Coronary Artery Disease

Right after I was diagnosed with lupus, I began having occasional episodes of shortness of breath and sweating-when it wasn't even hot out! Initially, these were only mild inconveniences so I continued an active life. It was when they worsened, that I consulted a lung speicalist (pulmonologist).

He ordered blood tests and a high-resolution CT scan of my lungs to determine if there were easily explained complications of lupus that could be the cause. No.

Even with oxygen and lung medications, the shortness of breath worsened. More tests. All normal. One by one, potential causes led to more tests: again, all normal. Then, I was referred to a heart doctor (cardiologist); more tests.

An echocardiogram led the cardiologist to believe that I needed a stress test. Usually done on a treadmill. the goal of this test is to see how the heart muscle responds to stress. This time, results weren't so normal; I had coronary artery disease (CAD) made worse by lupus.

As blood circulates throughout the body, it transports oxygen and nutrients to organs. In addition, fats, cholesterol and calcium also circulate in the blood.

If excess fats, cholesterol and calcium are deposited on artery walls, they form what is known as plaque. This narrows the arteries. Gradually, plaque hardens, decreasing elasticity of arteries; a condition often referred to as 'hardening of the arteries.' This process is called arteriosclerosis.

If arteries develop enough plaque, the heart has to pump harder to get oxygen to the cells and the patient develops symptoms: chest pain (angina) and shortness of breath: coronary artery disease.

Heart disease is the number one killer in the US and its risk factors are often divided into modifiable and unmodifiable risk factors. Modifiable risk factors are those you can change. Unmodifiable risk factors are those you can't change.

According to the American Heart Association, the major risk factors for developing CAD (coronary heart disease) are smoking, hypertension, high amounts of fats and cholesterol in the blood, obesity, inactivity and high amounts of sugar in the blood resulting from diabetes.

Of all causes of CAD, cigarette smoking is the most modifiable. Smoking also accelerates the process of atherosclerosis and increases LDL cholesterol, decreasing HDL cholesterol.

Hypertension causes heart disease by continually exerting pressure on the artery walls, increasing their susceptibility to CAD and making the heart work harder.

High amounts of dietary fat and cholesterol are other modifiable risk factors. So are obesity, inactivity and high amounts of sugar from diabetes.

Unmodifiable risk factors are age, gender, heredity or race. They are unmodifiable and can't be changed. You can't help if you were born with a blood disorder, are in your 60s, African American or Mexican American

A test to determine the extent of coronary artery disease is the cardiac catheterization. In this test, an intravenous line is begun and you are given a mild sedative to help you relax. Then the cardiologist numbs the skin in your groin or arm and inserts a hollow catheter through an artery into the heart. Then, the doctor injects dye through the catheter and visualizes the coronary arteries on x-ray.

During this procedure you are awake, and you may feel pressure at the catheter insertion site. But you won't notice pain. You may feel flushed when dye is injected to visualize your coronary arteries. When the doctor is done taking x-rays, the catheter is removed and the site in the groin or arm is bandaged very carefully. Because it is an artery, there is a great risk of bleeding.