating conditions related to CAD such as high cholesterol, high blood pressure,

overweight and obesity, and diabetes. Most people are able to return to their normal activities after a heart attack. Ask your

doctor when you can resume daily activities such as driving, exercise, work, sexual

activity, strenuous activities (for example, running or heavy lifting), and travel.

Many people survive heart attacks and live active and full lives.

What Is Cholesterol?

To understand high blood cholesterol (ko-LES-ter-ol), it is important to know more aboutcholesterol.

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The illustration shows a normal artery with normal blood flow (Figure A) and an artery

containing plaque buildup (Figure B).

Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your

coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When

the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary

artery disease (CAD). Large plaque areas can lead to chest pain calledangina (an-JI-nuh or

AN-juh-nuh). Angina happens when the heart does not receive enough oxygen-rich blood.

Angina is a common symptom of CAD.

Some plaques have a thin covering and burst (rupture), releasing fat and cholesterol into the

bloodstream. The release of fat and cholesterol may cause your blood to clot. A clot canblock the flow of blood. This blockage can cause angina or a heart attack.

Lowering your cholesterol level decreases your chance for having a plaque burst and cause

a heart attack. Lowering cholesterol may also slow down, reduce, or even stop plaque from

building up.

Plaque and resulting health problems can also occur in arteries elsewhere in the body.

February 2006

Other Names for High Blood Cholesterol

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Hypercholesterolemia (HI-per-ko-LES-ter-ol-E-me-a)

Hyperlipidemia (HI-per-lip-i-DE-me-a)

What Causes High Blood Cholesterol?

A variety of things can affect the cholesterol levels in your blood. Some of these things you

can control and others you cannot.

You can control:

What you eat. Certain foods have types of fat that raise your cholesterol level.

o Saturated fat raises your low-density lipoprotein (LDL) cholesterol level more

than anything else in your diet.

o Trans fatty acids (trans fats) are made when vegetable oil is hydrogenated to

harden it. Trans fatty acids also raise cholesterol levels.

o Cholesterol is found in foods that come from animal sources, for example, egg

yolks, meat, and cheese.

Your weight. Being overweight tends to increase your LDL level, lower your high-

density lipoprotein (HDL) level, and increase your total cholesterol level.

Your activity. Lack of regular exercise can lead to weight gain, which could raise your

LDL cholesterol level. Regular exercise can help you lose weight and lower your LDL

level. It can also help you raise your HDL level.

You cannot control:

Heredity. High blood cholesterol can run in families. An inherited genetic condition

(familial hypercholesterolemia) results in very high LDL cholesterol levels. It begins at

birth, and may result in a heart attack at an early age.

Age and sex. Starting at puberty, men have lower levels of HDL than women. As

women and men get older, their LDL cholesterol levels rise. Younger women have

lower LDL cholesterol levels than men, but after age 55, women have higher levels

than men.

What Are the Signs and Symptoms of High Blood Cholesterol?

There are usually no signs or symptoms of high blood cholesterol. Many people don't

know that their cholesterol level is too high.

Everyone age 20 and older should have their cholesterol levels checked at least once

every 5 years. You and your doctor can discuss how often you should be tested.

How Is High Blood Cholesterol Diagnosed?

High blood cholesterol is diagnosed by checking levels of cholesterol in your blood. It is best

to have a blood test called a lipoprotein profile to measure your cholesterol levels. Mostpeople will need to not eat or drink anything (fast) for 9 to 12 hours before taking the test.

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The lipoprotein profile will give information about your:

Total cholesterol

Low-density lipoprotein (LDL) bad cholesterol: the main source of cholesterol buildup

and blockage in the arteries High-density lipoprotein (HDL) good cholesterol: the good cholesterol that helps keep

cholesterol from building up in arteries

Triglycerides: another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL

cholesterol can give you a general idea about your cholesterol levels. Testing for total and

HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if

your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done.

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

See how your cholesterol numbers compare to the tables below.

Total Cholesterol Level Total Cholesterol Category

Less than 200 mg/dL Desirable

200239 mg/dL Borderline high

240 mg/dL and above High

LDL Cholesterol Level LDL Cholesterol Category

Less than 100 mg/dL Optimal

100129 mg/dL Near optimal/above optimal

130159 mg/dL Borderline high

160189 mg/dL High

190 mg/dL and above Very high

HDL Cholesterol Level HDL Cholesterol Category

Less than 40 mg/dL A major risk factor for heart disease

4059 mg/dL The higher, the better

60 mg/dL and above Considered protective against heart

disease

Triglycerides can also raise your risk for heart disease. If you have levels that are borderline

high (150199 mg/dL) or high (200 mg/dL or more), you may need treatment. Things that

can increase triglyceride levels include:

Overweight

Physical inactivity

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Cigarette smoking

Excessive alcohol use

Very high carbohydrate diet

Certain diseases and drugs

Genetic disorders

How Is High Blood Cholesterol Treated?

