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Coronary Artery Disease
Coronary artery disease is a common heart condition. The major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle. Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of coronary artery disease.
Signs and symptoms of coronary artery disease occur when the heart doesn’t get enough oxygen-rich blood. If you have coronary artery disease, reduced blood flow to the heart can cause chest pain (angina) and shortness of breath. A complete blockage of blood flow can cause a heart attack.
Coronary artery disease often develops over decades. Symptoms may go unnoticed until a significant blockage causes problems or a heart attack occurs. Following a heart-healthy lifestyle can help prevent coronary artery disease.
Coronary artery disease may also be called coronary heart disease.
WHAT IS CORONARY ARTERY DISEASE?
Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk.
Symptoms may go unrecognized at first, or they may only occur when the heart is beating hard like during exercise. As the coronary arteries continue to narrow, less and less blood gets to the heart and symptoms can become more severe or frequent.
Coronary artery disease signs and symptoms can include:
- Chest pain (angina). You may feel pressure or tightness in your chest. Some people say it feels like someone is standing on their chest. The chest pain usually occurs on the middle or left side of the chest. Activity or strong emotions can trigger angina. The pain usually goes away within minutes after the triggering event ends. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back.
- Shortness of breath. You may feel like you can’t catch your breath.
- Fatigue. If the heart can’t pump enough blood to meet your body’s needs, you may feel unusually tired.
- Heart attack. A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. Women may have less typical symptoms, such as neck or jaw pain, nausea and fatigue. Some heart attacks don’t cause any noticeable signs or symptoms.
When to see a doctor
If you think you’re having a heart attack, immediately call 911 or your local emergency number. If you don’t have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last option.
Smoking or having high blood pressure, high cholesterol, diabetes, obesity or a strong family history of heart disease makes you more likely to get coronary artery disease. If you’re at high risk of coronary artery disease, talk to your health care provider. You may need tests to check for narrowed arteries and coronary artery disease.
Coronary artery disease starts when fats, cholesterols and other substances collect on the inner walls of the heart arteries. This condition is called atherosclerosis. The buildup is called plaque. Plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.
Besides high cholesterol, damage to the coronary arteries may be caused by:
- Diabetes or insulin resistance
- High blood pressure
- Not getting enough exercise (sedentary lifestyle)
- Smoking or tobacco use
Coronary artery disease is common. Age, genetics, other health conditions and lifestyle choices can affect the health of the heart arteries.
Coronary artery disease risk factors include:
- Age. Getting older increases the risk of damaged and narrowed arteries.
- Sex. Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause.
- Family history. A family history of heart disease makes you more likely to get coronary artery disease. This is especially true if a close relative (parent, sibling) developed heart disease at an early age. The risk is highest if your father or a brother had heart disease before age 55 or if your mother or a sister developed it before age 65.
- Smoking. If you smoke, quit. Smoking is bad for heart health. People who smoke have a significantly increased risk of heart disease. Breathing in secondhand smoke also increases the risk.
- High blood pressure. Uncontrolled high blood pressure can make arteries hard and stiff (arterial stiffness). The coronary arteries may become narrow, slowing blood flow.
- High cholesterol. Too much bad cholesterol in the blood can increase the risk of atherosclerosis. Bad cholesterol is called low-density lipoprotein (LDL) cholesterol. Not enough good cholesterol — called high-density lipoprotein (HDL) — also leads to atherosclerosis.
- Diabetes. Diabetes increases the risk of coronary artery disease. Type 2 diabetes and coronary artery disease share some risk factors, such as obesity and high blood pressure.
- Overweight or obesity. Excess body weight is bad for overall health. Obesity can lead to type 2 diabetes and high blood pressure. Ask your health care provider what a healthy weight is for you.
- Chronic kidney disease. Having long-term kidney disease increases the risk of coronary artery disease.
- Not getting enough exercise. Physical activity is important for good health. A lack of exercise (sedentary lifestyle) is linked to coronary artery disease and some of its risk factors.
- A lot of stress. Emotional stress may damage the arteries and worsen other risk factors for coronary artery disease.
- Unhealthy diet. Eating foods with a lot of saturated fat, trans fat, salt and sugar can increase the risk of coronary artery disease.
- Alcohol use. Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease.
- Amount of sleep. Too little and too much sleep have both been linked to an increased risk of heart disease.
Risk factors often occur together. One risk factor may trigger another.
