Coronary Artery Disease (CAD)

What is coronary artery disease (CAD)?

Coronary artery disease is also called CAD. It is the most common form of heart disease in the U.S. — and is the leading cause of death, too. It occurs when the coronary arteries (blood vessels) that carry blood to your heart get blocked with plaque. That plaque collection is called atherosclerosis. Plaque is made of elements including fat and cholesterol. Over time, plaque can harden inside the walls of your arteries. When it does, it blocks the flow of blood to your heart. That blockage can cause angina (squeezing pain or pressure in your chest), a heart attack, or death. Coronary artery disease can lead to other problems, too, including heart failure and arrhythmias.

Symptoms of coronary artery disease

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

• Angina
• Tightness in your arms, back, the back of your neck, or jaw
• Shortness of breath
• Heart attack

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

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
• Poor diet
• Obesity or being very overweight
• Not exercising (sedentary lifestyle)
• Other health conditions (such as diabetes)

How is coronary artery disease diagnosed?

Your doctor will perform a physical exam and listen to your heart. They will discuss your symptoms, family history, diet, activity level, and other medical conditions. There is no single test that can diagnose coronary artery disease. If you doctor suspects you have it, they 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 heart, blood pressure, and oxygen monitors during the test. These monitors can detect changes to your heart rate, rhythm, electrical activity, or blood pressure during the test. The staff will also monitor you for shortness of breath or chest pain. If you are unable to exercise for medical reasons, the staff will administer medicine to raise your heart rate. Your heart’s response to the workout may mean you have blockages and need further testing.
• Echocardiogram. This test is painless. It uses sound waves to see a picture of your heart while it’s beating. The picture 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 on your heart and lungs. 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.
• Cardiac catheterization and coronary angiogram. This procedure is done if other tests suggest you have coronary artery disease. It’s performed in a hospital. You will get medicine before the test to make you sleepy. However, you may remain awake. A thin, flexible tube is inserted into a blood vessel in your arm, groin, or neck. The doctor will move the tube to your coronary arteries, then inject a dye. An X-ray is used to monitor the dye as it travels through your coronary arteries. This helps the doctor see your blood flow through your heart and blood vessels. This test is generally painless.

Can coronary artery disease be prevented or avoided?

Coronary artery disease can’t be completely prevented or avoided. This is because everyone develops some degree of CAD as we age. However, you can reduce your risks for getting the disease by:

• Quitting smoking. Nicotine raises your blood pressure, which contributes to coronary artery disease.
• Controlling your high blood pressure. Take your blood pressure medicine and follow a diet that helps lower your blood pressure.
• Eating 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 very good for heart health. If you have questions, talk to your doctor about how to make heart-healthy changes to your diet.
• Getting regular exercise. This can make your heart stronger and reduce your risk of heart disease.
• Taking vitamin supplements. A healthy diet will provide all the vitamins and minerals your body needs. For example, foods that are rich in vitamin E and beta-carotene are 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.

Talk to your family doctor about how to improve your diet. Diet and lifestyle changes will lower your risk of coronary artery disease. Your body will need time to respond to the changes you make. 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 it. You need to keep up the healthy lifestyle changes you 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 also can help relieve angina. Taking low-dose aspirin daily 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 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 surgery that opens blocked arteries around the heart. During this surgery, your doctor inserts a small tube, called a catheter, into an artery in your arm or leg. A small balloon and a metal stent are on the tip of the catheter. With a special instrument, the doctor threads the catheter from your arm or leg to the area around your heart. They will then inflate the balloon, which also moves the stent into place. The balloon moves the plaque out of the way. The stent keeps your artery open so the blood can flow properly to your heart.

Another surgical treatment for coronary artery disease is heart bypass surgery. Pieces of veins or arteries are often 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. Your doctor also may decide it’s a better choice for you.

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 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 for your doctor

• Does coronary artery disease ever go away?
• How many blockages do I have in my arteries?
• How severe are the blockages?
• What treatment is best for me?
• What are the signs 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?
• What nutrition guidelines should I follow to lower my risk of coronary artery disease?

Resources

Centers for Disease Control and Prevention: Heart Disease

National Heart, Lung, and Blood Institute: What is Coronary Heart Disease?