What Is Coronary Artery Disease?
Coronary artery disease, also called coronary or atherosclerotic heart disease, is a serious condition caused by a buildup of plaque in your coronary arteries, the blood vessels that bring oxygen-rich blood to your heart. It affects millions of Americans.
Your arteries are smooth and elastic. But when plaque builds up on their inner walls, it can make them become stiff and narrow. This slows blood flow to your heart muscle, so it doesn’t get the oxygen it needs.
The plaque could break off, leading to a heart attack or sudden cardiac death.
Coronary Artery Disease Causes and Development
More of these materials build up, along with cholesterol. That pushes your artery walls out while making them narrower.
Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to your heart muscle. But if you’re pushing yourself or stressed out, the new arteries may not be able to bring enough oxygen-rich blood to your heart.
Studies have found that taking low-dose aspirin each day could help prevent heart attacks and strokes in some people who are 50 or older and at risk for heart disease. Talk with your doctor about whether you should take low-dose aspirin.
Coronary Artery Disease Risk Factors
There are many risk factors for coronary artery disease. Some you can change, and some you can’t.
- Age, especially being older than 65
- Being overweight or obese
- Family history, especially if one of your close relatives got heart disease at a young age
- Gender. Men have a greater risk of heart attack and have them earlier, compared with women, until the risk evens out at age 70.
- High blood pressure and high cholesterol
- High stress
- Lack of physical activity
- Race. African-Americans have a higher risk than people of other races because they tend to have higher blood pressure. Higher rates of obesity and diabetes in some Asian and Hispanic people may also put them at higher risk of heart disease.
- Smoking or breathing secondhand smoke
- Unhealthy diet, including a lot of food that has high saturated fat, trans fat, salt, and sugar
Coronary Artery Disease Symptoms
People describe angina as a:
You usually feel angina in your chest, but you might feel it in your:
Other symptoms of coronary artery disease include:
- Faster heartbeat
- Palpitations (irregular heartbeats, skipped beats, or a "flip-flop" feeling in your chest)
- Shortness of breath
What Is Ischemia?
Cardiac ischemia is when plaque and fatty matter narrow the inside of your artery so much, it can’t supply enough oxygen-rich blood to your heart. This can cause heart attacks -- with or without chest pain and other symptoms.
Ischemia happens most during:
Coronary artery disease can get to a point where ischemia happens even when you’re resting. This is a medical emergency and may lead to a heart attack. If this happens to you, call your doctor or go to the emergency room. Ischemia can happen without warning in anyone with heart disease, although it is more common in people with diabetes.
Coronary Artery Disease Diagnosis and Tests
Your doctor can tell if you have coronary artery disease after:
- They learn your symptoms, medical history, and risk factors.
- They do a physical exam.
You might also get diagnostic tests so your doctor can find the extent of your coronary artery disease and its effect on your heart. This helps them choose the best treatment for you. These tests include:
- Cardiac catheterization
- Electrocardiogram (EKG)
- Electron beam (ultrafast) CT scan
- Exercise stress tests
Coronary Artery Disease Treatment
Treatments can involve:
Lifestyle changes. If you smoke, quit. Eat less processed food, and change to a low-trans-fat, low-salt, and low-sugar diet. Keep your blood sugar in control if you have diabetes. Exercise regularly (but talk to your doctor before starting an exercise program).
Medications . If lifestyle changes aren’t enough, you might need medication. The drugs you’ll take depend on your situation. If you’ve been diagnosed with coronary artery disease, you’ll probably take aspirin and a drug to lower your cholesterol called a statin, if not other things. Research shows that the drug evolocumab (Repatha) also lowers the risk of heart attack and stroke in people with cardiovascular disease.
Surgery and other procedures. Common ones to treat coronary artery disease include:
All of these treatments boost blood supply to your heart, but they can’t cure coronary artery disease.
Doctors are also studying innovative ways to treat heart disease, including:
Angiogenesis. For this treatment, you’ll get stem cells and other genetic material through your vein or directly into your damaged heart tissue. It helps new blood vessels grow and go around the clogged ones.
EECP (enhanced external counterpulsation). People who have chronic angina but haven’t gotten any help from nitrate medications or don’t qualify for some procedures may find relief with this. It’s an outpatient procedure -- one where you won’t need to be admitted to the hospital -- that uses cuffs on the legs that inflate and deflate to boost blood supply to your coronary arteries.
Coronary Artery Disease Complications
Complications of coronary artery disease include:
- Abnormal heart rhythm (arrhythmia), when your heartbeat loses its regular rhythm because of damage to your heart or a lack of blood supply. The most common form is called atrial fibrillation (AFib). These rhythm problems can cause heart failure or make it worse. An irregular heartbeat might lead to blood clots in your heart, and these can cause a stroke if they reach your brain.
- Heart attack, when your coronary artery is totally blocked, keeping part of your heart muscle from getting enough oxygen. When blood flow to your heart muscle is blocked, your doctor might call it acute coronary syndrome.
- Heart failure, when your heart becomes too weak to supply your body with the blood it needs. This can be because your heart isn’t getting enough oxygen and nutrients or it was damaged by a heart attack.
What to Do if You Have a Coronary Emergency
It’s important to know your heart disease symptoms and what causes them.
Call your doctor if you feel new symptoms or if the ones you’re used to become more frequent or severe. Call 911 if you or someone you’re with has chest pain, especially when it comes with things like shortness of breath, heart palpitations, dizziness, a fast heartbeat, nausea, or sweating.
Emergency workers may tell you to chew an aspirin to help keep a blood clot from forming or getting larger.