Coronary artery disease (CAD) is a prevalent form of heart disease that impacts the coronary arteries, which are responsible for delivering blood to the heart muscle. This condition occurs when blood flow to the heart is restricted due to a buildup of plaque – a mixture of fats, cholesterol, and other substances – on the artery walls, a process known as atherosclerosis. Over time, the narrowing of these arteries limits blood supply to the heart.
CAD typically progresses over several years, with symptoms arising as the heart struggles to receive sufficient blood. Common symptoms include chest pain and shortness of breath. A complete blockage of an artery can lead to a heart attack.
Treatment options for CAD include medication and surgical interventions. Preventive measures, such as maintaining a healthy diet, exercising regularly, and avoiding smoking, can lower the risk of developing CAD and related conditions.
Symptoms
The symptoms of coronary artery disease appear when the heart doesn’t receive enough oxygen-rich blood. These symptoms may include:
- Chest pain (angina): Often described as pressure, tightness, or a heavy sensation, this discomfort typically occurs in the middle or left side of the chest. It can be triggered by physical activity or intense emotions. Angina can vary in severity and response to rest or medication. Some individuals, especially women, may experience brief or sharp pain in areas like the neck, arm, or back.
- Shortness of breath: A feeling of difficulty in catching your breath.
- Fatigue: When the heart struggles to meet the body’s demands, you may feel unusually tired.
Initially, symptoms may only occur during physical exertion. However, as the disease progresses and the arteries narrow further, symptoms can become more frequent or severe.
A fully blocked coronary artery results in a heart attack. Symptoms of a heart attack can include:
- Chest discomfort resembling pressure, tightness, or aching.
- Pain or discomfort radiating to the shoulder, arm, back, neck, jaw, teeth, or upper abdomen.
- Cold sweats.
- Fatigue.
- Nausea or heartburn.
- Shortness of breath.
- Lightheadedness or sudden dizziness.
While chest pain is the most common sign of a heart attack, some individuals – particularly women, older adults, and people with diabetes – may experience atypical symptoms, such as nausea or mild neck or back pain, or in some cases, heart attacks occur without noticeable symptoms. This is called Silent ischemia. Silent ischemia is usually not discovered until someone undergoes a stress test for another reason, like angina or cardiovascular disease risk. An electrocardiogram may also find evidence of ischemia. A Holter monitor is a long-term electrocardiogram. You wear a heart monitor for one or two days, and your heart rate and rhythm are monitored the whole time. If you have an episode of ischemia during that time and you didn’t experience any symptoms during the episode, your doctor may diagnose silent ischemia.
When to Seek Medical Help
If you suspect you’re having a heart attack, call the ambulance immediately. If this isn’t an option, have someone drive you to the nearest hospital.
Certain factors, such as smoking, high blood pressure, high cholesterol, diabetes, obesity, or a family history of heart disease, increase the likelihood of developing CAD. If you are at higher risk, consult your cardiologist about potential tests to assess for narrowed arteries or CAD.
Diagnosis
Coronary artery disease is diagnosed through a combination of medical history review, physical examination, and diagnostic testing. Individuals presenting with symptoms such as chest discomfort or difficulty breathing may undergo various tests to assess heart function and overall health.
Diagnostic Tests
A range of tests may be utilized to identify or monitor coronary artery disease:
- Blood tests: These evaluate cholesterol levels and blood sugar. Additionally, a high-sensitivity C-reactive protein (CRP) test may be used to detect inflammation associated with artery damage.
- Electrocardiogram (ECG or EKG): This test records the heart’s electrical signals using adhesive electrodes placed on the chest, arms, or legs. Results can indicate current or previous heart attacks by revealing abnormal heart rhythms or activity.
- Echocardiogram: By using sound waves, this imaging test shows how blood moves through the heart. Areas with reduced movement may suggest damage from insufficient oxygen supply or a prior heart attack.
- Exercise stress test: For symptoms that appear during physical activity, this test monitors heart performance while walking on a treadmill or cycling on a stationary bike. When physical exercise isn’t possible, medication simulating exercise effects may be administered. An echocardiogram may be performed simultaneously in some cases.
- Nuclear stress test: In this test, a radioactive tracer is injected to visualize blood flow to the heart both at rest and under stress. Images produced by a scanning device can reveal areas with limited blood supply or previous damage.
