Chronic Total Occlusions

What are Chronic Total Occlusions (CTOs)?

CTOs occur in as many as 30% of patients with complex coronary artery disease. The symptoms may include:

• Chest pain, tightness or pressure
• Dizziness
• Fatigue
• Irregular heartbeat
• Nausea
• Racing or rapid heartbeat
• Shortness of breath (dyspnea)
• Upper arm pain

CTO symptoms often worsen when you exert yourself and lessen during rest. However, you may also experience symptoms while at rest. You may also have no symptoms at all.

What are the risk factors of CTOs?

Some of these risk factors can be changed or reduced and some of them cannot. Lifestyle changes, medication management and knowledge are just some of the ways to help lower your risk.

What increases my risk for CTOs?

• Age older than 55 years
• Being a man
• Being a woman who smokes and takes birth control pills, or in menopause
• Diabetes, high blood pressure, high cholesterol, or atherosclerosis (hardening of the arteries)
• A heart problem, such as a coronary artery spasm, heart valve disease, or an enlarged heart
• A history of smoking, being around secondhand smoke, or using cocaine
• Not enough exercise, or being overweight

How are CTOs diagnosed?

Healthcare providers typically diagnose a chronic total occlusion using a coronary angiogram. During a coronary angiogram, your provider injects a contrast dye into your blood vessels. The dye highlights your blood vessels on an X-ray and shows how blood moves through your coronary arteries.

Your provider may also use tests such as a:

• Cardiac MRI to look at the anatomy and blood flow in your heart.
• Cardiac stress test to view how your heart responds to exercise.
• Echocardiogram (echo) to evaluate your heart walls, valves, and see how blood flows through your heart.
• Electrocardiogram (EKG) to look at the electrical signals and rhythm of your heart.

How is CTO treated?

A CTO treatment plan typically focuses on lowering symptoms and reducing your risk of a heart-related event such as a heart attack. The treatment you need depends on how severe your symptoms are and whether you are already on a treatment plan for coronary artery disease. Your provider may recommend:

• Medications to help reduce frequency and intensity of chest pain, prevent future blockages and reduce the risk of myocardial infarction
• Angioplasty and stenting help open the coronary arteries and allow blood to flow to the heart.
• Coronary artery bypass graft (CABG), or open heart surgery, can improve blood flow to the heart. This will help decrease your chest pain and prevent a heart attack.

When should I seek immediate care for a CTO?

Call 911 if:

• You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns
  • Discomfort or pain in your back, neck, jaw, stomach, or arm
  • Trouble breathing
  • Nausea or vomiting
  • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing
• You have chest pain that does not go away after you take medicine as directed.
• You lose feeling in your face, arms, or legs, or you suddenly feel weak.

When should I contact my healthcare provider?

• Your CTO symptoms are happening more frequently, lasting longer, or causing worse pain.
• You have blood in your urine or bowel movements, or you vomit blood.
• You are dizzy or nauseated after you take your medicine.
• You have trouble breathing at rest.
• You have new or worse swelling in your feet or ankles.
• You are bleeding from your gums or nose.
• You have questions or concerns about your condition or care.