Coronary Artery Disease: Causes, Symptoms and Treatment with Dr. Curtiss Stinis | San Diego Health

Aug 18, 2023

Coronary Artery Disease: Causes, Symptoms and Treatment with Dr. Curtiss Stinis | San Diego Health

Did you know coronary artery disease is the most common form of heart disease in the United States? While the heart pumps blood through the body, the coronary arteries are the blood vessels that carry blood to the heart and can be found on the heart’s outer surface. When a person has coronary artery disease, plaque builds up in the walls of the arteries and restricts blood flow to the heart. What are symptoms of coronary artery disease and how is it treated? Scripps cardiologist Dr. Curtiss Stinis answers these questions and more. Learn more: https://www.scripps.org/7254y

0:42 - Where are the coronary arteries located in the heart?
1:10 - What causes blocked arteries?
1:24 - What is atherosclerosis?
1:56 - What causes plaque to build up?
2:11 - What age does plaque build up?
2:33 - What are the signs and symptoms of blocked arteries?
3:05 - What should you do if symptoms are present?
3:26 - If you have shortness of breath, should you go to urgent care or the ER?
3:45 - How is coronary artery disease diagnosed?
4:15 - Who is most at risk for coronary artery disease?
4:42 - Can blocked arteries be reversed?
5:03 - How do you unclog your arteries?
5:53 - Do stents require an overnight hospital stay or is it an outpatient procedure?
6:20 - Can you prevent your arteries from getting blocked?
7:09 - Once you’ve unblocked the arteries, can they become blocked again?
7:45 - Final thoughts

Content

6.17 -> - I am Susan Taylor was Scripps Health

7.75 -> in San Diego, California.

9.43 -> According to the Centers for Disease Control and Prevention,

12.4 -> coronary artery disease is the most common form

15.75 -> of heart disease in the United States.

18.19 -> Our coronary arteries or the blood vessels

20.17 -> that actually carry blood to the heart.

22.41 -> But what happens to them if they start to narrow

24.814 -> or become blocked?

26.52 -> Joining us to talk about this is Dr. Curtiss Stinis.

29.72 -> He is an interventional cardiologist with Scripps Health.

32.8 -> Dr. Stinis thanks so much for being with us.

35.22 -> - Thanks for having me, Susan.

37.02 -> - So let's start with the basics.

38.48 -> Show us where these coronary arteries

40.71 -> are located in the heart.

42.56 -> - Yeah. So I've brought along a model of the heart here.

44.83 -> It's very small.

46.241 -> The heart of course,

47.39 -> is the engine of the body and pumps blood through the body

50.58 -> but it also has its own blood supply.

53.16 -> And those arteries are right on the outside surface

55.46 -> of the heart.

56.5 -> And I have a clear model here,

58.35 -> which might make it a little easier to understand.

60.46 -> So this is a model of the heart,

62.73 -> which shows these red lines here.

64.32 -> These are the coronary arteries

65.87 -> and they're right on the outer surface of the heart.

67.76 -> - So what causes blocked arteries?

71.18 -> - Yeah, that's a great question.

72.39 -> So arteries can become blocked typically from buildup of

75.6 -> fatty deposits and calcium and occasionally from blood clot.

80.43 -> - And what is atherosclerosis?

83.85 -> - Yeah.

84.683 -> So atherosclerosis is the fancy term for

87.14 -> hardening of the arteries,

88.3 -> which is a very common term that people have heard.

91.1 -> And I brought along a little model here to kind of show you

94.22 -> what that looks like.

95.053 -> So a normal artery of course is nice and clean,

98.27 -> but patients that develop atherosclerosis

100.87 -> or hardening of the arteries develop plaque

103.426 -> underneath a very thin wall

105.74 -> inside the artery called the intima.

107.93 -> And those fatty deposits start to narrow the inside

110.9 -> of the artery restricting the flow of blood.

114.11 -> - So what causes that plaque to build up?

116.9 -> - You know,

117.733 -> there are a lot of factors that are involved with this.

119.908 -> There's genetic factors

121.59 -> and then there are of course lifestyle decisions

124.11 -> such as smoking, diabetes and other risk factors.

