Coronary Artery Disease

What is coronary artery disease?

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Coronary artery disease is a condition that impairs blood flow in the arteries. These arteries supply blood to the heart. People who have this condition experience the buildup of plaque, which grows along the walls of the coronary arteries. This limits blood flow and may eventually lead to a blood clot, which can cause death.

This condition is known colloquially as CAD, and some physicians may refer to it as coronary heart disease (CHD) or ischemic heart disease (IHD). Coronary artery disease can be either chronic or acute. For those experiencing chronic CAD, the narrowing of the coronary artery occurs over time, sometimes beginning in childhood. Acute CAD is often the result of a sudden rupture of plaque, which can form a blood clot.

Coronary heart disease is a leading cause of death for both women and men in the United States. If you suspect you have CAD, seek medical attention from a cardiologist. The condition must be consistently managed in order to achieve a good prognosis.

What causes coronary artery disease?

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Coronary artery disease causes vary, but the most common results from a vascular injury caused by cholesterol plaque buildup. This is known as atherosclerosis. Healthy arteries have smooth walls, which allow blood to easily enter the heart. By contrast, arteries affected with atherosclerosis are narrowed, hindering blood flow. Over time, especially for people with chronic CAD, this plaque can harden.

Acute CAD involves the same plaque buildup, but the cause may be different. For example, an embolism may cause acute CAD. When this happens, a piece of plaque breaks off from a separate vein or artery and travels into a coronary artery. Additionally, aneurysm, artery vasculitis, and spontaneous coronary artery dissection can all cause variations of coronary artery disease.

What are the symptoms of coronary artery disease?

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Coronary artery disease symptoms will vary by person. That said, most will experience angina, which is the clinical term for chest discomfort. This may include one or more of the following sensations.

  • Chest heaviness
  • Chest tightness or squeezing
  • Burning in the chest
  • Chest pain

Unfortunately, angina may also be the result of indigestion or heartburn. This can make it difficult to identify your CAD. However, if your angina is accompanied by more acute CAD symptoms, especially if it is painful or lasts longer than five minutes, contact emergency medical services as soon as possible. These symptoms include shortness of breath, sweating, dizziness, and arm or shoulder pain. Additional symptoms may occur as the condition progresses. In the most severe cases, blood flow will cut off completely, resulting in a heart attack.

Preliminary symptoms, or experiences resulting from slightly decreased blood flow, include weakness, fatigue, and arrhythmia, or an abnormal heartbeat.

Importantly coronary artery disease symptoms may present differently in women. This group is more likely to experience back pain, jaw pain, nausea, and vomiting in addition to the more well-known symptoms.

What are the risk factors for coronary artery disease?

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Certain groups may be at a higher risk for developing CAD. In general, men have a higher risk of developing heart disease than women. However, by the time women reach 70 years old, they typically have around the same risk as men.

Several other demographic concerns and habits can also contribute to a higher risk for developing coronary artery disease. The most common include the following.

  • Smoking
  • Obesity
  • Insulin resistance
  • High blood pressure
  • High cholesterol
  • Unhealthy eating
  • Emotional stress
  • Sleep apnea
  • Excessive alcohol consumption

Having two or more of these risk factors can increase the lifetime risk of developing CAD. Additionally, coronary artery disease is more likely to occur as a person ages, and those with a family history of heart disease are more at risk.

The risk factors associated with coronary artery disease are similar across other cardiovascular conditions. The Centers for Disease control has a helpful guide to understanding why specific habits factors may contribute to your risk.

In some cases, your doctor may perform a cardiac risk assessment to understand whether you are predisposed to developing CAD. This group of tests and health variables is typically assessed before the onset of symptoms. It can be used to understand a person’s chance of having a major cardiovascular event, which can be caused by CAD.

How is coronary artery disease diagnosed?

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If you suspect the onset of coronary artery disease, or if you are in two or more of the risk factor groups, you should see a doctor as soon as possible. Your physician will perform a range of diagnostic tests to better understand your condition. This will likely include two or more of the following.

 

  • Physical Exam: Your doctor will ask about your medical history, any ongoing or recurrent symptoms, and any genetic predispositions you may be aware of. They will also measure your weight and height, your blood pressure, and listen to your heartbeat for arrhythmia, such as atrial fibrillation.
  • Laboratory Tests: Your doctor will likely draw blood to perform a variety of lab tests. The most common is a lipid panel, which is a group of tests that measures the amount and type of lipids, or fats, in the blood. This can help determine your cholesterol levels. They might also run an hs-CRP, which detects a specific protein that indicates inflammation. This protein is associated with atherosclerosis and can therefore provide insight about your arterial health.
  • Imaging: If a doctor suspects a coronary artery disease diagnosis, they will likely order a range of imaging tests. This can include a chest X-ray, echocardiogram, or coronary angiogram. All of these can provide images of the heart, surrounding bones, and tissues.
  • Stress Test: This test is designed to measure the stress blockage may be placing on your heart. A stress test will measure this during both physical activity and while at rest. Your doctor will monitor your heart’s electrical activity while you ride a stationary bike or walk on a treadmill.
  • Cardiac Catheterization: This procedure is designed to check the inside of the arteries for blockage. The doctor will insert a thin, flexible tube through an artery elsewhere in the body, typically in the arm, neck, or groin. This can measure pressure within the heart and blood flow strength.

Is there a treatment for coronary artery disease?

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There is no cure for coronary artery disease, but people can take measures to manage the condition. Most treatment includes the implementation of healthier lifestyle choices, like eating healthily, quitting smoking, and getting regular exercise. However, some may need to undergo medical procedures and take regular medications in order to manage CAD.

Common medications for coronary artery disease include beta-blockers, which can reduce blood pressure and heart rate. Calcium channel blockers can also improve symptoms, and ranolazine can help with angina. Importantly, cholesterol-modifying medications will almost always be a part of your coronary artery disease treatment plan.

For those whose conditions do not improve with lifestyle changes and medication, a surgical procedure may be necessary. This can include a balloon angioplasty, which will widen blocked arteries and compress plaque buildup. You may also receive enhanced external counterpulsation, which can help form new small blood vessels, allowing blood to naturally bypass clogged arteries. In some cases, a coronary artery bypass graft may be necessary.

What are some strategies for coronary artery disease prevention?

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There are certain changes individuals can make to decrease their risk of developing coronary artery disease. Most have to do with lifestyle and general health. For example, eating a healthy diet with a low sodium content can contribute to heart disease prevention. Additionally, getting regular exercise, controlling high blood pressure, controlling high cholesterol, and losing weight if you are overweight can reduce your risk.

If these lifestyle changes are not enough to prevent coronary artery disease, your doctor may also recommend or prescribe preventative medications. Aspirin, a common, over-the-counter medication, can help prevent CAD development by stopping platelet blood cells from clumping. Additional medications used to target high cholesterol, high blood pressure, and irregular heartbeat may also be prescribed.

CAD will affect people differently, but taking preventative measures is the best way to improve health later in life. If you are at risk for developing coronary artery disease, or if you are experiencing symptoms, visit your doctor to receive diagnostic tests. If you receive a diagnosis, you will need to see a cardiologist regularly to monitor the state of your condition. However, the earlier you understand your risk of developing CAD, the better your outlook will be.