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Coronary artery disease (CAD) Coronary artery disease, also known as atherosclerotic heart disease or coronary heart disease, results from an accumulation of fatty substances and plaque within the walls of the coronary arteries that supply the muscle of the heart with oxygen and nutrients. This causes a narrowing of the artery decreasing blood flow to the heart muscle. Some of these atheromatous plaques may rupture at any stage of the disease and form a blood clot that also can cut off blood flow to the heart muscle and cause a heart attack. Coronary arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessel. The lining of the artery becomes hardened, stiffened, and enlarged with debris including calcium and fatty deposits and abnormal cells to form a plaque. Patients with CAD can have one or two plaques or many scattered throughout their coronary arteries. Cardiologists affiliated with St. Vincent’s Regional Heart & Vascular Center are skilled in diagnosing and treating CAD. CAD Consequences CAD is the leading cause of death worldwide because often there are no noticeable symptoms until the disease has progressed to a more serious state. Many individuals with coronary artery disease show no evidence of disease for years as the disease progresses before the first onset of symptoms, often a "sudden" heart attack occurs. As the disease progresses, there may be complete blockage of one or more arteries, and a heart attack may result. Heart attack or myocardial infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood. Prevalence The disease is the most common cause of sudden death. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. Because CAD is often due to heredity, where heart disease runs in the family, otherwise healthy individuals can lead very active lifestyles and appear physically fit while remaining completely unaware of the plaque that's been building up throughout child and young adulthood. While eating a healthy diet may reduce your risk, it doesn't preclude you from having this often inherited disease. Symptoms Symptoms, when they present themselves, are often mild and ignored - It's critical that you not ignore any of the following symptoms and be screened by a cardiologist right away. See a cardiologist or a health care professional if you experience any of these symptoms. - Angina: Individuals with severe blockages may show signs of chronic coronary ischemia, which means the blood supplied to the tissue is inadequate. This may cause chest pain or angina. - Shortness of breath. If your heart is not pumping enough blood, you may develop shortness of breath or fatigue with activity. - Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. - Risk Factors for CAD - Smoking - Diet - High blood pressure - High cholesterol - Diabetes - Family History CAD diagnosis There is much you can do to limit your risk for CAD. Adopt a healthy lifestyle and stop smoking. Physicians at St. Vincent’s can help you modify your risk still further or manage symptoms of CAD by using screening tools such as monitoring blood pressure and cholesterol including low-density lipoprotein (LDL), high-density lipoprotein (HDL). They can help you develop a healthy diet and guide you to resources to help you quit smoking and get the exercise you need to stay strong and manage your weight. If symptoms indicate a problem, St. Vincent’s cardiologists can call upon a physical examination, non-invasive testing and a family history along with the most advanced technology to get to the heart of the problem including: - Electrocardiogram (ECG or EKG) (see Electrocardiogram) A noninvasive test that checks for electrical problems of the heart to show evidence of a heart attack, lack of blood supply or a rhythm disturbance. - Blood tests. A blood test identifies certain heart enzymes that indicate a damaged heart or risk factors for CAD. - Chest X-ray: Can reveal damage - Stress test. Done while patient is on a treadmill, it can show how well blood is flowing. - Echocardiogram (Doppler echocardiogram). Produces images of the heart to identify valve function or blood flow problems using sound waves. - Nuclear scan –Using a radioactive substance, a picture will emerge of the blood flow to your heart. - Positron emission tomographic scan (PET). A PET scan defines areas of