127.918 -> - And at what age does this plaque start to build up?

131.77 -> - Yeah, unfortunately we think it starts

133.63 -> at a relatively young age.

135.47 -> There've been studies over the years of younger individuals

138.44 -> who have passed away and they've done autopsies

140.58 -> and found that even very early plaques can form

143.73 -> in your twenties and thirties.

145.85 -> So the process can start very early in life

148.28 -> and then progress as we get older.

150.298 -> - So what are the signs and the symptoms

151.87 -> of blocked arteries?

153.78 -> - Typically patients that developed blocked arteries

156.15 -> in the heart will have symptoms when they try to

158.48 -> exert themselves or exercise.

160.39 -> Like shortness of breath, chest pressure or chest pain,

164.398 -> chest tightness.

166.31 -> Occasionally, if the arteries are severely blocked,

169.11 -> the heart muscle will suffer and become weakened

172.4 -> and patients will have fatigue,

174.54 -> maybe some swelling in the legs or feet

177.21 -> and even fluid building up in the lungs

179.32 -> developing a condition called congestive heart failure.

182.685 -> - So if you have these symptoms, what should you do?

185.83 -> - Certainly anyone that has chest pressure,

188.22 -> shortness of breath, any of the symptoms I mentioned,

190.93 -> should definitely seek medical attention.

193.52 -> Your doctor can do some simple tests to determine whether

196.25 -> there's a cardiac or heart problem involved

198.62 -> versus something else.

200.89 -> - So if you have the shortness of breath though,

202.64 -> is this something that you should go to urgent care

204.76 -> or the ER for?

206.37 -> - If it's a chronic condition,

207.75 -> it's probably best to make an appointment with your

210.03 -> primary care doctor or a specialist

211.95 -> to discuss those symptoms.

213.77 -> Certainly if it's a sudden onset or an acute presentation,

217.43 -> it's best to go to the ER or the urgent care.

219.53 -> You don't want to ignore these types of symptoms.

222.251 -> - And how is coronary artery disease diagnosed?

225.96 -> - Yeah, so there's lots of different ways

227.66 -> that it can be diagnosed.

228.82 -> Typically we start with basic testing,

231.01 -> like an electrocardiogram or EKG for short.

234.04 -> Stress testing is a common method that we use

237.09 -> to determine if there's a lack of blood flow

239.02 -> to the heart muscle.

240.41 -> And in patients that we have a very high suspicion,

242.87 -> there are other advanced imaging studies

244.76 -> like CAT scans and angiograms to look at the actual arteries

248.62 -> to determine whether they're blocked up or not.

251.26 -> - So emphasize who is most at risk

253.06 -> for this coronary artery disease.

255.07 -> - If you have a family history,

256.56 -> if anyone in your family has had heart disease

259.127 -> or stroke or other circulation problems,

261.98 -> certainly that increases the risk.

263.633 -> Those that smoke cigarettes or use tobacco products.

267.02 -> Any drug use.

268.5 -> Patients with diabetes are definitely at risk.

271.01 -> Patients with high blood pressure,

272.51 -> high cholesterol or overweight.

275.29 -> These are all risk factors for developing blockage

278.31 -> of the arteries.

279.69 -> - Can these blocked arteries be reversed?

282.73 -> - You know, that's a good question

283.71 -> and somewhat of a controversial question.

286.15 -> There are some studies to suggest that, you know,

289.17 -> certain medications and certain diet and lifestyle changes

291.787 -> may help to slowly make some reversal,

294.53 -> but complete reversal is probably not possible

296.96 -> once there's significant blockage that's built up.

299.88 -> - So then how do you unclog them

301.54 -> because there's great technology out there.

303.74 -> - Yeah. So patients that have mild blockage

306.08 -> can be treated conservatively with diet and exercise

308.97 -> and lifestyle changes as we mentioned.

311.07 -> Patients that already have very significant blockage,

313.83 -> we typically need to do something physically

316.04 -> to restore blood flow to the heart.

