Coronary Artery Disease (CAD)

What is coronary artery disease (CAD)?

Coronary artery disease also is called CAD or coronary heart disease. It is occurs when the blood vessels (coronary arteries) that carry blood to your heart harden. The thickening looks like a fatty substance. It is called plaque. As it builds up inside the walls of the arteries, it blocks blood flow to your heart. That blockage could cause angina (squeezing pain or pressure in your chest), a heart attack, or death.

Symptoms of coronary artery disease

As your arteries become blocked over time, you may experience:

  • angina
  • shortness of breath
  • heart attack.

Coronary artery disease may take years to develop. You may not notice any symptoms until the disease has progressed significantly.

What causes coronary artery disease?

Coronary artery disease affects both men and women. Several factors can increase your risk of developing the disease, including:

  • age
  • family history
  • high blood pressure
  • high cholesterol
  • smoking
  • poor diet
  • obesity or being significantly overweight
  • inactivity (sedentary lifestyle)
  • other health conditions (diabetes).

How is coronary artery disease diagnosed?

Your doctor will perform a physical exam (specifically listening to your heart). He or she also will discuss your symptoms, family history, diet, activity level, and any other medical conditions. There is no one test that can diagnose coronary artery disease. If you doctor suspects you have it, he or she may order one or more of the following tests.

  • EKG (Electrocardiogram). This is a painless, simple test that monitors your heart’s beat and rhythm. Also, it tests the strength and timing of your heart’s electrical signals. It involves putting electrodes (tiny pads attached to wires) on your chest. The pads are held in place by a sticky substance.
  • Stress test. During this test, you will be asked to exercise to give your heart a workout. You will be connected to a heart monitor. You strap the monitor around your chest. It can detect abnormal changes to your heart rate, rhythm, electrical activity, blood pressure, shortness of breath, or chest pain. If you are unable to exercise (for medical reasons), you doctor will prescribe medicine that raises your heart rate.
  • Echocardiography. This test is painless. It relies on a test that uses sound waves to see a picture of your heart while it is beating. It will give doctors a look at the size and shape of your heart. Also, it shows your heart chambers and valves.
  • Chest X-ray. This is an X-ray focused in the area of your heart. The X-ray can detect signs of heart failure.
  • Blood tests. Your doctor will take a sample of your blood to send to the lab. The lab can test for certain conditions that raise your risk of coronary artery disease. These include testing certain fats, cholesterol, sugar, and proteins.
  • Coronary angiography and cardiac catherization. This is a procedure that is normally done if other tests show you have coronary artery disease. The procedure is performed in a hospital. It involves injecting dye into your coronary arteries with a thin, flexible tube. The tube is inserted into a blood vessel in your arm, groin (upper thigh), or neck. An X-ray is used to monitor the dye as it travels through your coronary arteries. It helps doctors monitor your blood flow through your heart and blood vessels. This test is generally painless, and you remain awake throughout the procedure.

Can coronary artery disease be prevented or avoided?

Coronary artery disease cannot be completely prevented or avoided. However, you can reduce your risks for getting the disease by:

  • Stop smoking. Nicotine raises your blood pressure, which contributes to coronary artery disease.
  • Control your high blood pressure. Take your blood pressure medicine and follow a diet that helps lower your blood pressure.
  • Eat healthy. 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.
  • Exercise. Regular exercise can make your heart stronger and reduce your risk of heart disease.
  • Aspirin. Talk to your doctor about the pros and cons of daily low dose aspirin. It helps reduce heart disease. However, it does have some health side effects.
  • Vitamin supplements. A healthy diet will provide all the vitamins and minerals your body needs. Foods that are rich in vitamin E and beta-carotene are very healthy and help reduce cardiovascular risk. The American Academy of Family Physicians (AAFP) recommends against taking vitamin E or beta-carotene supplements for the prevention of cardiovascular disease. There is no clear evidence that taking multivitamins offers additional protection.

Diet and lifestyle changes will lower your risk of coronary artery disease. Your body will 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. You will still need to keep up the healthy lifestyle changes you’ve started to help the medicine work.

Coronary artery disease treatment

Most people who have coronary artery disease take medicine to help control their condition. Medicines called beta-blockers, calcium channel blockers, and nitrates can help relieve angina, as well. Taking low-dose aspirin every day can reduce the chance of a second heart attack in people who have already had one. ACE (angiotensin-converting enzyme) inhibitors help lower blood pressure and reduce the workload on the heart. Statins reduce the LDL (“bad”) cholesterol level in your blood. Your doctor will tell you whether you should take any of these medicines.

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. Most patients don’t have side effects. If you have side effects after taking a medicine, tell your doctor.

Angioplasty is a surgical treatment for coronary artery disease. This procedure involves using a tiny balloon to 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 coronary artery disease is called heart bypass surgery. Pieces of veins or arteries are taken from the legs and sewn into the arteries of the heart. This moves 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.

Surgery, such as angioplasty or heart bypass surgery, has potential risks. These include heart attack, stroke, or 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 heart bypass surgery.

Living with coronary artery disease

Living with coronary artery disease means being aware of your risks and reducing the ones you can control. This includes diet, exercise, and stopping smoking. It is important to take your prescription medicine for high blood pressure, high cholesterol, diabetes, and any other health conditions.

Questions to ask your doctor

  • Does coronary artery disease ever go away?
  • How many blockages do I have in my arteries?
  • How severe are the blockages?
  • What are the signs that I need to go to a hospital or seek treatment right away?
  • What are the side effects of medication to treat coronary artery disease?
  • Is exercising a problem?