Dr. Rashesh Shah, FACC, MD

During angioplasty, a patient is given a sedative while lying on a table under an x-ray machine. A catheter (a thin, flexible, and hollow tube) is inserted into the patient's skin in the arm or groin and guided into the blocked artery. Dye is injected via the catheter, and x-rays are used to position the tip of the catheter exactly at the blockage. The tiny balloon is guided through the catheter and inflated with saline. It pushes the plaque out of the way, squishing it against the walls of the artery. The balloon may be inflated and deflated several times to let blood pass by. A stent, a tiny tube of metal mesh like a spring, may be inserted to help keep the artery open. Then the x-ray is used again to check that blood is flowing properly, the catheter is removed, and the tiny incision is bandaged.

There are no nerves within veins and arteries, so an angioplasty is generally not painful. However, there may be some discomfort at the site of the incision and when the balloon is inflated. Overall, angioplasty is a very effective and low-risk procedure, useful for helping patients avoid more difficult bypass surgery.

• 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.