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Coronary Artery Disease (CAD)

Cardiac Surgery Atheroschlerosis
Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.

Coronary artery disease (CAD) is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

Plaque is made up of fat, cholesterol, calcium and other substances found in the blood.
When plaque builds up in the arteries, the condition is called atherosclerosis.

Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

 

Overview

When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina or a heart attack.

Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing to an area of your heart muscle. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back.

A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die. Without quick treatment, a heart attack can lead to serious problems and even death.

Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can't pump enough blood throughout your body. Arrhythmias are problems with the speed or rhythm of your heartbeat.

Outlook

CAD is the most common type of heart disease. It's the leading cause of death in the United States for both men and women. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people.

Other Names for Coronary Artery Disease

  • Atherosclerosis
  • Coronary heart disease
  • Hardening of the arteries
  • Heart disease
  • Ischemic heart disease
  • Narrowing of the arteries

What Causes Coronary Artery Disease?

Research suggests that coronary artery disease (CAD) starts when certain factors damage the inner layers of the coronary arteries.

These factors include:

  • Smoking
  • High amounts of certain fats and cholesterol in the blood
  • High blood pressure
  • High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Plaque also can crack, which causes blood cells called platelets to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack.

Who Is At Risk for Coronary Artery Disease?

Coronary artery disease (CAD) is the leading cause of death in the United States for both men and women. Each year, more than half a million Americans die from CAD.

Certain traits, conditions, or habits may raise your chance of developing CAD. These conditions are known as risk factors.

You can control most risk factors and help prevent or delay CAD. Other risk factors can't be controlled.

Major Risk Factors

Many factors raise the risk of developing CAD. The more risk factors you have, the greater chance you have of developing CAD.

  • Unhealthy blood cholesterol levels
  • High blood pressure
  • Smoking
  • Insulin resistance
  • Diabetes
  • Overweight or obesity
  • Metabolic syndrome
  • Lack of physical activity
  • Age (In men, risk increases after age 45; in women, risk increases after age 55)
  • Family history of early heart disease
  • Sleep apnea
  • Stress
  • Alcohol

Making lifestyle changes and/or taking medicines to treat other risk factors can often lessen genetic influences and prevent CAD from developing, even in older adults.

What Are the Signs and Symptoms of Coronary Artery Disease?

A common symptom of coronary artery disease (CAD) is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. This may feel like pressure or a squeezing pain in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. This pain tends to get worse with activity and go away when you rest. Emotional stress also can trigger the pain.

Another common symptom of CAD is shortness of breath. This symptom happens if CAD causes heart failure. When you have heart failure, your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe.

The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary arteries.

Signs and Symptoms of Heart Problems Linked to Coronary Artery Disease

Some people who have CAD have no signs or symptoms. This is called silent CAD. It may not be diagnosed until a person shows signs and symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).

Heart Attack

A heart attack happens when an area of plaque in a coronary artery breaks apart, causing a blood clot to form.

The blood clot cuts off most or all blood to the part of the heart muscle that's fed by that artery. Cells in the heart muscle die because they don't receive enough oxygen-rich blood. This can cause lasting damage to your heart.

Heart Damage Block - Department of Cardiac Surgery
Figure A is an overview of a heart and coronary artery showing damage
(dead heart muscle) caused by a heart attack.
Figure B is a cross-section of the coronary artery
with plaque buildup and a blood clot.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to your body. Heart failure doesn't mean that your heart has stopped or is about to stop working. It means that your heart can't fill with enough blood or pump with enough force or both. This causes you to have shortness of breath and fatigue that tends to increase with activity. Heart failure also can cause swelling in your feet, ankles, legs and abdomen.

Arrhythmia

An arrhythmia is a problem with the speed or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is skipping beats or beating too fast. Some people describe arrhythmias as a fluttering feeling in their chests. These feelings are called palpitations. Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA can make you faint and it can cause death if it's not treated right away.

How Is Coronary Artery Disease Diagnosed?

Your doctor will diagnose coronary artery disease (CAD) based upon:

  • Your medical and family histories
  • Your risk factors
  • The results of a physical exam and diagnostic tests and procedures

Heart Attack

Diagnostic Tests and Procedures

No single test can diagnose CAD. If your doctor thinks you have CAD, he or she will probably do one or more of the following tests:

  • EKG (Electrocardiogram)
  • Stress Testing
  • Echocardiography
  • Chest X Ray
  • Blood Tests
  • Electron-Beam Computed Tomography
  • Coronary Angiography and Cardiac Catheterization

How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines and medical procedures.
The goals of treatments are to:

  • Relieve symptoms
  • Reduce risk factors in an effort to slow, stop or reverse the buildup of plaque
  • Lower the risk of blood clots forming, which can cause a heart attack
  • Widen or bypass clogged arteries
  • Prevent complications of CAD

Lifestyle Changes

Making lifestyle changes can often help prevent or treat CAD. For some people, these changes may be the only treatment needed:

  • Follow a heart healthy eating plan.
  • Increase your physical activity (check with your doctor first).
  • Lose weight, if you're overweight or obese.
  • Quit smoking, if you smoke. Avoid exposure to secondhand smoke.
  • Learn to cope with and reduce stress.

Medicines

Medicines used to treat CAD include:

  • Anticoagulants
  • Aspirin and other antiplatelet medicines
  • ACE inhibitors
  • Beta blockers
  • Calcium channel blockers
  • Nitroglycerin
  • Glycoprotein IIb-IIIa
  • Statins
  • Fish oil and other supplements high in omega-3 fatty acids

Procedures & Treatments

You may need a medical procedure to treat CAD. Possible treatments are

  • Angioplasty and Stenting
  • Coronary Artery Bypass Graft (CABG)

You and your doctor can discuss which treatment is right for you.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Cardiac rehab, when combined with medicine and surgical treatments, can help you recover faster, feel better, and develop a healthier lifestyle. Almost everyone with CAD can benefit from cardiac rehab.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists or other behavioral therapists.

Rehab has two parts:

  • Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual abilities, needs, and interests.
  • Education, counseling and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and with your fears about the future.

Source: National Heart Lung and Blood Institute

Please feel free to download and view our booklet on heart surgery information for patients and their families (1.7MB, PDF).

More information is available on the Cardiovascular Center Coronary Artery Disease (CAD) website page.