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Understanding
Coronary & Peripheral Artery Disease

Healthy arteries are clean, smooth, and slick. As we age, the inside walls of our arteries thicken and harden. Poor health habits—like eating a high-fat, high-cholesterol diet—can help speed the aging process by causing the gradual build-up of deposits (called plaque) in our artery walls. Over time, these plaque deposits can narrow the arteries so that less blood flows to the heart, which may cause chest pain (angina). In extreme cases, the plaques can completely block the flow of blood through the arteries, leading to a heart attack.

There are two main types of artery diseases: coronary artery disease and peripheral artery disease. Coronary artery disease involves the arteries that supply the blood to your heart. Peripheral artery disease is a circulatory problem involving the arteries that supply blood to your limbs.

Coronary Artery Disease (CAD)

Coronary artery disease is the most common type of heart disease and the leading cause of death in Canada. When heart arteries narrow, the heart muscle can’t get enough oxygen, resulting in angina or a heart attack.

Risk Factors

There are certain risk factors that increase the likelihood that you’ll develop CAD. Some of these risk factors are things you can change; some are not.

Risk factors that are beyond your control include:

Sex: Men are generally at greater risk for heart disease than women. However, the risk for women increases after menopause.
Age: As you get older, your arteries harden, and your risk of CAD increases.
Family history: If your sisters, brothers, parents, or grandparents have heart disease, you may be at greater risk of developing it.

The following risk factors are under your control:

Smoking: Exposure to cigarette smoke acts with other factors to increase your risk of CAD by damaging blood vessels.
High blood pressure: Over time, uncontrolled high blood pressure can damage your coronary arteries.

High blood cholesterol: The risk of CAD increases as your blood cholesterol rises.
Diabetes: People with diabetes have a higher risk of CAD, especially if their blood sugar isn’t well-controlled.
Obesity: Excess weight increases the strain on your heart, raises your blood pressure, increases your cholesterol levels, and increases your risk of diabetes.
Physical inactivity: Regular exercise is an important part of avoiding CAD.

Diagnosing the Problem

There is no single test to diagnose CAD. If you have risk factors for coronary artery disease, you should be tested for it. Your doctor will conduct a physical examination, a detailed medical and family history, and routine blood tests. After compiling all of the information, your doctor may recommend further tests.

Symptoms

In some cases, people may not experience any symptoms. This is referred to as silent ischemia. For others, chest pain is often the first sign of CAD. Warning signs to watch for include:

tightness across the chest
burning or pressure beneath the breast bone
pain or ache spreading to the shoulders, jaw, arms, throat, neck, or upper abdomen
fatigue or weakness
nausea or vomiting
sweating
shortness of breath
feeling lightheaded

The symptoms of a heart attack are similar, but may be stronger. Typical heart attack symptoms include:

crushing, squeezing, burning pain in the middle of the chest that may spread to the neck, jaw, left shoulder, or arm
tightness or squeezing in the chest
dizziness
chills or sweating
nausea, possibly with vomiting
weak pulse
shortness of breath

Some women experience the same feelings as men, but others may feel:

shoulder, neck, or back pain
throat discomfort
a sharp pain when breathing in cold air
fatigue

If you experience these symptoms, seek medical help immediately. However, not all heart attacks produce typical symptoms. If you have any reason to think that you might be having a heart attack, don’t wait; call for emergency assistance.

Treatment

Drugs and surgical techniques can repair narrowed coronary arteries, but the best long-term solution is to make the following healthy lifestyle choices to reduce your risk factors:

Stop smoking.
Improve your diet. Eat foods low in fat and salt and high in fibre.
Exercise regularly. Even moderate amounts of activity— 30 minutes a day—can lower your risk of CAD.

In addition to lifestyle changes, your doctor may prescribe medications. For more serious cases of CAD, surgery may be required. The following procedures are the most common:

Coronary angioplasty: A small balloon is inserted into an artery in your groin or arm, then threaded to the blocked coronary artery. The balloon is inflated to widen the artery and improve blood flow. It is then deflated and removed.
Coronary bypass surgery: This procedure creates an alternate route for blood to travel around (bypass) the blocked part of an artery.
Atherectomy: This technique involves inserting a catheter into an artery and shaving plaque off your artery walls.

Peripheral Artery Disease (PAD)

Peripheral artery disease occurs when blood flow is reduced to your extremities (your feet, legs, hands, or arms). When this happens, they are left with less blood flow than they need, which may cause either of these two types of muscle pain:

Intermittent claudication: This leg pain occurs during exercise. The severity of the problem varies widely, from slightly bothersome to severely debilitating.
Ischemic rest pain: This pain indicates a more advanced stage of PAD and occurs when you are at rest.

Risk Factors

Peripheral artery disease is two to three times more common in men than women, and people in northern regions tend to have a higher risk than those in southern areas. Other risk factors for PAD include:

being overweight
diabetes
unhealthy cholesterol and lipid (blood fat) levels
smoking
high blood pressure
family history of artery disease

Diagnosis

If you have risk factors for heart disease, leg pain during walking, or ulcers on your legs, you should be checked for peripheral artery disease. Your doctor will look for signs of PAD, including:

a weak or absent pulse below the narrowed area of an artery
whooshing sounds over your arteries that can be heard with a stethoscope
evidence of poor wound healing in the area where blood flow is restricted
decreased blood pressure in your affected limb

Treatment

There are two main goals for treatment of PAD. The first is to manage the pain so you can return to your normal activities. The second goal is to stop the progression of PAD to reduce your risk of having a heart attack or stroke.

Certain medications can help reduce your risk factors and make you more comfortable. Your doctor may prescribe medicine to prevent blood clots, lower your blood pressure, and decrease your cholesterol levels. Blood thinning medications can help prevent clotting.

In some cases, surgical procedures may be needed to treat intermittent claudication. These include:

Stent: A medical device made of expandable mesh tube is inserted into a narrowed artery. Once inside, it can expand and hold the artery open.
Angioplasty: A tiny balloon is placed directly inside the narrowed artery and inflated, widening the blocked area. The balloon is then deflated and removed.
Bypass surgery: Blood is re-routed around the blockage.

The following lifestyle tips can help keep your arteries in tip-top shape:

Quit smoking. This is the most significant step you can take to reduce the risk of developing PAD.
Eat a healthy diet. Choose foods low in salt and fat and high in fibre.
Check your blood pressure and cholesterol levels regularly. If they aren’t healthy, ask your doctor or pharmacist what you can do to bring them into a healthy range.
Get regular exercise. Physical activity helps lower your heart rate, improves cholesterol levels, and helps control high blood pressure.

Regular check-ups with your doctor and a healthy approach to living can minimize your risk of CAD and PAD. If you have any questions about artery diseases, your pharmacist will be happy to answer them.

The material in this pamphlet has been supplied by a professional medical writer. It is intended for information purposes only and should not be used in place of consultation with a health care professional. Axis Pharmacy is not responsible for errors, omissions, or inconsistencies with respect to the information contained in this pamphlet and does not accept any liability whatsoever for reliance by the reader on the information contained herein.

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