Heart Disease and Diabetes in 3D

Coronary Artery Disease

What Is Coronary Artery Disease?

Coronary artery disease, also called CAD, 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 stiff and narrow. This slows blood flow to your heart muscle, so it doesn’t get the oxygen it needs.

The plaque could also break off, leading to a heart attack or sudden cardiac death.

Coronary Artery Disease Symptoms

The most common symptom is angina, or chest pain.

People describe angina as:

  • Aching

  • Burning

  • Fullness

  • Heaviness

  • Numbness

  • Pressure

  • Squeezing

  • Weakness or dizziness

You might mistake it for indigestion or heartburn.

You usually feel angina in your chest, but you might feel it in your:

  • Arms

  • Back

  • Jaw

  • Neck

  • Shoulder

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

Other symptoms of coronary artery disease include:

Coronary Artery Disease Causes and Development

Experts think CAD starts with damage or injury to the inner layer of a coronary artery. This damage can even happen when you’re a child. Plaque can start to collect along your blood vessel walls when you’re young and build up as you get older. That buildup inflames those walls and raises your risk of blood clots and heart attacks.

The plaque makes the inner walls of your blood vessels sticky. Things like inflammatory cells, lipoproteins, and calcium attach to the plaque as they travel through your bloodstream.

More of these materials build up, along with cholesterol. That pushes your artery walls out while making them narrower.

Over time, 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.

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

If a blood vessel to your brain is blocked, usually by a clot, you can have an ischemic stroke.

If a blood vessel in your brain bursts, you might have a hemorrhagic stroke. These are usually brought on by high blood pressure.

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

Many things can make you more likely to have coronary artery disease. Some you can change, and some you can’t. They include:

  • Age, especially being older than 65

  • Being overweight or obese

  • Diabetes

  • 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

What Is Ischemia?

Cardiac ischemia is when plaque and fatty matter narrow the inside of your artery so much that it can’t supply enough oxygen-rich blood to your heart. This can cause heart attacks, with or without chest pain and other symptoms.

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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’s 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 and angiogram

  • Echocardiogram

  • Electrocardiogram (EKG)

  • Electron beam (ultrafast) CT scan

  • Exercise stress tests

 

Coronary Artery Disease Treatment

Your treatment may involve:

Lifestyle changes. If you smoke, quit. Eat less processed food, and change to a diet low in trans fats, salt, and sugar. loKeep 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 could  take: 

  • Aspirin

  • Medications to help your cholesterol (statins, niacin, fibrates, and bile acid sequestrants)

  • Beta blockers

  • Calcium channel blockers

  • Ranolazine

  • Nitroglycerin

  • ACE inhibitors

  • Angiotensin II receptor blockers (ARBs)

  • Evolocumab (Repatha), which 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.

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Doctors are also studying new 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.

  • Enhanced external counterpulsation (EECP). People who have long-term 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.

Home remedies for coronary artery disease

Lifestyle changes can prevent or slow CAD:

  • Stop smoking.

  • Control your blood pressure, cholesterol, and blood sugar levels.

  • Eat foods that are good for your heart.

  • Avoid alcohol, or at least cut back.

  • Exercise.

  • Keep a healthy weight.

  • Manage your stress.

Coronary Artery Disease Complications

Complications of coronary artery disease include:

  • Abnormal heart rhythm (arrhythmia), when your heart 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 because it was damaged by a heart attack.

Coronary Artery Disease Outlook

An important part of recovering from CAD or other heart problems is cardiac rehabilitation (rehab). Research shows that it can lower your chance of death from heart disease and future heart problems. You’ll work with a team of people who will help you with:

  • Exercise and movement

  • Information about a healthy lifestyle, including food, medication, and other changes

  • Counseling to lower your stress and improve your mental health

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.

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

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

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on August 05, 2020

Sources

SOURCES:

The American Heart Association. 

The American Association of Family Physicians. 

columbiasurgery.org: ''Angiogenesis: Four Approaches to Restoring Cardiac Function.'' 

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

Texas Heart Institute: “Are coronary artery disease, coronary heart disease, atherosclerotic heart disease and ischemic heart disease the same?”

Cleveland Clinic: “Coronary Artery Disease," “Coronary Artery Disease Symptoms.”

Mayo Clinic: “Coronary artery disease," “Cardiac rehabilitation.”

Merriam-Webster Dictionary: “Outpatient.”

Institute for Quality and Efficiency in Health Care: “Complications of coronary artery disease.”

American Heart Association: “Acute Coronary Syndrome.”

CDC: “Coronary Artery Disease (CAD).”

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