CORONARY ARTERY DISEASE

Coronary artery disease (called CAD for short) is the most common type of heart disease.

It happens when your coronary arteries – which act like fuel lines to supply blood rich with oxygen and nutrients to the heart – become damaged or diseased. The main cause is a buildup of fat and cholesterol in the blood that sticks to the inner walls of the arteries (this is also called atherosclerosis). An unhealthy lifestyle, including a poor diet and lack of exercise, increases your risk of developing heart disease. In some cases, a family history of CAD plays a role.

Over time, the arteries can narrow or become blocked. Keep in mind, CAD typically develops over decades, so many people don’t even know they have it until it starts causing problems. Also, the disease affects blood vessels throughout the body. It’s important to understand that even if major narrowing is found in one place, other areas likely also have some disease.

When you have CAD, your heart muscle may not get the blood and oxygen it needs. This can result in chest pain (angina) or a heart attack. For many people, this may be the first sign they have CAD. CAD is often to blame for heart failure and heart rhythm disorders (arrhythmias), too.

You are more likely to develop CAD and other heart problems if you are overweight, smoke, or don’t exercise regularly. Having diabetes, high blood pressure or high cholesterol also increases your risk. Luckily, heart-healthy choices can make a big difference.

The sooner you can make positive changes to support your heart health, the better. The goal is to reduce your risk of heart problems down the line. Use this condition center to learn more about coronary artery disease.

Coronary artery disease is the most common type of heart disease. But because CAD usually progresses over many decades, you may not know you have it until it starts causing symptoms.

CAD develops when your coronary arteries, which are blood vessels supplying blood rich with nutrients and oxygen to the heart, become damaged or diseased. Most often, CAD develops from a buildup of plaque – fat, cholesterol, and other substances – that collect in the walls of the coronary artery (called atherosclerosis).

Over time, this plaque can harden, and the arteries can become narrow or blocked. When this happens, blood supply to the heart becomes restricted. As a result, the heart doesn’t get the oxygen and nutrients it needs. This can lead to chest pain, heart attack, heart failure and some heart rhythm problems.

CAD is sometimes called atherosclerotic heart disease or coronary heart disease.

The signs of coronary artery disease can vary. Some people have no symptoms at all, which is fairly typical during the early stages of the disease. For others, chest pain or chest pressure – or even a heart attack – might be the first sign of blockages in the heart’s arteries.

Chest pain or discomfort (also known as angina) is the most common symptom of reduced blood flow to the heart. It occurs when the heart isn’t getting enough oxygen or blood. People describe it as pain, pressure, squeezing or fullness in their chest. But this feeling can also be very subtle.

Chest pain or discomfort can be brought on by activity or extreme emotion, but it usually goes away with rest. You may also feel short of breath, weak or unusually tired.

Severe narrowing or blockage of an artery can also lead to heart attack, which can happen when plaque ruptures into the artery and a clot forms to heal the injury.

When to Call for Help
If you think you are having a heart attack, don’t question it. Act fast and dial 911 if you or a loved one has any of these symptoms.

Heart Attack Symptoms

Chest pain or discomfort is the most common symptom of a heart attack for both men and women. But women are more likely than men to have additional symptoms, such as nausea and shortness of breath.

Chest Pain Can Feel Like Other Symptoms Include
  • Chest pressure, tightness, squeezing or burning
  • Discomfort in your chest, shoulders, arms, back, neck, or jaw
  • Pain that travels down one or both arms
  • Shortness of breath
  • Unusual or extreme tiredness
  • Feeling dizzy or lightheaded
  • Nausea or vomiting
  • Cold sweat
  • Anxiety
Anyone with risk factors for heart disease can develop coronary artery disease. But it’s more likely as you get older and if you:

  • Have high blood pressure, high cholesterol or diabetes
  • Smoke
  • Are overweight or obese
  • Don’t lead a very active lifestyle
  • Eat a high-fat, poor diet
  • Have a family history of early heart disease (genetics), meaning if your mother, or a sister or daughter has heart disease before the age of 65; or if your father, or a brother or son has heart disease before the age of 55

Although you can’t change your genetic risk for heart disease, there are risk factors that you can change to help protect yourself. Learn more about healthy habits such as eating better, moving more, maintaining a healthy weight, and not smoking on this website in our healthy living section.

Your health care team will take a medical history, ask about your symptoms and listen to your heart with a stethoscope.

Your care team also may order tests to determine whether you have coronary artery disease and to what extent.

The results of these tests can also help guide treatment decisions.

Tests may include:

  • Routine blood tests to check the level of fats, cholesterol, sugar and proteins in your blood. These are risk factors for heart disease that can be modified with lifestyle changes and, if needed, medication.
  • Electrocardiogram (ECG), which records your heart’s electrical activity and shows how fast or evenly the heart is beating. It can also show whether there is enough blood supply to the heart or if it is already damaged.
  • Echocardiogram to look at the structure and overall function of your heart.
  • Stress testing, which involves exercising, usually on a treadmill or stationary bike (or taking medicine to simulate exercise if you are unable to be active), to non-invasively evaluate blocked arteries in the heart.
  • Chest X-ray to look at the heart and lungs and to see if there are abnormalities that might explain your symptoms.
  • Computed tomography (CT) angiography scan of the heart that shows pictures of the heart’s arteries and whether there is a buildup of plaque, even in the early stages before the plaque hardens.
  • Coronary angiogram is done in the cardiac catheterization laboratory. It involves threading a thin tube or catheter into an artery, usually in the wrist or leg, and up to the heart. Dye is injected into the artery to evaluate it for any blockage. This test usually is recommended when a non-invasive one is abnormal, or a patient’s symptoms strongly suggest CAD, or after a heart attack.

