Coronary Artery Disease
Overview of Coronary Artery Disease (CAD)
The NYU Approach to CAD
Diagnosing and Evaluating CAD
Treating CAD
Cardiac and Pulmonary Rehabilitation
Our CAD specialists
Overview of Coronary Artery Disease
Coronary artery disease, or CAD, is the most common form of heart disease and the leading cause of death in the U.S. for both men and women.
CAD occurs when the coronary arteries, which supply blood to the heart muscle, become hardened and narrowed. Arteries harden and narrow because of the buildup of plaque (fatty deposits) on their inner walls, a phenomenon known as atherosclerosis. As the plaque accumulates, the arteries grow narrower, restricting the flow of blood to the heart and starving the heart muscle of oxygen.
As CAD progresses, patients typically experience angina (chest pain or discomfort) and shortness of breath. CAD also increases the risk of heart attack (myocardial infarction). A heart attack occurs when a blood clot lodges in a coronary artery — usually where plaque has accumulated — and suddenly cuts blood supply to a portion of the heart muscle. If an insufficient amount of oxygen-carrying blood reaches the cells in the heart muscle, the cells will start to die. This can lead to permanent damage of the heart muscle and even death. Over time, CAD can weaken the heart and lead to heart failure, a condition in which the heart cannot pump enough blood to the rest of the body. Arrhythmias, or abnormal heart rhythms, may also result from CAD.
The effects of CAD may not be apparent for years, even decades. In some people, the disease may go unnoticed until it a heart attack occurs.
The classic risk factors for CAD include smoking, high blood pressure, elevated cholesterol levels, diabetes, obesity, physical inactivity, stress, and a family history of heart disease. However, CAD can develop without the presence of any of these classic risk factors.
The NYU Approach to Coronary Artery Disease
At NYU, we bring a multidisciplinary approach to the treatment of CAD. Our team includes experts in cardiology, cardiac imaging, interventional cardiology, cardiac surgery, cardiac rehabilitation, nutrition, and social work. Each patient is considered individually, and a treatment plan is designed with input from surgeons and nonsurgeons alike — as well as from the patient and his or her family.
We offer all treatments for CAD, ranging from medications to interventional procedures to coronary artery bypass surgery. Our surgeons have extensive experience with traditional as well as minimally invasive surgery, arrested-heart and beating-heart (off-pump) techniques, and robotic surgery.
Diagnosing and Evaluating Coronary Artery Disease
Much of our success in treating CAD can be traced to our close ties with NYU’s expert diagnosticians. These include members of the Noninvasive Echocardiography Laboratory, one of the best facilities of its kind in the nation, and the Cardiac Imaging Section, which uses the latest magnetic resonance imaging (MRI) and computed tomography (CT) technologies to obtain high-quality cross-sectional images of the heart and the great vessels.
Among the advanced tests for CAD we offer are:
- cardiac catheterization : an X-ray exam of the heart and its arteries, which is used to assess the location and extent of arterial blockage or narrowing.
- cardiopulmonary exercise testing: the standard stress test formeasuring how the heart, lungs, and muscle respond to exercise.
- dobutamine stress echocardiogram: a nonexercise stress test,which isused to detect blockage of blood flow to the heart. This test is useful for those who cannot tolerate a standard stress test, which requires patients to use an exercise treadmill. Instead, the intravenous drug dobutamine is used to make the heart beat faster, mimicking the effects of exercise on the heart.
- transesophageal echocardiogram (TEE):echocardiograms use high-frequency sound waves to visualize the heart. In TEE, images are obtained through a probe inserted into the esophagus and positioned directly behind the heart, allowing better visualization of certain heart structures than with a standard echocardiogram.
- 64-slice cardiac CT angiography: CT angiography uses X-rays to build highly detailed three-dimension pictures of cardiac anatomy, including coronary arteries, great arteries and veins, cardiac chambers, muscle, and valves.
- cardiac magnetic resonance imaging (MRI):: MRI employs noninvasive magnetic fields and radio waves (instead of x-rays) to obtain two- and three-dimensional images of the body. Cardiac MRI provides details about damage to heart muscle after a heart attack, arterial blockage, and how various parts of the heart are functioning, among other information.
