Learn About Your Heart...
Made Simple

By Nicolas Shammas, MD

A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics

Statistics about Heart and Blood Vessel Diseases in the United States
Structure and Function of the Heart and Blood Vessels
Diseases of the Blood Vessels of the Heart
Surgical Therapies for the Cardiovascular Patient
Peripheral Vascular Disease
Diseases of the Blood Vessels of the Head and Neck
Strokes: How to Survive Them and How to Prevent Them
Valvular Heart Disease
Heart Rhythms: How to Recognize Them and Treat Them
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test

Click below to view larger images

Figure 1.

Figure 2.


Eric J. Dippel, MD

What are the blood vessels that lead to the brain?

There are 4 major blood vessels that go to the brain: 2 carotid arteries and 2 vertebral arteries. The 2 carotid arteries are in the front part of the neck; these can actually be felt pulsating adjacent to your Adam's apple, just below the angle of the jaw. The 2 vertebral arteries go to the back of the brain and run in the bony portion of the spine. All 4 arteries connect with each other in the brain (see Figure 1).

What is carotid artery disease (CAD)?

Carotid arteries, like the other arteries in the body, can become clogged with cholesterol over time.The risk factors that cause these blockages include high cholesterol, cigarette smoking, diabetes, high blood pressure, and family history. When the carotid arteries become severely narrowed, this can lead to decreased blood flow to the brain, which can subsequently lead to a stroke.

What are the symptoms of CAD?

CAD is not associated with pain in the neck or headaches.When the carotid arteries become significantly narrowed, the blood can actually be heard "whooshing" through the blockage when a physician listens to the neck with a stethoscope. This noise is called a bruit. Some patients might experience chest pain and/or dizziness.

What are the risk factors for CAD?

The risk factors for CAD are the same as for a stroke:

  • Hypertension (high blood pressure)

  • Diabetes

  • A genetic tendency (family history)

  • Prior stroke or transient ischemic attack (TIA)

  • Lack of exercise

  • Poor diet

  • Obesity

  • Uncontrolled stress

  • Excess consumption of alcohol

  • Use of certain drugs that can weaken the heart muscle.

How can a person prevent blockage in the carotid arteries?

The buildup of cholesterol, or atherosclerosis, in the carotid arteries occurs for the same reason cholesterol builds up in other arteries of the body. In fact, many patients that have CAD or peripheral vascular disease (PVD) also have carotid artery disease. Aggressive modification of the risk factors that cause atherosclerosis will prevent the buildup of cholesterol in the arteries. This includes stopping smoking, lowering your cholesterol, controlling diabetes and high blood pressure, maintaining an ideal body weight, and getting regular exercise.

What kinds of tests can diagnose CAD?

The simplest test is merely listening to the neck with a stethoscope for a bruit. Sometimes, however, bruits may be difficult to hear. A more accurate noninvasive test is a carotid Doppler, which is simply an ultrasound of the blood flow through the neck. Computed tomography (CT) scanning and magnetic resonance (MR) scanning can also be helpful in providing 3-dimensional images of the carotid and vertebral arteries. Finally, the "gold standard" is an angiogram, which is an invasive test where a catheter is inserted in the groin and threaded up to the carotid and vertebral arteries. Contrast dye is injected through the catheter, and x-ray movie pictures are taken of the arteries in the neck.

When should a person have a procedure to open the neck arteries?

Whether or not carotid arteries should be treated with a procedure to open them up depends on several factors. One of the primary factors is whether the patient has had a prior symptom, such as a stroke or TIA, and the second major factor is the degree of stenosis, or narrowing in the artery. In combination, these findings have provided a framework for who should have a procedure to open the arteries versus who should simply continue on medical therapy to prevent further buildup of cholesterol.

How can blocked arteries in the neck be reopened?

Historically, the primary way to open up the carotid arteries is with surgery. This procedure has been performed for approximately 50 years and involves a surgeon cutting open the artery, scraping out the plaque, and sewing the artery back together. This procedure is known as a carotid endarterectomy (CEA). Within the past few years, however, technology has evolved to the point where now the arteries can be opened with a balloon and a stent via a catheter inserted through the groin under minimally invasive techniques. Recent data comparing carotid stenting versus surgery suggest that in certain high-risk groups of patients, stenting appears to be superior to surgery. Ongoing studies are being conducted to evaluate the most appropriate procedure for lower-risk patients.

What is an aneurysm?

An aneurysm is a weakened segment of an artery that is bulging out, similar to the way a garden hose will bulge out at a weak point. The problem with aneurysms is that they are prone to rupture, which will cause bleeding in the brain and a stroke. Unfortunately, however, most people do not know that they have an aneurysm in their brain until it ruptures, because they typically do not have any symptoms beforehand, other than possible nonspecific headaches. Aneurysms are usually a genetic problem, so if there is a family history of aneurysms, it would be worthwhile to be screened (see Figure 2).

How are aneurysms in the brain treated? The traditional way to treat aneurysms in the brain was by surgery to clip the aneurysm sac. However, with recent advances in cardiac procedures, it is now possible to thread a small catheter up the artery from the groin into the brain and place small coils inside the aneurysm. The advantages of using the catheters are that the skull does not have to be opened and the recovery time is significantly less.

Summing up...

If you smoke, stop. Eat healthfully, maintain an appropriate body weight, and get plenty of exercise. If you have high blood pressure, get it under control with a combination of weight loss, healthful eating, exercise, and medication as prescribed by your doctor. If you have a family history of aneurysms, get screened.

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