Coronary Artery Disease (CAD)

Overview

What is coronary artery disease?

Coronary arteries are the blood vessels that carry blood to the heart muscle. Coronary artery disease (also called CAD or coronary heart disease) is caused by a thickening of the inside walls of the coronary arteries. This thickening is called atherosclerosis (say: “ath-uh-roe-skluh-roe-suhs”). A fatty substance called plaque builds up inside the thickened walls of the arteries, blocking or slowing the flow of blood. If your heart muscle doesn’t get enough blood to work properly, you may have angina or a heart attack.

Symptoms

What are the symptoms of CAD?

Coronary artery disease may take years to develop. You may not notice any symptoms of coronary artery disease until the disease progresses. As your arteries become blocked you may experience:

  • Angina (a squeezing pain or pressing feeling in your chest)
  • Shortness of breath
  • Heart attack

Causes & Risk Factors

What causes CAD?

Both men and women can get CAD. It can be hereditary (run in your family). It might also develop as you get older and plaque builds up in your arteries over the years.

Know your risk factors

In the United States, heart disease is the leading cause of death for women and men. Risk factors for heart disease include:

  • Age
  • Family history
  • High blood pressure
  • High cholesterol
  • Smoking
  • Poor diet
  • Overweight or obesity
  • Inactivity (sedentary lifestyle)
  • Other health problems (such as diabetes)

Prevention

What can I do to lower my risk of CAD?

  • Don’t smoke. Nicotine raises your blood pressure because it causes your body to release adrenaline, which makes your blood vessels constrict and your heart beat faster. If you smoke, ask your doctor to help you make a plan to quit.
  • Control your blood pressure. If you have high blood pressure, your doctor can suggest ways to lower it. If you’re taking medicine for high blood pressure, be sure to take it just the way your doctor tells you to.
  • Exercise. Regular exercise can make your heart stronger and reduce your risk of heart disease. Exercise can also help if you have high blood pressure. Before you start any new exercise program, talk to your doctor about the right kind of exercise for you.
  • Ask your doctor about taking a low dose of aspirin each day. Aspirin helps prevent CAD, but taking it also has some risks.
  • Ask your doctor about taking vitamin supplements. While foods that are rich in vitamin E and beta-carotene are very healthy and help reduce cardiovascular risk, the U.S. Preventive Services Task Force and the American Academy of Family Physicians recommend against taking vitamin E or beta-carotene supplements for the prevention of cardiovascular disease. Even though a diet rich in healthy foods reduces cardiovascular risk, there is no clear evidence that taking multivitamins does the same thing.
  • Eat a healthy diet. Choose fruits, vegetables, meats, fish, and whole grains. Try to avoid processed foods, white flour, sugars, and high fructose corn syrup. The Mediterranean Diet is also very good for heart health. If you have questions, talk to your doctor about how to make heart-healthy changes to your diet.

How do I know lifestyle changes are helping?

Rest assured that these lifestyle changes will lower your CAD risk, even if you don’t feel any different. Your body will also need time to respond to the changes you’ve made. Your doctor will watch your progress. For example, if your cholesterol level hasn’t improved after you’ve made changes for a few months, your doctor may prescribe medicine to lower your cholesterol. However, you will still need to keep up the healthy lifestyle changes you’ve started to help the medicine work.

Treatment

How is CAD treated?

Most people who have CAD take medicine to help control their condition. Medicines called beta-blockers, calcium channel blockers and nitrates can help relieve angina. Taking low-dose aspirin every day can reduce the chance of a second heart attack in people who have already had one. Your doctor will tell you whether you should take any of these medicines.

What about surgery?

Angioplasty is a surgical treatment for CAD. Angioplasty uses a tiny balloon to push open blocked arteries around the heart. The balloon is inserted in an artery in the arm or leg. A small metal rod called a stent might be put into the artery where the blockage was to hold the artery open.

Another surgical treatment for CAD is bypass surgery. Pieces of veins or arteries are taken from the legs and sewn into the arteries of the heart to bring blood past a blockage and increase the blood flow to the heart. Bypass surgery is usually done when angioplasty isn’t possible or when your doctor feels it’s a better choice for you.

Are there side effects and other risks to the treatment of CAD?

