The arteries play an essential role in the vascular system; they transport oxygen and nutrients to the body's tissues. However, like any part of the body, they're susceptible to damage and disease. Coronary artery disease and carotid stenosis are two arterial diseases that, if left untreated, can lead to serious complications, including heart attack and stroke. Lifestyle habits and genetics both influence the health of our arteries, and at TCIM, our functional approach aims to find the root cause to treat and prevent serious health conditions.
What are coronary artery disease and carotid stenosis?
Coronary artery disease, also called CAD, is the most common type of heart disease in the United States (1). The coronary arteries branch and enclose the surface of the heart and supply it with oxygenated blood and nutrients (3). The carotid arteries are located in the neck and deliver oxygenated blood to the brain (2). When plaque made up of products like cholesterol, calcium and fat are deposited on the walls of the arteries and cause them to narrow, known as atherosclerosis, CAD and carotid stenosis occur (1). Unstable or ruptured plaque in coronary arteries can cause a heart attack, while a similar process in the carotid arteries and cerebral arteries can cause a stroke (1, 2, 3).
Symptoms of CAD and carotid stenosis
CAD reduces blood flow to the heart and may cause the following symptoms (1):
• A pressure or tightness in the chest, also called angina, that usually lasts a few minutes, worsens with physical activity and improves with rest
• Shortness of breath
• A heart attack will occur if the coronary artery is completely blocked. Common heart attack symptoms include left arm, jaw or shoulder pain, chest pressure, shortness of breath, and sweating.
Carotid stenosis can be asymptomatic and go undetected until it causes a stroke. Symptoms of a stroke may include (4):
• Trouble seeing in one or both eyes
• Weakness, tingling, or numbness in the face, arm, or leg, especially on one side of the body
• Sudden difficulty walking, loss of balance or coordination
• Sudden dizziness
• Difficulty speaking or swallowing
• Sudden severe headache
Risk factors of CAD and carotid stenosis
Some factors, known as modifiable risk factors, are within your control and, if managed properly, can significantly reduce the chance of vascular conditions like CAD or carotid stenosis. Modifiable risk factors include (4, 5, 6, 7, 8):
• Hypertension: high blood pressure can harden and thicken the arteries and promote plaque buildup.
• Hyperlipidemia: high cholesterol levels can increase the risk of atherosclerosis
• Diabetes mellitus: heart disease is more than two times higher in diabetics compared to non-diabetics
• Obesity: excess weight increases the risk of vascular disease and other conditions. A recent study found obese patients were twice as likely to have CAD, and a 2012 study found that a high body mass index in childhood is associated with an increased risk of heart disease in adulthood.
• Smoking increases the risk of heart disease. A 2018 study found that smoking one cigarette per day still carries a considerable risk of developing vascular diseases, and no safe level of smoking exists. Second-hand smoke exposure also increases the risk of heart disease.
• Poor Diet: consuming too much food that is high in salt, sugar, and saturated and trans fats
• Sedentary lifestyle
Others factors are non-modifiable, meaning they cannot be changed. These include (4, 5, 7):
• Age increases the risk, especially after the age of 45 for men and 55 in women
• Gender: men are at an increased risk compared to women
• Ethnicity: Blacks, Hispanics, Latinos, and Southeast Asians are at an increased risk
• A family history of developing cardiac disease before age 50 increases the risk
Diagnosis of CAD and Carotid Stenosis
Our goal at TCIM is to find the root cause of any ailments. The conventional approach to physicals usually includes taking a patient's blood pressure, providing a physical exam, blood work, and preventative cancer screening. We also offer executive physicals that take a more integrative and aggressive approach and aim to identify early changes in the body to prevent future damage. Many of the included tests in an executive physical aim to prevent vascular complications like heart attacks and strokes.
One of the most valuable tests included in the executive physical is the ultrasound. Carotid ultrasonography looks for plaque build-up, blood clots, and arterial thickening — which is often a visible symptom long before the presence of plaque (4). Other vascular tests included in an executive physical are plethysmography, a non-invasive test that measures blood flow within vessels, and EKGs, which measure the heart's electrical activity (4).
Predicting a patient's health based on blood tests and a physical exam alone isn't easy, and normal cholesterol levels and blood work do not necessarily indicate perfect health. Executive physicals are preventative and can identify existing problems. They also provide an objective marker to see if lifestyle changes are effective; for patients who have been working hard to control their high cholesterol via diet and exercise, an ultrasound will show them if their regimen is working.
Other tests used to diagnose CAD include (1):
• Echocardiogram: measures the heartbeats electrical activity, rate, and regularity
• Exercise stress test: measures heart rate while walking on a treadmill or riding a stationary bike. This test determines how well the heart works while having to pump more blood.
• X-ray of the heart, lungs, and other chest organs