What Do the Results Mean?

Your care team might tell you that you have “less than 70% blockage in an artery.” That means that you have non-obstructive CAD. In other words, blood flow to the heart muscle is not reduced at rest but may be limited during intense exercise or exertion. In this case, risk reduction through lifestyle and medication is the best treatment.

Or your care team might say you have “over 70% blockage in one artery.” This means that you have a severe blockage in a coronary artery. Blood flow to a portion (or portions) of the heart muscle is greatly reduced and would likely explain any chest pain or shortness of breath you may have been feeling. In this case, your care team might recommend stepped up medical treatment, and possibly a procedure or surgery.

There are a number of treatment options for coronary artery disease, including lifestyle changesmedicationssurgery or medical procedures.

Your treatment will depend on the following:

  • How much narrowing there is and where it is (if it’s near the heart muscle or if the branches are involved)
  • How many arteries are affected
  • Your symptoms
  • Your age and overall health
  • Other risk factors
  • Your preferences

Lifestyle Changes

Lifestyle changes include:

Adopting a heart-healthy, plant-rich eating plan
Exercising regularly
Getting to a healthy body weight
Not smoking
Managing stress
Sleeping enough
Establishing more social support

Medications

Medications may be recommended to treat high cholesterol, high blood pressure, and high blood sugar.

Sometimes, medications for chest pain that comes on with activity are recommended.

Aspirin or other blood thinners may also be recommended.

Procedures or Surgeries

Procedures or surgeries may be recommended if you have a severely narrowed coronary artery to reduce the risk of a heart attack.

There are two main ways to improve blood flow to the heart:

Placing a stent to prop open the artery, typically through a small tube placed in a blood vessel in the wrist (percutaneous coronary intervention).
Having open-heart surgery, or coronary artery bypass (CABG) surgery, to re-route blood around the blocked or narrowed area by using other arteries or veins in the body.

Cardiac Rehabilitation

Cardiac rehabilitation (rehab) is a 12-week program that includes a mix of supervised exercise, nutrition counseling, stress management and help to quit smoking. It also teaches you about the disease, including how you can better take control of your health and improve outcomes.

Intensive cardiac rehab might be available in your area and consists of 9 weeks of 4-hour sessions two times per week. In these sessions you get supervised exercise, as well as an hour of nutrition counseling and a meal, an hour of stress relief, and an hour of group support. The outcomes from this intensive program are usually even better than traditional cardiac rehab.

Cardiac rehab is good for patients with angina (chest pain) or heart failure, or who have had a heart attack, coronary procedure, heart valve surgery or heart transplant.

Being told that you or a loved one has CAD can be upsetting. But you’re not alone and there is good news: More people are living with CAD than ever before thanks to finding it early and better treatments.

Steps you can take to help prevent problems and feel better:

  • Learn all you can about your condition. It will help you to ask the right questions, and know how to manage it.
  • Make heart-healthy choices every day. Simple changes can make a big difference.
  • Ongoing care is important. Your heart team will want you to come in for routine visits and imaging tests to help track your condition. It’s important to keep these appointments. Be prepared to talk about any changes in your health or how you are feeling.
  • Find an exercise program that’s right for you. Talk with your health care team about what type of physical activity is best, and how often you should be active.
  • Ask your family and friends to help you adopt – and keep up with – healthy habits. Think about ways to make it fun. For example, cooking a new, healthy meal together or planning get-togethers around activities such as taking a nature hike, riding bikes or trying a new exercise class.
  • Take your medications as prescribed. Medications don’t work the way they should if you don’t take the right dose at the right time. Talk with your heart doctor and pharmacist if you don’t know how to take your medications or what their role is.
  • Ask whether talking to a nutritionist or dietitian might be helpful. A nutritionist or dietitian can look at your eating patterns and map out a plan for making heart healthier choices, and also give tips on how to control portions and how to prepare foods.
  • Seek counseling or join a support group, especially if you feel depressed or anxious. Untreated depression or high stress is linked to worsening heart disease, including heart attacks.
  • Find positive ways to cope with stress. Too much stress can be bad for the heart – and your general health.

Your care team knows what’s best in terms of supporting your heart health. Learn all you can about coronary artery disease, and share any concerns or questions with your health care team.

Here are some questions you might want to ask:

  • What might be causing my coronary artery disease?
  • To what extent are my arteries blocked or narrowed?
  • How does this condition relate to how I’m feeling?
  • What treatment do you suggest?
  • How will we know whether treatment is working?
  • Are there tests to show whether my condition is progressing?
  • Are there certain symptoms I should pay attention to or report?
  • Is there a specific eating plan I should try to follow? What about exercise?
  • Do I need to have a procedure to open my arteries?
  • Is cardiac rehab an option?
  • How do I know if my chest pain is a heart attack?
  • Do I need to take all the medications I was given after a heart attack for the rest of my life?
  • What can I do to prevent a second heart attack?
  • Are my children or siblings at risk for coronary artery disease? If so, what do they need to do?

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