ESOPUS Illustration: Coronary Artery Disease

final illustration

Background Information

Coronary artery disease is the number one cause of death in the United States. It occurs when the coronary arteries are damaged or blocked, most often by cholesterol plaque. As plaques gather in the vessel, blood flow gradually decreases and results in chest pain and shortness of breath. Excessive yawning has also been observed, potentially to relieve chest tightness or from a vasovagal reaction from the Vagus nerve acting on blood vessels, indicative of heart defects.

Diagnosis of coronary artery disease often involves a stress test to observe the severity of the disease. Signs and symptoms are displayed during the test because the heart is not receiving enough blood or oxygen while under the stress of exercise. Those with coronary artery disease will show abnormal changes in heart or blood pressure, shortness of breath or chest pain at low levels of exercise, abnormal changes in heart rhythm or electrical activity, and they will also be unable to exercise for long.

Once the patient is confirmed to have coronary artery disease, an angiogram is performed to view the blockages. A fiber optic cardiac catheter with a viewing tube is inserted into the clogged artery and the vessels are filled with contrast dye. The catheter is usually inserted into the groin or arm and then eventually fed into the artery. X-ray images are taken with the dye highlighting sites of sudden vessel narrowing that indicate blockages.

Finally a coronary artery bypass graft (CABG) is used to remedy blood flow by grafting an additional vessel, taken from another part of the body, onto the heart that will circumvent the blockage. This procedure is often used on patients with multiple narrowing in multiple coronary artery branches, such as patients with diabetes. A successful CABG procedure normally guarantees long term survival in patients that have narrowing in the left main coronary artery or multiple arteries. Commonly used vessels for the graft are pieces of the great saphenous vein from the leg, left internal mammary artery, right internal mammary artery, or internal mammary field.

Second Color Draft

Project Goals

This project was based on a testimony submitted to the ESOPUS magazine which described the reader's experience with coronary artery disease. We were to create an illustration based on this testimony which recounted excessive yawning and stretching to relieve a tightness in the chest. The testimony went on describe experiences with the diagnosis and treatment, including a stress test, an angiogram, and finally a CABGx5 surgery to remove the blockages.


With a CABGx5 surgery, the most common vessels to be blocked are the left anterior descending artery, right coronary artery, obtuse marginal branch of the circumflex, diagonal branch of the left anterior descending, and the distal circumflex. With two of these vessels being in the posterior of the heart, we decided to focus on the grafts of the anterior side rather than overwhelm the audience by trying to show both sides with all of the grafts. The testimony was vivid in its explanation of how it felt during the diagnosis, therefore we limited the composition to what the main points were while trying to convey the sensation that the reader described as their heart feeling cold and 'floating in mercury' when they learned they would have to undergo this surgery. Tying the elements together in the background is the fiber optic catheter the reader mentioned that was used to visualize the blockages during the angiogram.



Date Started: 11/18/2014
Date Completed: 02/10/2015
Client: ESOPUS Magazine
Audience: General public
Materials: Adobe Photoshop
Final Deliverable: 8" x 9.5" magazine illustration for print