Treating Coronary Artery Disease
Treatments for CAD
Minimally invasive & Off-pump surgery
Re-operative and High-Risk Surgery
A combination of approaches are typically used to treat CAD, including lifestyle changes, medications, interventional procedures, and surgery. The type of therapy chosen depends on several factors: the extent of cardiovascular disease, the severity of symptoms, the patient’s age, and the presence of other medical conditions.
Lifestyle changes
Changes in lifestyle can slow the progression of CAD. We recommend that patients quit smoking, control their diabetes, lower their blood pressure, check their cholesterol levels, exercise, eat a balanced diet, maintain a healthy weight, and manage their stress.
Medications
Various medications can be used to treat CAD, including cholesterol-lowering drugs, aspirin, beta blockers, nitroglycerin, ACE (angiotensin-converting enzyme) inhibitors, and calcium-channel blockers.
Interventional procedures
In many cases, more aggressive treatment is warranted. A common procedure for CAD is angioplasty (percutaneous coronary intervention), in which a small balloon-tipped catheter is inserted into the coronary arteries and then inflated to flatten the blockage. During the procedure, a stent (mesh tube) may be inserted in the artery to help keep the blood vessel open. We offer the last innovations in stent technology.
Coronary artery bypass surgery (CABG)
If several coronary arteries have significant obstructions, coronary artery bypass graft (CABG) surgery may be needed. In CABG surgery, blood vessels taken from another part of the patient’s body (the chest, arm, or leg) are used to reroute, or “bypass,” blood around the clogged arteries, thereby improving the flow of blood and oxygen to the heart. Studies show that arterial grafts last longer and improve long-term survival, compared to vein grafts. At NYU, nearly all CABG patients receive one internal mammary artery graft, and many receive a second internal mammary artery graft or a radial artery graft (taken from the arm).
Animated view of CABG surgery: Windows Media Player or Quicktime.
Minimally invasive coronary bypass surgeryWhenever possible, CABG surgery at NYU is performed using minimally invasive techniques. Our staff is experienced with all minimally invasive techniques, including MID-CAB (minimally invasive direct coronary artery bypass) surgery, port-access (“keyhole”) surgery, and robotic surgery.
We also offer OP-CAB ( off-pump, or beating-heart, surgery). In traditional CABG surgery, the heart is stopped and connected to a heart-lung machine (which oxygenates the blood and pumps it around the body), allowing the surgeon to operate on a stationary surface. To reach the heart and connect the heart-lung machine, the surgeons makes an incision in the chest and then divides the breast bone — the most traumatic aspect of the operation.
Today, it is possible to perform CABG surgery without putting the patient on the heart-lung machine. In off-pump surgery, certain areas of the heart are immobilized with cardiac stabilizers, allowing the surgeon to operate while the heart is still beating. Studies (including a study conducted by physicians at NYU and the Veterans Administration) show that off-pump surgery is advantageous for patients at high risk for complications from heart-lung bypass, including those with vascular disease, a history of stroke or transient ischemic attacks, heavily calcified aortas, carotid artery stenosis, and heart or kidney problems, and those over age 70.
Re-operative and High-Risk SurgeryOur surgeons and dedicated cardiac intensive care specialists have extensive experience with patients who require second or third CABGs, as well as with other high-risk patients, such as the elderly and those with multiple health problems.
Cardiac and Pulmonary Rehabilitation
Rehabilitation is essential to recovering from cardiopulmonary disease. We encourage our patients, when appropriate, to obtain care at the Joan and Joel Smilow Cardiac and Pulmonary Rehabilitation and Prevention Center at NYU or at another rehabilitation program.
The Smilow Cardiac and Pulmonary Rehabilitation and Prevention Center, a component of the renowned Rusk Institute of Rehabilitation Medicine, offers the most comprehensive cardiopulmonary wellness and rehabilitation services in the tri-state area. Both inpatient and outpatient services are provided, helping patients move seamlessly into the recovery phase of their care. Facilities include a 22-bed inpatient unit, a state-of-the-art cardiopulmonary rehabilitation gym, and dedicated space for patient education.
Our Coronary Artery Disease SpecialistsAubrey C. Galloway, MD
Gregory A. Crooke, MD
Alfred T. Culliford, MD
Juan B. Grau, MD
Eugene A. Grossi, MD
David B. Meyer, MD
Greg H. Ribakove, MD
Charles F. Schwartz, MD