Coronary Artery Disease

Coronary artery disease, also called coronary heart disease, or simply, heart disease, affects millions of Americans. This serious condition is a result of plaque buildup in your arteries.

What Is Coronary Artery Disease?

The arteries, which start out smooth and elastic, get plaque on their inner walls, which can make them more rigid and narrowed. This restricts blood flow to your heart muscle, which can then become starved of oxygen.

The plaque could rupture, leading to a heart attack or sudden cardiac death.

How Does Coronary Artery Disease Develop?

From a young age, plaque can start to go into your blood vessel walls. As you get older, the plaque builds up. That inflames the walls and raises the risk of blood clots and heart attacks.

The plaque makes the inner walls of your blood vessels sticky. Then, other things, like inflammatory cells, lipoproteins, and calcium, travel in your bloodstream and mix with the plaque.

As more of these inflammatory cells join in, along with cholesterol, the plaque increases, both pushing the artery walls outward and growing inward. That makes the vessels narrower.

Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart muscle. However, if you’re pushing yourself or stressed, the new arteries may not be able to bring enough oxygen-rich blood to the heart muscle.

In some cases, when plaque ruptures, a blood clot may block blood supply to the heart muscle. This causes a heart attack.

If a blood vessel to the brain is blocked, usually from a blood clot, an ischemic stroke can happen.

If a blood vessel within the brain bursts, most likely as a result of uncontrolled hypertension (high blood pressure), a hemorrhagic stroke can result.

Studies have found that taking low-dose aspirin each day may help prevent heart attacks and strokes in people who are 50 or older and at risk for heart disease.

What Is Ischemia?

Cardiac ischemia is when plaque and fatty matter narrow the inside of an artery so much, it cannot 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:

  • Exercise or other exertion
  • Eating
  • Excitement or stress
  • Exposure to cold

Coronary artery disease can get to a point where ischemia happens even when you’re at rest. 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.

What Are the Symptoms of Coronary Artery Disease?

The most common symptom is angina, or chest pain.

Angina can be described as a:

  • Heaviness
  • Pressure
  • Aching
  • Burning
  • Numbness
  • Fullness
  • Squeezing
  • Painful feeling

It can be mistaken for indigestion or heartburn.

Angina is usually felt in the chest, but may also be felt in the:

Symptoms are often subtler in women. Nausea, sweating, fatigue, or shortness of breath can join the typical pressure-like chest pain.

Other symptoms that can occur with coronary artery disease include:

How Is Coronary Artery Disease Diagnosed?

Your doctor can tell if you have coronary artery disease after:

How Is Coronary Artery Disease Treated?

It can involve:

Lifestyle changes: If you smoke, quit. Avoid processed foods and adopt 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, medications may be needed. The drugs you’ll take depend on your situation. If you’ve been diagnosed with coronary artery disease, you’ll probably be on aspirin and a statin, if not other things. The PCSK9 inhibitor, evolocumab (Repatha) has been shown to significantly lower the risk of heart attack as well as stroke in people with cardiovascular disease.


Surgery and other procedures: Common ones to treat coronary artery disease include:

All of these boost blood supply to your heart, but they don’t cure coronary heart disease. Preventing heart disease is the key.

Doctors are also studying innovative ways to treat heart disease, including:

Angiogenesis. This involves things like stem cells and other genetic material being given through the vein, or directly into damaged heart tissue. It’s done to help new blood vessels grow and go around the clogged ones.

EECP (enhanced external counterpulsation). Folks who have chronic angina, but aren’t helped by nitrate medications or don’t qualify for some procedures, may find relief with this. It’s an outpatient procedure that uses cuffs on the legs that inflate and deflate to boost the blood supply to coronary arteries.

What to Do if You Have a Coronary Emergency

Learn to recognize your heart disease symptoms and what causes them.

Call your doctor if you begin to feel new symptoms or if the ones you’re used to become more frequent or severe. If you or someone you are with has chest pain, especially if there are also things like shortness of breath, heart palpitations, dizziness, a fast heartbeat, nausea, or sweating, call 911 for help.

If you’ve been prescribed nitroglycerin for chest pain, call 911 if you’re still feeling pain after two doses (at 5-minute intervals) or after 15 minutes.

Emergency personnel may tell you to chew an aspirin to help keep a blood clot from forming or getting larger.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on January 7, 2018



The American Heart Association. 

The American Association of Family Physicians. ''Angiogenesis: Four Approaches to Restoring Cardiac Function.'' 

St. John Hospital Providence Health System: ''How EECP Works.''

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