The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL)

level enough to reduce your risk of having a heart attack or diseases caused by hardening of

the arteries. In general, the higher your LDL level and the more risk factors you have, the

greater your chances of developing heart disease or having a heart attack. (A risk factor is a

condition that increases your chance of getting a disease.) Some people are at high risk for

heart attack because they already have heart disease. Other people are at high risk for

developing heart disease because they have diabetes or a combination of risk factors for

heart disease. Follow the steps below to find out your risk for getting heart disease.

Check the list to see how many of the risk factors you have. These are the risk factors that

affect your LDL goal:

Cigarette smoking

High blood pressure (140/90 mg/dL or higher), or if you are on blood pressure

medicine

Low high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL)1

Family history of early heart disease (heart disease in father or brother before age 55;

heart disease in mother or sister before age 65)

Age (men 45 years or older; women 55 years or older)

If you have two or more of the risk factors in the list above, use the NHLBI 10-Year Risk

Calculator to find your risk score. Risk scores refer to the chance of having a heart attack in

the next 10 years, given as a percentage.

Use your medical history, number of risk factors, and risk score to find your risk of developing

heart disease or having a heart attack according to the table below.

If You Have You Are in Category And Your LDL Goal Is

Heart disease, diabetes, or a

risk score higher than 20%

I. Highest risk Less than 100 mg/dL

Two or more risk factors and a

risk score 1020%

II. Next highest risk Less than 130 mg/dL

Two or more risk factors and a

risk score lower than 10%

III. Moderate risk Less than 130 mg/dL

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One or no risk factors IV. Low to moderate risk Less than 160 mg/dL

After following the above steps, you should have an idea about your risk for getting heart

disease or having a heart attack. The higher your risk is, the lower your LDL goal will be.

There are two main ways to lower your cholesterol:

Therapeutic Lifestyle Changes (TLC)includes a cholesterol-lowering diet (called the

TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL

is above goal.

Drug Treatmentif cholesterol-lowering drugs are needed, they are used together

with TLC treatment to help lower your LDL.

The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set

your LDL goal. Using the following guide, you and your doctor can develop a possible plan

for treating your high blood cholesterol.

Category I, highest risk, your LDL goal is less than 100 mg/dL.

Your LDL Level Treatment

If your LDL is 100 or above You will need to begin the TLC Diet

together with drug treatment.

Even if your LDL is below 100 You should follow the TLC Diet on your

own to keep your LDL as low as

possible.

Category II, next highest risk, your LDL goal is less than 130 mg/dL.

Your LDL Level Treatment

If your LDL is 130 mg/dL or above You will need to begin the TLC Diet.

If your LDL is 130 mg/dL or more after 3

months on the TLC Diet

You may need drug treatment along with

the TLC Diet.

If your LDL is less than 130 mg/dL You will need to follow the Heart Healthy

Diet.

Category III, moderate risk, your LDL goal is less than 130 mg/dL.

Your LDL Level Treatment

If your LDL is 130 mg/dL or above You will need to begin treatment with the

TLC Diet.

If your LDL is 160 mg/dL or more after You may need drug treatment along with

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you have tried the TLC Diet for 3 months the TLC Diet.

If your LDL is less than 130 mg/dL You will need to follow the Heart Healthy

Diet.

Category IV, low to moderate risk, your LDL goal is less than 160 mg/dL.

Your LDL Level Treatment

If your LDL is 160 mg/dL or above You will need to begin the TLC Diet.

If your LDL is still 160 mg/dL or more

after 3 months on the TLC Diet

You may need drug treatment along with

the TLC Diet.

If your LDL is less than 160 mg/dL You will need to follow the Heart Healthy

Diet.

Lowering Cholesterol With TLC

TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main

parts of TLC are:

The TLC Diet, which recommends:

o Limiting the amount of saturated fat and cholesterol you eat.

o Eating only enough calories to achieve or maintain a healthy weight.

o Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans,

and apples are good sources of soluble fiber.

o Adding cholesterol-lowering food, such as margarines that containplant sterol

or stanol esters that lower cholesterol for some people.

Weight management:

o Losing weight if you are overweight can help lower LDL. Weight management

is especially important for those with a group of risk factors that includes high

triglyceride and/or low HDL levels and being overweight with a large waist

measurement (more than 40 inches for men and more than 35 inches for

women).

Physical activity:

o Regularphysical activity is recommended for everyone. It can help raise HDL

levels and lower LDL levels, and is especially important for those with high

triglyceride and/or low HDL levels who are overweight with a large waist

measurement.

