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Women and
Coronary Artery Disease (CAD)
Module 4
Patient Education
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Supported by an unrestricted
educational grant from
Fujisawa Healthcare, Inc.
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Overview of Heart Disease
How Do I Know I Have Heart Disease?
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What Is Cardiovascular Disease
(CVD)?
• Diseases of the heart and blood vessels:
– Heart disease
– Myocardial Infarction (heart attack)
– Angina (chest pain or discomfort caused by
reduced blood supply to the heart muscle)
– Stroke
– High blood pressure
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Why Are Arteries
in the Heart Important?
Artery
Squeezing
Heart
Heart
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What Is Heart Disease?
Plaque builds up inside my arteries,
decreasing blood flow to my heart
Decreasing blood flow
Normal
heart artery
Minimal
heart disease
Moderate
heart disease
Severe
heart disease
Glagov S, et al. N Engl J Med. 1987
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How Heart Disease Happens
Heart disease occurs when arteries supplying blood to the
heart muscle become narrowed or blocked
Every muscle in your body needs a
constant flow of blood to stay healthy. Your
heart is a muscle, too (called the
myocardium). So, in addition to the blood
that goes through your heart as it pumps,
blood is carried into the heart muscle itself
by a network of coronary arteries. This flow
of blood supplies your heart muscle with
oxygen and nutrients.
In a person with heart disease, one or
more of the coronary arteries has been
narrowed or blocked by a buildup of fatty
deposits. This reduces "myocardial
perfusion," which is the amount of blood
flowing into the heart muscle. If the blood
flow is reduced too much, part of the heart
muscle is injured, causing a heart attack.
The injured part of the heart muscle can
be permanently damaged.
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Blood supply
is blocked
What Is a Heart Attack?
• When blood supply to my heart muscle is
severely reduced or stopped
• Heart attack/coronary/myocardial infarction
• Reduced blood flow is caused by a buildup
of plaque (or fatty deposits) in the heart’s
arteries.
• Buildup damages the arteries, causing clots
to form, blocking blood supply
• If the blood supply is cut off for more
than a few minutes, muscle cells suffer
permanent injury and die, which can kill
or disable someone depending on how
much heart muscle is damaged
Part of the Heart
Muscle Dies
Leaving the heart muscle
weaker and less able to
pump blood to the body
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What Are Common Symptoms of Heart
Disease?
• Shortness of breath
• Fatigue
• Chest discomfort or pain that can spread to
the arms, neck, back, or jaw
• Symptoms can occur during activity or stress
• Many women with heart disease experience
no symptoms at all
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What Tests Are Available?
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Electrocardiogram (ECG or EKG)
• Graphic record of the electrical activity of the heart as
it contracts and rests
• Electrodes are placed on your arms, legs, and chest
• Abnormal heartbeats, some areas of damage,
inadequate blood flow, and heart enlargement can be
detected
• Performed while you are resting or exercising (called
a “stress test”)
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Stress Test
• A stress test is a “work out”
for your heart
• Also called a “treadmill test”
or “exercise test”
• You walk on a treadmill
– Start at a relatively slow pace
– Speed and grade increase
every few minutes
• When you have fatigued or
reached the maximum
amount of work you can do,
the test will stop
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What If I Am Unable to Exercise
on a Treadmill?
• If you cannot exercise on a
treadmill, your doctor may
give you a drug that has an
effect on your heart similar
to exercise
• This is called a
“pharmacologic stress test”
• The drug is infused through
an IV tube into your arm
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Stress Test With Imaging
• Sometimes additional
imaging tests are
performed during your
stress test:
– Nuclear imaging
– Echocardiography
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Nuclear Imaging
• Also called “nuclear scan” or
“perfusion imaging”
• Small amount of radiation
(“tracer”) is injected into your
bloodstream
– The radiation level is the
same as a day at the beach
• A special camera takes
pictures of your heart
• Images can show damage to
heart muscle and blood flow
problems
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Echocardiography
• Small device called a
transducer moved around
your chest to image your
heart
• Transducer uses ultrasound
waves to generate images
• Images give information on
heart muscle, valves,
chambers, and major blood
vessels
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Magnetic Resonance Imaging (MRI)
• Uses strong magnets to detect
energy signals from your heart
• Produces clear 3-D images of
your heart
• Mostly investigational use at
present time
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Electron Beam Computed Tomography
• Also called “ultrafast CT”
or “heart scan”
• Detects coronary calcium levels
(a marker for coronary artery
disease)
• Electron beams produce
3-D views of your heart
• A dye is sometimes injected to
help visualize coronary arteries
and veins
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What if My Stress Test or Imaging
Tests Are Abnormal?
• Your doctor may order a cardiac
catheterization (also called “angiography”)
• Afterward, your doctor will show you any
blockages in your 3 major heart arteries
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Angiography
• A long, thin tube is inserted
through your arm or leg
artery into your heart
• Dye is sent through a
catheter into your arteries
• The movement of dye helps
visualize any blockages
• Compared with noninvasive
imaging, angiography is
more invasive and
relatively expensive
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Treatment for Heart Disease
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Treatment for Heart Disease
• Lifestyle changes
– Low-fat diet
– Appropriate exercise
– Quitting smoking
• Medications
• Surgical treatment
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Lifestyle Changes
• Low-fat diet
– A low-fat (low saturated fat) and low-cholesterol diet will help
reduce high cholesterol, a primary cause of heart disease
– If you are overweight, losing weight can help lower
cholesterol and high blood pressure
• Appropriate exercise
– Moderate amounts of physical activity are associated with
lower death rates from heart disease
– If you have severe heart disease, you may have to restrict
your exercise somewhat
• Quitting smoking
– Dramatically lowers the risk of a heart attack
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Medications
• Different drugs work in different ways to help
improve the functioning of your heart
– Digoxin, nitroglycerine, aspirin, diuretics, ACE
inhibitors, beta-blockers, etc
• Other medications can help control conditions
contributing to your heart disease
– Drugs to lower cholesterol (“statins”) or blood
pressure
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Surgical Treatment
Coronary artery
bypass surgery
(CABG)
Artery
Stent and/or
balloon
angioplasty
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Conclusions
• Know the symptoms of heart disease
• Know your risk factors for heart disease
• Visit your healthcare provider
– Discuss your risk factors
– Ask questions about your heart tests
• Maintain a healthy lifestyle