Coronary heart disease is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. But what about coronary artery disease? Is there a difference?

The short answer is often no — health professionals frequently use the terms interchangeably.

However, coronary heart disease , or CHD, is actually a result of coronary artery disease, or CAD, said Edward A. Fisher, M.D., Ph.D., M.P.H., an American Heart Association volunteer who is the Leon H. Charney Professor of Cardiovascular Medicine and also of the Marc and Ruti Bell Vascular Biology and Disease Program at the NYU School of Medicine.

With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. This is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to Fisher. Obesity may also be a risk factor.

24-Hour Holter Monitoring

A Holter monitor is a portable EKG that monitors the electrical activity of a freely moving person's heart, generally for one to two days, 24 hours a day. It is most often used when the doctor suspects an abnormal heart rhythm or ischemia, which means not enough blood flowing to the heart muscle.

It is a painless test – electrodes from the monitor are taped to the skin. Once the monitor is in place, you can go home and perform all of your normal activities, except showering. You will be asked to keep a diary of your activities, any symptoms you experience and when they occur.

What is an event monitor?

If your symptoms are infrequent, your doctor may suggest an event monitor. This is a device that, when you push a button, will record and store the heart's electrical activity for a few minutes. Each time you develop symptoms you should try to get a reading on the monitor. They are used for weeks to months, typically one month. This information can later be transmitted by telephone to the doctor for interpretation.

What is a Holter scan?

After the patient wears the Holter monitor for a 24-hour period, he or she brings the monitor back and a technician scans through more than a hundred thousand beats looking for any irregular rhythms or rates. The technician interprets the findings, creates a written report and has it reviewed by an electrophysiologist. Finally, the report is sent to the referring physician.

The Cardiac Event Monitor is small device, about the size of an iPod, that is worn on the chest and is used to detect abnormal heart rhythms. When patients feel an “event,” such as dizziness, weakness or palpitations, they push a button on the device. The monitor stores the event and it is later sent over a telephone line to the cardiologist for review.

This test allows for on-demand heart monitoring outside the office setting as patients go about their normal routine. The monitor can be worn for up to 30 days and is only removed for bathing.

CARDIAC CATHETERIZATION/CORONARY ANGIOGRAM

An invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to your heart with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your valves, coronary arteries and heart chambers are taken.

Your doctor uses cardiac catheterization to:

• evaluate or confirm the presence of heart disease (such as coronary artery disease, valve disease or disease of the aorta)

• evaluate heart muscle function

• determine the need for further treatment (angioplasty or bypass surgery)

The x-ray camera is used to take photographs of the arteries and heart chambers. When all the photos have been taken, the catheter is removed. The cardiac catheterization procedure only takes about 30 minutes but requires several hours from the preparation through the recovery time.

Types of Angioplasties

LOWER EXTREMITY ANGIOPLASTY; CAROTID ANGIOPLASTY; RENAL ANGIOPLASTY;

Patients suffering from pain with walking, claudication or nonhealing ulcers may benefit from lower extremity Angioplasty and stent placement to increase the circulation to the legs. In addition, patients who have had strokes, dizziness or fainting spells may have blockages in the carotid arteries (the arteries that supply the brain). In the past surgery was the only alternative. Now we can offer carotid angioplasty and stent placement without the need of general anesthesia and prolonged hospital days to open these arteries. Similar angioplasty and stent techniques can be applied to the kidney arteries to treat patients with severe high blood pressure.

LASER ANGIOPLASTY

A laser device is utilized to open blocked arteries in the chest, legs and heart by pulverizing plaque that lines the arterial walls.

ANGIOPLASTY WITH STENTING

In most cases, balloon angioplasty is performed in combination with the “stenting” procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent.

ECHOCARDIOGRAM

An Echocardiogram is an ultra-sound of the heart. It uses sound waves to create a moving picture of the heart that is more detailed than x-ray and involves no radiation exposure.

A trained sonographer performs the test, then your physician interprets the results. An instrument that transmits high-frequency sound waves called a transducer is placed on your chest near the breast bone and directed toward the heart. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses, which are then converted into moving pictures of the heart.

STRESS ECHOCARDIOGRAM

The stress echocardiogram combines an echocardiogram with the standard treadmill stress test. It tests the heart's reaction during periods of rest and exercise. The echocardiogram uses high-frequency sound waves (ultrasounds) to look at how the various parts of the heart work. If Coronary Artery Disease is present, the stress echo will often note changes in how the heart muscle contracts.

TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE)

If a standard echocardiogram is unclear due to an obstruction, it may be necessary to perform a transesophageal echocardiogram. With TEE, the back of the throat is anesthetized and a scope is inserted. On the end of the scope is an ultrasonic device that a cardiologist will guide down to the lower part of the esophagus, where it is used to obtain a clearer, two-dimensional echocardiogram of the heart.