your heart with altered blood supply and can help to identify areas of your heart damaged previously. - Angiogram (coronary catheterization). The most precise test to determine the extent of CAD (see Cardiac Catheterization). - Magnetic resonance imaging (MRI). Detailed images of the heart disclosing areas of damage are produced using magnetic energy. - CT scan. Produces images of larger coronary arteries. Treatment: Lifestyle Changes Treatments for CAD include lifestyle changes, medication therapy and in some cases, medical procedures. CAD Medication Therapy may include those to lower cholesterol, aspirin to reduce clotting and blockage of the arteries, beta blockers to lower your heart rate, blood pressure and the body’s demand for oxygen and also the risk of heart attack, nitroglycerin to open up the arteries and reduce demand for blood, other drugs to decrease blood pressure, open the arteries and reduce risk of heart attack. When lifestyle changes and medications are not enough, cardiologists at St. Vincent’s have a range of options to help you manage CAD by improving blood flow. Angioplasty and stent placement (see also Cardiac Catheterization) In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery, inflates a balloon when the blockage is reached, pressing back the plaque to allow an opening. A permanent stent is often placed in the artery to keep it open. Some stents slowly release medication to help keep the artery open. Coronary artery bypass surgery. A surgeon creates a graft to detour the blood flow around blocked coronary arteries using a blood vessel from another part of your body. Usually this open-heart surgery is performed when an individual has more than one blockage. See Cardiovascular/Cardiothoracic Surgery. Contact us To find a St. Vincent’s physician who can discuss your health concerns or those of a loved one, please click on our FIND A DOCTOR tool and search by specialty, practice, location or keyword. We’re here to help you locate the medical expert you need. To speak with a St. Vincent's Care Line representative, call (877) 255-7847 To speak with someone at the front desk of the Medical Center, please call (203) 576-6000 Click in for St. Vincent's Medical Center DIRECTIONS | MAPS | PARKING information
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Srčani udar (infarkt miokarda) – uzroci, simptomi i liječenje Srčani udar se obično događa kada krvni ugrušak blokira protok krvi kroz koronarne arterije- krvne žile koje hrane krvlju srčani mišić. Prekid protoka krvi koji se javlja tijekom srčanog udara može oštetiti ili uništiti dio srčanog mišića. Srčani udar, koji se naziva i infarkt miokarda, može biti koban. Liječenje nakon srčanog udara je značajno poboljšano tijekom godina. No, i dalje je ključno pravovremeno prepoznati simptome i nazvati hitnu liječničku pomoć uoliko mislite da imate srčani udar. Uzroci srčanog udara Srčani udar nastaje kada jedna ili više arterija koje opskrbljuju srce krvlju bogatu kisikom postaju začepljene. Tijekom vremena, koronarne arterije se mogu suziti zbog nakupine različitih tvari, poput kolesterola. Te nakupine- koletivno poznate kao plak- u arterijama se nazivaju ateroskleroza. Kada su vaše koronarne arterije sužene zbog ateroskleroze, tada se to stanje naziva bolest koronarnih arterija. Ta bolest je temeljni uzrok većine srčanih udara. Tijekom srčanog udara, jedan od plakova može puknuti i prosuti kolesterol i druge tvari u krvotok. Na mjestu puknuća se formira krvni ugrušak, dijelom i zato što je tijelo zbunjeno i pokušava popraviti ozlijeđenu krvnu žilu. Ako je ugrušak dovoljno velik, može u potpunosti blokirati protok krvi kroz koronarne arterije. Drugi uzrok srčanog udara jest grč koronarne arterije koji gasi dotok krvi do srčanog mišića. Supstance, poput kokaina, mogu izazati takav, po život opasan grč. Ostali rijetki uzroci srčanog udara su mali krvni ugrušci ili tuomori koji su putovali iz drugih dijelova tijela (koronarna embolija). Srčani udar također se može dogoditi ukoliko je protok krvi do srca izrazito smanjen, a to je moguće kod osoba sa niskim krvnim tlakom. Simptomi srčanog udara Uobičajeni simptomi srčanog udara uključuju: - Pritisak, stezanje i bol u prsima ili rukama, koja se može proširiti na vrat, čeljust i leđa - Osjećaj punoće, mučnina, probavne smetnje, žgaravica ili bolovi u trbuhu - Kratkoća daha - Znojenje ili hladan znoj - Osjećaj tjeskobe - Umor i poteškoće sa spavanjem - Lakomislenost i vrtoglavica Nemaju svi ljudi iste simptome niti ih doživljavaju u istoj mjeri. Mnogi srčani udari nisu toliko dramatični kao oni koje ste vidjeli na TV-u. Neki ljudi uopće nemaju simptome, dok je kod drugih prvi simptom nagli zastoj srca. Ipak, što više znakova i simptoma imate, to je veća vjerojatnost da ćete imati srčani udar. Jačina simptoma srčanog udara veoma se može razlikovati od osobe do osobe. Neki ljudi imaju blagu bol, dok drugi doživljavaju jake bolove. Srčani udar može se dogoditi u bilo koje vrijeme- na poslu, tijekom igre, dok odmarate ili dok ste u pokretu. Neki srčani udari se pojavljuju iznenada, ali mnogi ljudi koji su doživjeli srčani udar su imali upozoravajuće znaove i simptome satima, danima ili čak tjednima unaprijed. Najranije upozorenje srčanog udara može biti bol u prsima koja je potaknuta naporom, a povlači se tijekom odmora. Mnogi ljudi brkaju srčani udar sa stanjem u kojem se srce iznenada zaustavi- iznenadni srčani zastoj. Iznenadni zastoj srca nastaje kada električni poremećaj u srcu narušava njegovo pumpanje krvi i uzrokuje njegov zastoj. Srčani udar može uzrokovati srčani zastoj, ali to nije njegov jedini uzrok. Liječenje srčanog udara Što učiniti ako vidite da netko ima srčani udar? Ako naiđete na nekoga tko je u nesvijesti od pretpostavljenog srčanog udara, pozovite hitnu medicinsku pomoć. Ukoliko ste prošli obuku za slučaj izvanrednog događaja (prva pomoć), započnite kardiopulmonalnu reanimaciju. To će pomoći u dotoku kisika tijelu i mozgu. Tretman u bolnici Liječenje srčanog udara varira o situaciji. Možete biti liječeni lijekovima, invanzivnim postupkom, ili kombinacijom oba tretmana- ovisno o težini vašeg stanja i nastale štete na srcu. Lijekovi Svakom minutom nakon srčanog udara vaše srčano tkivo gubi kisik, propada ili umire. Glavni način da se spriječi oštećenje srca jest brzo vratiti normalan protok krvi. Lijekovi za liječenje srčanog udara: - Aspirin- smanjuje zgrušavanje krvi, čime pomaže u održavanju protoka krvi kroz sužene arterije. - Trombolitici- ti lijekovi pomažu u otapanju krvnog ugruška koji blokira protok krvi do srca. Što ranije primite trombolitički lijek nakon srčanog udara, veća je vjerojatnost da ćete preživjeti i da će biti manja šteta na srcu. - Ostali lijekovi za razrjeđivanje krvi- najčešće se daje heparin, kako bi vaša krv bila manje „ljepljiva“ i kako bi bila manja vjerojatnost od formiranja opasnih ugrušaka. Daje se intravenozno ili injekcijom pod kožu, nakon srčanog udara. - Lijekovi protiv bolova- ukoliko je bol u prsima velika, možda ćete dobiti lijekove protiv bolova, poput morfija, kako bi se smanjila nelagoda. - Nitroglicerin- koristi se za liječenje bolova u prsima; privremeno otvara arterijske krvne žile te poboljšava protok krvi do srca. - Beta blokatori- ovi lijekovi pomažu u opuštanju srčanog mišića, usporavaju rad srca i smanjuju krvni tlak, te tako olakšavaju posao srcu. Oni mogu ograničiti količinu oštećenja srčanog mišića i spriječiti buduće srčane udare. - Lijekovi za snižavanje kolesterola- mogu biti od pomoći ubrzo nakon srčanog udara i poboljšavaju šanse za preživljavanje. Kirurški i drugi postupci Koronarna angioplastika i postavljanje stenta- hitna angioplastika otvara blokirane koronarne arterije te omogućava bolji protok krvi do srca. Liječnici umetnu dugu, tanku cijev (kateter) koji prolazi kroz arterije, najčeše u nozi ili preponama, do blokiranih arterija u srcu. Taj kateter je opremljen sa posebnim balonom. Nakon što ga se stavi u odgovarajući položaj, napuhan balon nakratko otvori blokiranu koronarnu arteriju. U isto vrijeme, stent može biti umetnut u arteriju kako bi otvaranje bilo dugoročno i kako bi se vratio protok krvi do srca. Ovisno o vašem stanju, vaš liječnik može odlučiti staviti stent obložen sporo oslobađajućim lijekovima koji će pomoći zadržati vaše arterije otvorenima. Bypass- kirurgija koja se izvodi kako bi se poboljšao protok krvi do srčanog mišića; koristeći premosnice- arteriju stijenke prsnog koša ili dio vene s noge- kirurg premošćuje suženja u koronarnim arterijama. Krv obogaćena kisikom tada može putem premosnice prolaziti do područja srčanog mišića iza mjesta suženja. Strauss kapi za srce Osiguravaju optimalan dotok krvi u srce. ARTEROprotect Doprinosi održavanju normalne funkcije srca.