All medicines may have side effects. Aspirin may cause upset stomach. Nitrates may cause a flush (redness in the face) and headaches. Beta-blockers cause tiredness and sexual problems in some patients. Calcium channel blockers may cause constipation and leg swelling. Fortunately, most patients don’t have side effects from these medicines. If you have side effects after taking a medicine, tell your doctor.

Surgery, such as angioplasty or bypass surgery, also has potential risks. The major risks can include heart attack, stroke or even death. These are rare and most patients do well. After angioplasty, you can usually expect to return to your previous activity level, or even a better activity level, within a few days. It takes longer (a few weeks or months) to recover from bypass surgery.

How do I know which treatment is right for me?

Your doctor will help you decide which treatment is best for you.

Does CAD ever go away?

CAD doesn’t go away, but by working with your doctor, you can live longer and feel better.

Stents

What is a stent?

A stent is a small rod made out of metal or fabric. It is inserted into a coronary artery when there is a blockage or when the artery is narrow. A coronary artery is a blood vessel that carries oxygen to the heart muscle.

There are two types of stents:

  • Bare-metal stent: This is a stent made of metal that is placed in the artery to help hold it open. Over time, the artery will heal and tissue will grow over the stent, holding it in place.
  • Drug-eluting stent: A drug-eluting stent is a metal stent that is coated in a medicine. The medicine is slowly released and may help prevent excess tissue from growing over the stent. Excess tissue can cause the artery to narrow again, restricting blood flow.

Why do I need a stent?

You may need a stent if you have coronary artery disease (also called CAD or coronary heart disease). CAD is caused by a thickening of the inside walls of the coronary arteries. This thickening is called atherosclerosis (say: “ath-uh-roe-skluh-roe-suhs”). A fatty substance called plaque builds up inside the thickened walls of the arteries, blocking or slowing the flow of blood. If your heart muscle doesn’t get enough blood to work properly, you may have angina (chest pain) or a heart attack. The stent will help hold the artery open so blood can flow and help keep the artery from narrowing again.

My doctor says I will need a stent. What will the procedure be like?

If you need a stent, it will be placed during a procedure called an angioplasty. Angioplasty is a surgical treatment for CAD. You will be awake during the procedure, but you will be given medicine to help you relax. The doctor will make a very small incision in an artery in your leg, arm, or neck. The area will be numb so that you will not feel pain. A very small tube, called a catheter, will be inserted into the artery. On the tip of the catheter is a small, deflated balloon. The doctor will put the stent around the deflated balloon. The catheter will be carefully guided into the artery and up to the point where there is a blockage. The balloon will be inflated to help stretch out the artery and allow blood to flow. This also expands the stent, which locks into place to permanently help support the artery. Once the stent is in place, the balloon is deflated and the catheter and balloon will be removed.

How will I feel after getting a stent?

After an angioplasty, you will stay in the hospital for a day while your heart is monitored. You will be given medicine to keep clots from forming and to relax your arteries. The place where the incision was made may be sore or tender.

Once you go home, you will need to rest and relax. You will not be able to exercise or lift heavy objects for about a week. Your doctor will tell you what you can and cannot do while you recover at home.

Call your doctor if you experience symptoms such as chest pain, shortness of breath, or any pain, swelling, or bleeding from the incision area.

What will my life be like after I get a stent?

After you have an angioplasty, you will need to take medicine that keeps the stent open and blood flowing. It is very important to take the medicine exactly how your doctor tells you to take it.

In addition to taking medicine, the best way to keep your heart healthy is to maintain a healthy lifestyle. Your doctor can help you to do the following:

  • Quit smoking.
  • Make sure you keep your blood pressure and cholesterol at healthy levels.
  • Exercise 30 minutes, 5 days per week.
  • Eat a heart-healthy diet.

Other Organizations

Questions to Ask Your Doctor

  • Am I at risk for coronary artery disease (CAD)?
  • What lifestyle changes should I make to decrease my risk of CAD?
  • Do I need any tests?
  • How many blockages do I have in my arteries? How severe are the blockages?
  • What’s my best treatment option? Do I need medicine? Surgery?
  • Will the medicine(s) you prescribed interact with the medicine(s) I currently take?
  • What are some signs that I need to go to a hospital or seek treatment right away?

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