- Heart CT scan: This imaging test identifies calcium buildup and arterial blockages. When contrast dye is used to enhance image detail, it is referred to as a CT coronary angiogram.
- Cardiac catheterization and angiogram: A thin catheter is inserted into a blood vessel—typically in the wrist or groin—and guided to the heart. Contrast dye injected through the catheter allows the arteries to be clearly visualized on X-ray. Treatments can be performed during this procedure if blockages are detected.
Treatment Options
Managing coronary artery disease typically involves a combination of lifestyle changes, medications, and possibly procedures or surgery.
Medications
A cardiologist may prescribe various medications to control symptoms and prevent disease progression:
- Cholesterol-lowering drugs: These include statins, fibrates, niacin, and bile acid sequestrants. Their purpose is to decrease LDL (“bad”) cholesterol and reduce plaque accumulation.
- Aspirin: Low-dose aspirin therapy may be suggested for some individuals to reduce clot formation. However, long-term use carries bleeding risks and should only be started under medical supervision.
- Beta blockers: These drugs slow the heart rate and lower blood pressure. They are particularly beneficial following a heart attack to reduce the risk of future events.
- Calcium channel blockers: These may be used when beta blockers are ineffective or unsuitable. They can relieve chest pain by relaxing blood vessels.
- ACE inhibitors and ARBs: These medications help lower blood pressure and may slow disease progression.
- Nitroglycerin: Available as a spray, pill, or patch, nitroglycerin helps widen blood vessels and alleviate chest pain.
- Ranolazine: This medication may reduce persistent chest pain and can be used alongside or in place of beta blockers.
Surgical and Interventional Procedures
Surgical interventions aim to improve blood flow to the heart by addressing blocked arteries:
- Coronary angioplasty and stent placement: A catheter with a small balloon is used to widen narrowed arteries. A stent—often drug-coated—is then placed to keep the artery open. This procedure is also called percutaneous coronary intervention.
- Coronary artery bypass graft (CABG) surgery: In this open-heart surgery, a surgeon uses a blood vessel from another part of the body to reroute blood around a blocked artery. This increases blood flow to the heart muscle.
Following bypass surgery, participation in cardiac rehabilitation may be recommended. This program includes supervised exercise, education, and counseling to enhance recovery and long-term heart health.
Lifestyle Modifications
Sustained changes in daily habits can significantly improve cardiovascular health and slow the progression of coronary artery disease:
- Avoid tobacco: Smoking greatly increases the risk of artery damage and heart strain due to nicotine.
- Follow a heart-healthy diet: Emphasize fruits, vegetables, whole grains, and limit saturated fats, salt, and added sugars. Incorporating fish into meals once or twice a week may also be beneficial.
- Engage in regular physical activity: Physical exercise helps manage weight, cholesterol, blood pressure, and blood sugar. Most adults should aim for 30 to 60 minutes of activity on most days, under a cardiologist’s guidance.
- Maintain a healthy weight: Even modest weight loss can reduce cardiovascular risk.
- Monitor blood pressure: Routine checks—at least every two years or more frequently if elevated—are crucial for early detection and management.
- Check cholesterol levels: Regular screening helps identify the need for lifestyle changes or medication.
- Manage blood sugar: For individuals with diabetes, controlling glucose levels can reduce heart disease risk.
- Prioritize quality sleep: Adults should aim for 7 to 9 hours of sleep each night to support cardiovascular health.
- Reduce stress: Techniques such as physical activity, mindfulness, and social support can aid in emotional well-being and heart health.
Regular medical evaluations remain essential, as conditions like high blood pressure, cholesterol, or diabetes may not show symptoms early on. Preventive screenings and timely interventions play a critical role in maintaining a healthy heart. Vaccinations, such as the annual flu shot, may also be advised to reduce complications.
Prevention
Preventing coronary artery disease largely mirrors its treatment approach. Adopting and maintaining healthy lifestyle habits can help keep arteries unobstructed and functioning well:
- Refrain from smoking or using tobacco.
- Keep blood pressure, cholesterol, and blood sugar within healthy ranges.
- Maintain physical activity.
- Achieve and sustain a healthy weight.
- Choose a diet low in saturated fat and sodium, and high in fiber-rich fruits, vegetables, and whole grains.
- Manage psychological stress.
- Ensure consistent, restful sleep.