Coronary Artery Disease

Coronary artery disease

Coronary artery disease (CAD) is the narrowing or occlusion of coronary arteries, typically caused by plaque accumulation. Your coronary arteries supply your heart with oxygen-rich blood. Plaque accumulation in these arteries restricts the amount of blood that can reach the heart.

There may be no symptoms of coronary artery disease until the plaque causes a blood clot. Similarly, when blood cannot reach the heart, a heart attack occurs.

CAD is also referred to as coronary heart disease (CHD) and ischemic heart disease. It is the most common type of heart disease among adults.

It is the most common form of heart disease affecting adults.

Types of Coronary Artery Disease

There are two predominant types of coronary artery disease:

  • Stable Ischemic Heart Disease. This condition is chronic. Your coronary arteries gradually narrow over a long period of time. With time, less oxygen-rich blood reaches the heart. You may experience some symptoms, but you are able to live normally with the condition.
  • Acute Coronary Syndrome. This is a severe case that constitutes a medical emergency. The plaque in your coronary artery ruptures suddenly and forms a blood clot that obstructs blood flow to the heart. This abrupt obstruction leads to a heart attack.

Symptoms of Coronary Artery Disease

You may have no symptoms of coronary artery disease for a long time. CAD is a chronic disease. Plaque formation can take many years, if not decades. However, as your arteries narrow, you may experience minor symptoms. These symptoms indicate that your heart is working harder to deliver oxygen-rich blood to your body.

Among the symptoms of chronic CAD are:

  • Stable angina is the most common symptom. Stable angina is defined as intermittent chest pain or discomfort that comes and goes in a predictable pattern. It is usually noticeable during physical activity or emotional distress. It goes away when you rest or take nitroglycerin (medicine that treats angina).
  • Shortness of breath (dyspnea): Some people experience shortness of breath during light physical activity.

A heart attack is sometimes the first sign of CAD. A heart attack can cause the following symptoms:

  • Chest ache or discomfort (angina). Angina can cause mild discomfort to severe pain. It may feel like heaviness, tightness, pressure, aching, burning, numbness, fullness, squeezing, or a dull ache. The pain may spread to your shoulder, arm, neck, back, or jaw.
  • Shortness of breath or difficulty breathing.
  • Feeling dizzy or lightheaded.
  • Palpitations in the chest.
  • Feeling tired.
  • Nausea, stomach discomfort, or vomiting. This may feel like indigestion.
  • Weakness.

Causes of Coronary Artery Disease

Coronary artery disease is caused by atherosclerosis. Atherosclerosis is the gradual accumulation of plaque in your body’s arteries. Coronary artery disease occurs when plaque restricts blood flow in your coronary arteries.

Plaque consists of cholesterol, waste products, calcium and fibrin (a substance that helps your blood clot). As plaque accumulates along your artery walls, your arteries narrow and stiffen.

Plaque can clog or damage your arteries, limiting or stopping blood flow to a specific area of your body. When plaque accumulates in your coronary arteries, your heart muscle is deprived of oxygen and nutrients. As a result, your heart is deprived of the oxygen and nutrients it requires to function properly. This is known as myocardial ischemia. It causes chest pain (angina) and puts you at risk for a heart attack.

People who have plaque buildup in their coronary arteries frequently have plaque buildup elsewhere in their bodies as well. This can result in diseases such as carotid artery disease and peripheral artery disease.

Complications of Coronary Artery Disease

Heart attack is the primary complication of coronary artery disease. This is a life-threatening medical emergency. Your heart muscle begins to die due to a lack of blood supply. To save your life, you require immediate medical attention to restore blood flow to your heart.

CAD can also weaken the heart over time and lead to complications such as:

  • Arrhythmias (like atrial fibrillation).
  • Cardiac arrest.
  • Cardiovascular shock
  • Heart failure.

Diagnostics of Coronary Artery Disease

Your doctor may also suggest one or more tests to evaluate your heart function and diagnose CAD. These are some examples:

  • Blood tests. They examine your body for substances that can damage your arteries or increase your risk of developing CAD.
  • Catheterization of the heart. Tubes are inserted into your coronary arteries to evaluate or confirm CAD. This is the gold standard for detecting CAD.
  • Coronary angiogram using computed tomography (CT). CT and contrast dye are used to create 3D images of your heart as it moves. Identifies coronary artery blockages.
  • A calcium scan of the coronary arteries. The amount of calcium in the walls of your coronary arteries is measured (a sign of atherosclerosis). This does not determine whether or not you have significant blockages, but it does assist in determining your risk for CAD.
  • Echocardiogram: This test uses sound waves to assess the structure and function of your heart.
  • EKG/ECG stands for electrocardiogram. The electrical activity of your heart is recorded. Can detect previous or current heart attacks, ischemia, and irregular heartbeats.
  • Exercise stress test: Determines how your heart responds when working extremely hard. Can detect angina and coronary artery blockages.


Treatment of Coronary Artery Disease

Some patients with coronary artery disease require a procedure or surgery, including:

  • Percutaneous Coronary Intervention (PCI).
    This procedure is also known as coronary angioplasty. Your physician uses a small balloon to reopen your blocked artery and improve blood flow. Your healthcare provider may also insert a stent to help keep your artery open.
  • Coronary artery bypass grafting (CABG)
    This procedure creates a new pathway for your blood to bypass blockages. This “diversion” restores blood circulation to the heart. CABG aids patients with severe blockages in multiple coronary arteries.

Your healthcare provider will recommend which of these treatment options is optimal for your specific situation.