318.03 -> And that involves things like stents or bypass surgery.

322.37 -> Stents are small little metal tubes.

324.08 -> Here's an example of one here.

325.35 -> This is a very large stent.

327.02 -> Much larger than would fit in a heart.

328.86 -> In fact, this one is made for a leg artery,

331.45 -> but the concept is the same.

332.66 -> It's a small metal chicken wire mesh tube

335.93 -> that's got some flexibility to it

337.83 -> and this can be placed into the artery

339.69 -> and push that blockage that we described before to the side

343.66 -> and prop open the artery

345.13 -> so that you have a normal size space for blood.

347.76 -> And that's a very common procedure that's done.

350.34 -> - Do you spend the night in the hospital for that

351.97 -> or is that an outpatient procedure?

353.74 -> - Yeah. So most patients that have come in electively,

357.46 -> meaning they have symptoms for a long time

360.33 -> and nothing that's an emergency,

362.08 -> typically those procedures are done as an outpatient basis.

364.85 -> So patients come in,

366.067 -> have a procedure done and go home the same day.

368.85 -> Patients who are sicker,

370.26 -> that maybe they've had a heart attack

371.71 -> or something more acute happened to them,

373.75 -> they may stay in the hospital for several days.

376.17 -> - Can you actually prevent your arteries

378.15 -> from getting blocked in the first place?

380.523 -> - That's the million dollar question, right?

382.56 -> So the answer is we're not totally sure about that

385.49 -> but we do believe that certainly if we make some

388.88 -> lifestyle changes, you know, stop smoking,

391.87 -> get your blood pressure under control,

394.03 -> get your cholesterol under control, eat right, exercise.

397.52 -> If we do those things starting at an early age,

399.98 -> we certainly give ourselves the best opportunity to avoid

403.09 -> developing these problems.

404.8 -> Once these problems exist,

406.46 -> they are a little bit harder, you know, to control,

409.21 -> but we have ways of controlling them.

410.94 -> But preventing it in the first place is challenging

413 -> because again,

414.01 -> genetic factors probably play a large role here.

416.67 -> So knowing if you're at risk and identifying, you know,

419.867 -> signs and symptoms early on is very important.

423.89 -> - And once you have unblocked the arteries,

426.98 -> can they get clogged up again?

429.33 -> - Unfortunately, yes.

430.66 -> So the process that creates the plaque is some sort of

434.02 -> biochemical process that we don't fully understand.

437.12 -> So when we fix the blockage,

439.15 -> we're fixing the physical blockage.

441.58 -> The underlying, you know, condition

444.49 -> that created the blockage still exists unfortunately.

447.17 -> We can control those things to some degree

449.58 -> with the things we mentioned,

451.19 -> medications and diet and exercise,

453.55 -> but there's always a chance that you know,

455.432 -> that blockage can reform in the future.

458.39 -> So anyone that's had blockage problems

460.36 -> is at risk unfortunately for future blockage problems.

463.494 -> - Any final thoughts doctor?

465.472 -> - You know, this is a really common condition.

467.712 -> It affects many, many people.

470.2 -> And unfortunately, in this day and age,

472.53 -> we do have, you know, a larger percentage of our population

475.52 -> that have diabetes and obesity and other factors

477.99 -> so this is a very common disease.

479.93 -> So it's very important to, you know,

481.86 -> see your doctor regularly,

483.37 -> make sure that you're being screened for these things

485.16 -> and make sure that you take good care of yourself

486.84 -> and make good decisions.

488.95 -> - Dr. Stinis thanks so much for being with us.

490.69 -> We appreciate it.

491.98 -> - My pleasure. Thank you, Susan.

493.78 -> - If you want more information about blocked arteries,

496.13 -> just click on the link or go to scripps.org/videos.

499.87 -> For more critical information about your health

501.92 -> we take care of you from head to toe.

503.81 -> Please subscribe to our Scripps Health YouTube channel

506.46 -> and follow us on social media at Scripps Health.

509.22 -> I'm Susan Taylor. Thanks for joining us.

Source: https://www.youtube.com/watch?v=K9HmINKBu-4