Cholesterol-Lowering Medicines

Along with suggesting that you change the way you eat and exercise regularly, your doctor

may prescribe medicines to help lower your cholesterol. Even if you begin drug treatment,

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you will need to continue TLC. Drug treatment controls but does not "cure" high blood

cholesterol. Therefore, you must continue taking your medicine to keep your cholesterol level

in the recommended range.

The five major types of cholesterol-lowering medicines are:

Statins

o Very effective in lowering LDL (bad) cholesterol levels

o Safe for most people

o Rare side effects to watch for are liver and muscle problems

Bile Acid Sequestrants (seh-KWES-trants)

o Help lower LDL cholesterol levels

o Sometimes prescribed with statins

o Not usually prescribed as the only medicine to lower cholesterol

Nicotinic (Nick-o-TIN-ick) Acid

o Lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol

o Should only be used under a doctor's supervision

Fibrates

o Lower triglycerides

o May increase HDL (good) cholesterol levels

o

When used with a statin, may increase the chance of muscle problems Ezetimibe

o Lowers LDL cholesterol

o May be used with statins or alone

o Acts within the intestine to block cholesterol absorption

When you are under treatment, you will be checked regularly to:

Make sure your cholesterol level is controlled

Check for other health problems

You may take medicines for other health problems. It is important that you take ALL

medicines as your doctor prescribes. The combination of medicines may lower your risk for

heart disease or heart attack.

When trying to lower your cholesterol or keep it low, it is important to remember to follow

your treatments for other conditions you may have, such as high blood pressure. Get help

with quitting smoking and losing weight if they are risk factors for you.

____________1If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.

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Key Points

Cholesterol is a fat-like substance that is made in your body. Cholesterol is also in

some foods that you eat. Your body needs some cholesterol to work the right way.

Your body makes all the cholesterol it needs.

Too much cholesterol in the blood is called high blood cholesterol or

hypercholesterolemia.

High blood cholesterol increases the chance of having a heart attack or some other

symptom of heart disease, like chest pain (angina).

Lowering cholesterol is important for everyoneyoung, middle-aged, and older

adults, and both men and women.

Eating too much saturated fat and cholesterol raises the level of cholesterol in your

blood.

Too much cholesterol in your blood can build up in the walls of arteries. This is calledplaque.

There are no signs or symptoms of high blood cholesterol. Many people don't know

that their cholesterol level is too high.

High blood cholesterol is diagnosed by checking cholesterol levels in your blood.

A blood test called a lipoprotein profile measures the cholesterol levels in your blood

and is the recommended test.

It is important that everyone age 20 and older get their cholesterol checked at least

once every 5 years.

Many people are able to lower their cholesterol levels by eating a low saturated fat

and low cholesterol diet, exercising, and losing weight if needed.

Some people will need to take medicines prescribed by their doctor to lower their

cholesterol in addition to eating a low saturated fat and low cholesterol diet,

exercising, and losing weight if needed.

What Is a Stent?

A stent is a small mesh tube thats used to treat narrowed or weakened arteries in the body.

You may have a stent placed in an artery as part of a procedure called angioplasty (AN-jee-

oh-plas-tee). Angioplasty can restore blood flow through narrowed or blocked arteries. Stents

help prevent arteries from becoming narrowed or blocked again in the months or years after

treatment with angioplasty. You may also have a stent placed in a weakened artery to

improve blood flow and to help prevent the artery from bursting.

Stents are usually made of metal mesh, but sometimes theyre made of fabric. Fabric stents,

also called stent grafts, are used in larger arteries. Some stents are coated with medicines

that are slowly and continuously released into the artery. These medicines help prevent theartery from becoming blocked again.

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May 2007

How Are Stents Used?

Stents for Arteries in the Heart

With age and some health conditions, the inside openings of the coronary arteries (arteries of

the heart) tend to narrow due to deposits of a fatty substance called plaque (plak). High

cholesterol, diabetes, and smoking can cause the arteries to narrow. This narrowing of the

coronary arteries can cause angina (chest pain) or lead to heart attack.

During angioplasty, doctors use an expanding balloon inside the artery to compress the

plaque and widen the passageway. The result is improved blood flow to the heart and a

decreased chance of heart attack.

Unless an artery is too small, doctors usually place a stent in the treated portion of the arteryduring angioplasty. The stent supports the inner artery wall and reduces the chance of the

artery closing up again. A stent also can keep an artery open that was torn or injured during

angioplasty.

When stents are placed in coronary arteries, there's a 1 in 5 chance that the arteries will

close in the first 6 months after angioplasty. When stents aren't used, the risk of the arteries

closing can be twice as high.

