Blocked Arteries

Woman taking a cardiopulmonary stress test in clinic.jpg

Narrowed or blocked arteries refer to the buildup of fat and cholesterol (plaque) within the walls of the arteries. They’re most often associated with the heart (coronary artery disease) and can lead to heart attack and stroke. Ankur Vyas, MD, MS, interventional cardiologist at UnityPoint Health, outlines blocked artery symptoms, treatments and how to minimize arterial blockages and reduce the risk of heart attack and stroke.

What Causes Blocked Arteries?

Arterial blockages are caused by plaque, which builds up as a person ages. Over time, the buildup can disrupt or stop blood flow to the heart as well as to the brain, kidneys, legs and other areas of the body.

“Plaque buildup is affected by multiple factors, many of which we can control and some we cannot,” Dr. Vyas explains. “Uncontrollable factors include family history, genetics and age.”

Controllable risk factors are minimized with lifestyle modifications, such as:

What are the Signs and Symptoms of a Blocked Artery?

Because they can occur in any part of the body, Dr. Vyas says signs of a blocked artery vary. When it comes to symptoms of a blocked artery in the heart, he says it depends on when or how quickly they appear.

Chronic Coronary Artery Disease
  • Chest pain, especially with exertion 
  • Shortness of breath, especially with exertion 
  • Arm pain
  • Heartburn-like feeling

“Signs of chronic coronary artery disease, or slowly evolving blockages, primarily occur during activity,” Dr. Vyas describes. “Classic symptoms are chest pain or shortness of breath with exertion. In some people, symptoms manifest as arm pain or feel like heartburn, but the underlying theme is symptoms of chronic coronary artery disease happen when you’re active and resolve at rest."

Acute Artery Blockage

“Acute blockages are the bigger thing we’re trying to prevent,” Dr. Vyas reports. “They’re caused by plaque rupture, where the buildup of plaque cholesterol suddenly opens, forms a clot and causes either a total or partial obstruction of an artery. It’s the sudden disruption of blood flow to significant areas of the heart that, if left untreated, can lead to permanent damage.”

Dr. Vyas says symptoms of a sudden blocked artery are heart attack symptoms, which are more severe and can happen at rest or with activity. They include chest pain, sudden shortness of breath, chest discomfort radiating to the arm or jaw or a combination of these. They don’t resolve right away, either.

“The best thing to do if you have symptoms of a heart attack is to call 911 to go to the nearest emergency room for an evaluation,” he advises.

  • Trouble with balance
  • Blurred vision
  • Drooping face
  • Weakness on one side of the body
  • Slurred speech

In a stroke, Dr. Vyas says the sudden onset of symptoms is similar to what happens with heart attack.

“A stroke is a sudden event, typically when a new clot forms, goes ‘downstream’ and lodges in an artery of the brain,” he explains.

“Stroke symptoms include trouble with balance, blurred vision, drooping face, weakness on one side of the body and slurred speech,” he describes. “Like a heart attack, a stroke is a medical emergency that requires immediate attention to prevent long-term damage.”

Blocked Artery in the Leg
  • Pain in the calf when walking, especially going uphill
  • Loss of sensation
  • Numbness
  • Severe pain in the leg
  • Pale appearance

Dr. Vyas says if arterial blockages develop in the legs, symptoms typically occur with activity and go away within a few minutes of rest. Signs of a chronic blocked artery in the leg may feel like pain in the calf when walking, especially when going uphill. Symptoms of an acute, new blockage include sudden loss of sensation, numbness or severe pain in the leg or pale appearance.

These, too, are a medical emergency that requires urgent emergency room evaluation.

How Do You Test for Blocked Arteries?

Symptoms of blocked arteries determine how a patient is evaluated. In an acute event like a heart attack, Dr. Vyas lists several steps used to evaluate if a blocked artery is the cause. They include:

  • Electrocardiogram (EKG/ECG)
  • Lab tests for heart muscle damage
  • Stress testing
  • Invasive testing, such as coronary angiogram

A stress test may be done with exercise, such as walking on a treadmill, while technicians monitor the heart’s activity, or it may involve other methods. A coronary angiogram is done via catheter and uses X-rays to show blocked arteries from within the heart.

“In patients presenting with chronic symptoms, we often start with a stress test. If that’s abnormal, we may move to more invasive evaluation like coronary angiography,” Dr. Vyas says. “In some patients, a CT coronary angiography is useful as well.”

CT coronary angiography is a type of test that detects arterial blockages from outside the body.

For those with a family history of heart disease, Dr. Vyas recommends checking with their provider about a CT calcium score test, which estimates the amount of calcium buildup around the heart arteries. Those with higher numbers benefit from earlier, more aggressive medical treatment.

Testing for symptomatic blockages in peripheral arteries, those that carry blood to the rest of the body, is done using angiograms, ultrasound and CT scans.

How Do You Treat Blocked Arteries?

Treatment of arterial blockages depends on the presentation. You can live a long time with blocked arteries with appropriate management. They can often be treated without surgery, using minimally invasive procedures as well as medicine.

“Medication is the cornerstone of treating chronic arterial blockages involving the heart arteries,” Dr. Vyas explains. “The overall goal is to improve symptoms and reduce long-term risk of heart attacks. Medical therapy has been effective for both.”

He says medications can prevent clots, improve blood flow, reduce cholesterol plaque buildup, slow heartbeat, lower blood pressure, reduce stress on the heart and improve cardiac healing.

“Medications that lower cholesterol, especially statins, are some of the most effective medical tools to reduce long-term risk of heart attacks,” he points out.

For patients with chronic blocked arteries who remain symptomatic despite medical therapy, or who have high-risk findings on stress testing, Dr. Vyas says invasive treatment and stent placement are options. In some high-risk cases with extensive blockages, coronary artery bypass surgery may be considered.

“In acute blockages, medications are essential, but procedures are often required,” Dr. Vyas describes. “For someone who presents with heart attack symptoms, they typically need invasive therapy – urgent coronary angiography, heart catheterization and stenting.”

Treatment for blocked arteries in the legs or peripheral arteries may, again, include invasive procedures as well as medical therapy, depending on symptoms and clinical presentation.

What Can You Do to Avoid Blocked Arteries?

Because there’s no cure for blocked arteries, Dr. Vyas stresses managing risk factors.

“Putting in a stent doesn’t reduce the risk of future problems,” Dr. Vyas emphasizes. “The main way to reduce the long-term risk of arterial blockages – especially to prevent a heart attack and stroke – is to reduce risk factors. Making lifestyle modifications and aggressively treating contributing factors such as diabetes, high blood pressure and high cholesterol are essential.

“Routine physical examinations with primary care providers are an important step in helping reduce these risk factors and are the foundation of long-term health.” 

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