When grouped together, certain risk factors make you even more likely to develop coronary artery disease. For example, metabolic syndrome — a cluster of conditions that includes high blood pressure, high blood sugar, excess body fat around the waist and high triglyceride levels — increases the risk of coronary artery disease.
Sometimes coronary artery disease develops without any classic risk factors. Other possible risk factors for coronary artery disease may include:
- Breathing pauses during sleep (obstructive sleep apnea). This condition causes breathing to stop and start during sleep. It can cause sudden drops in blood oxygen levels. The heart must work harder. Blood pressure goes up.
- High-sensitivity C-reactive protein (hs-CRP). This protein appears in higher-than-usual amounts when there’s inflammation somewhere in the body. High hs-CRPlevels may be a risk factor for heart disease. It’s thought that as coronary arteries narrow, the level of hs-CRP in the blood goes up.
- High triglycerides. This is a type of fat (lipid) in the blood. High levels may raise the risk of coronary artery disease, especially for women.
- Homocysteine. Homocysteine is an amino acid the body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase the risk of coronary artery disease.
- Preeclampsia. This pregnancy complication causes high blood pressure and increased protein in the urine. It can lead to a higher risk of heart disease later in life.
- Other pregnancy complications. Diabetes or high blood pressure during pregnancy are also known risk factors for coronary artery disease.
- Certain autoimmune diseases. People who have conditions such as rheumatoid arthritis and lupus (and other inflammatory conditions) have an increased risk of atherosclerosis.
Coronary artery disease can lead to:
- Chest pain (angina). When the coronary arteries narrow, the heart may not get enough blood when it needs it most — like when exercising. This can cause chest pain (angina) or shortness of breath.
- Heart attack. A heart attack can happen if a cholesterol plaque breaks open and causes a blood clot to form. A clot can block blood flow. The lack of blood can damage the heart muscle. The amount of damage depends in part on how quickly you are treated.
- Heart failure. Narrowed arteries in the heart or high blood pressure can slowly make the heart weak or stiff so it’s harder to pump blood. Heart failure is when the heart doesn’t pump blood as it should.
- Irregular heart rhythms (arrhythmias). Not enough blood to the heart can alter normal heart signaling, causing irregular heartbeats.
The same lifestyle habits used to help treat coronary artery disease can also help prevent it. A healthy lifestyle can help keep the arteries strong and clear of plaque. To improve heart health, follow these tips:
- Quit smoking.
- Control high blood pressure, high cholesterol and diabetes.
- Exercise often.
- Maintain a healthy weight.
- Eat a low-fat, low-salt diet that’s rich in fruits, vegetables and whole grains.
- Reduce and manage stress.
To diagnose coronary artery disease, a health care provider will examine you. You’ll likely be asked questions about your medical history and any symptoms. Blood tests are usually done to check your overall health.
Test to help diagnose or monitor coronary artery disease include:
- Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. It can show how fast or slow the heart is beating. Your provider can look at signal patterns to determine if you’re having or had a heart attack.
Echocardiogram. This test uses sound waves to create pictures of the beating heart. An echocardiogram can show how blood moves through the heart and heart valves.
Parts of the heart that move weakly may be caused by a lack of oxygen or a heart attack. This may be a sign of coronary artery disease or other conditions.
- Exercise stress test. If signs and symptoms occur most often during exercise, your provider may ask you to walk on a treadmill or ride a stationary bike during an ECG. If an echocardiogram is done while you do these exercises, the test is called a stress echo. If you can’t exercise, you might be given medications that stimulate the heart like exercise does.
- Nuclear stress test. This test is similar to an exercise stress test but adds images to the ECG recordings. A nuclear stress test shows how blood moves to the heart muscle at rest and during stress. A radioactive tracer is given by IV. The tracer helps the heart arteries show up more clearly on images.
Heart (cardiac) CT scan. A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries.
Sometimes dye is given by IV during this test. The dye helps create detailed pictures of the heart arteries. If dye is used, the test is called a CT coronary angiogram.
Cardiac catheterization and angiogram. During cardiac catheterization, a heart doctor (cardiologist) gently inserts a flexible tube (catheter) into a blood vessel, usually in the wrist or groin. The catheter is gently guided to the heart. X-rays help guide it. Dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages.
If you have an artery blockage that needs treatment, a balloon on the tip of the catheter can be inflated to open the artery. A mesh tube (stent) is typically used to keep the artery open.