Stents for the Carotid Arteries in the Neck

Both the right and left sides of your neck have blood vessels called carotid (ka-ROT-id)

arteries. These arteries carry blood from the heart to the brain. Carotid arteries can become

narrowed by plaque. These plaque deposits limit blood flow to the brain and increase your

risk forstroke. Your chance of developing plaque in your carotid arteries increases with age,

and may increase if you smoke.

A new procedure uses stents to help keep the carotid arteries fully open after they're

widened with angioplasty. Not all hospitals offer this procedure. How effective it is long term

is still not known. The National Institute of Neurological Disorders and Stroke supports

clinical studies to explore the risks and benefits of angioplasty and stenting of carotidarteries.

Stents for Other Arteries

The arteries in the kidneys also can become narrowed. This reduces blood flow to the

kidneys, which can affect their ability to control blood pressure. This can cause severe high

blood pressure.

The arteries in the arms and legs also can narrow with plaque over time. This narrowing can

cause pain and cramping in the affected limbs. If the narrowing is severe, it can completely

cut off the blood flow to a limb, which could require surgical treatment.

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To relieve these problems, doctors may perform angioplasty on the narrowed kidney, arm, or

leg arteries. This procedure often is followed by placing a stent in the treated artery. The

stent helps keep the artery fully open.

Stents for the Aorta in the Abdomen or Chest

The major artery coming out of the heart and supplying blood to the body is called the aorta.

The aorta travels through the chest and then down into the abdomen. Over time, some areas

of the walls of the aorta can become weak. These weakened areas can cause a bulge in the

artery called an aneurysm.

An aorta with an aneurysm can burst, leading to potentially deadly internal bleeding. When

aneurysms occur, they're usually in the part of the aorta in the abdomen. To help avoid a

burst, doctors place a fabric stent in the weakened area of the abdominal aorta. The stent

creates a stronger inner lining for the artery.

Aneurysms also can develop in the part of the aorta in the chest. These aneurysms also can

be treated with stents. But this new use of stents is not offered by all hospitals, and how

effective it is long term is still not known.

Stents To Close Off Aortic Tears

Another problem that can develop in the aorta is a tear in the inside wall. Blood can be forced

into this tear, causing it to widen and eventually block blood flow through the artery or burst.

When this occurs, it's usually in the part of the aorta that's in the chest.

Fabric stents are being developed and used experimentally to prevent aortic dissection by

stopping blood from flowing into the tear. Tears in the aorta reduce blood flow to the tissues

the aorta serves. A fabric stent placed within the torn area of the artery can help restore

normal blood flow and reduce the risk of a burst aorta. Stents to treat aortic tears are still

being researched. Only a few hospitals offer this procedure.

How Are Stents Placed?

To place a stent, your doctor will make a small opening in a blood vessel in your groin (upper

thigh), arm, or neck. Through this opening, your doctor will thread a flexible, plastic tube(catheter) with a deflated balloon on the end. A stent may be placed around the deflated

balloon. The tip of the catheter is threaded up to the narrowed artery section or to the

aneurysmor aortic tear site. Special x-ray movies are taken of the tube as it is threaded up

into your blood vessel. These movies help your doctor position the catheter.

For Arteries Narrowed by Plaque

Once the tube is in the area of the artery that needs treatment:

Your doctor uses a special dye to help see narrowed areas of the blood vessel.

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Your doctor inflates the balloon. It pushes against the plaque and compresses it

against the artery wall. The fully extended balloon also expands the surrounding

stent, pushing it into place in the artery.

The balloon is deflated and taken out along with the catheter. The stent remains in

your artery. Cells in your artery eventually grow to cover the mesh of the stent andcreate an inner layer that resembles what is normally seen inside a blood vessel.

Coronary Artery Stent Placement

The illustration shows the placement of a stent in a coronary artery with plaque buildup.

The coronary artery is located on the surface of the heart. Figure A shows the deflated

balloon catheter and closed stent inserted into the narrowed coronary artery. The insert

image on figure A shows a cross-section of the artery with the inserted balloon catheter

and closed stent. In figure B, the balloon is inflated, expanding the stent and compressing

the plaque to restore the size of the artery. Figure C shows normal blood flow restored in

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the stent-widened artery. The insert image on figure C shows a cross-section of the

compressed plaque and stent-widened artery.

The animation below shows coronary angioplasty and stent placement. Click the "start"

button to play the animation. Written and spoken explanations are provided with each frame.

Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the

scroll bar below the buttons to move through the frames.

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The animation shows how a doctor inserts a tube called a balloon catheter into a coronary

artery narrowed by plaque. The balloon catheter compresses the plaque, widens the artery,

and restores blood flow. Through the catheter, a stent is placed in the artery to help

maintain the restored blood flow.

A very narrow artery, or one that is difficult to reach with the catheter, may require more

steps to place a stent. This type of artery usually is first expanded by