January 28, 2020
Coronary Artery Disease: Symptoms, Diagnosis, and Treatment
Leo Gazoni, MD - Cardiothoracic (Heart) Surgeon
Coronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD), also known as coronary atherosclerosis, is the narrowing of these arteries, usually the result of plaque buildup. If the blockage is complete, areas of the heart muscle may be damaged or, in a severe case, the heart muscle dies. This can lead to a heart attack, also called a myocardial infarction (MI).
According to the American Heart Association, when the walls of the coronary arteries are narrowed it is known as ischemia. Ischemia can occur slowly, over time, as the amount of plaque grows. Or, ischemia sometimes happens suddenly when a bit of plaque ruptures and forms a blood clot that blocks blood flow to the heart. Either way, the result can be devastating.
There are important steps you can take to help prevent CAD from occurring at all.
What causes CAD?
- Thickening of the walls of the arteries that feed the heart muscle
- Build up of fatty plaques within the coronary arteries
- Sudden spasm of a coronary artery
- Narrowing of the coronary arteries
- Inflammation within the coronary arteries
- Development of a blood clot within the coronary arteries that blocks blood flow
Are there risk factors for developing CAD?
A risk factor is something that increases your chances of developing a certain disease or condition. The more risk factors you have, the higher your odds of having coronary artery disease. Factors that may increase your risk of CAD include:
Uncontrollable Risk Factors
Risk factors that you cannot change are known as uncontrollable risk factors. These include:
- Age: Men over age 45 and women over age 55
- Family History: Those with close relatives who have heart disease are more likely to get it themselves.
- Race: On average, African Americans have higher blood pressure than Caucasians and a higher risk of heart disease. Heart disease risk also is higher among Mexican Americans, American Indians, native Hawaiians, and some Asian Americans.
Controllable Risk Factors
Risk factors that you can change are known as controllable risk factors. Some are easier than others to adjust, but your doctor can recommend ways to be successful in lowering your risk for CAD. Controllable risk factors include:
- Obesity or being overweight
- Hypertension (high blood pressure)
- Inactive lifestyle
- High cholesterol (especially high LDL cholesterol and triglycerides, and low HDL cholesterol)
- Metabolic syndrome (a combination of high blood pressure and cholesterol, abdominal obesity, and insulin resistance)
- Chronic stress and/or fatigue that leads you to make poor decisions about your health
- Excessive alcohol use
- Psychological disorders, like depression and anxiety
- A diet high in saturated fat, trans fat, cholesterol, and/or calories
- Drinking sugary beverages on a regular basis
What are the symptoms of coronary artery disease?
CAD may progress without any symptoms, but angina can be a sign of coronary artery disease. Angina is chest pain or discomfort that is felt when there is not enough blood flow to your heart. It can come and go, and often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for 2-10 minute, and is often relieved with rest. Angina can be triggered by:
- Exercise or exertion
- Emotional stress
- Cold weather
- A large meal
Chest pain may indicate more serious unstable angina or a heart attack if it includes:
- Not being relieved by rest or nitroglycerin
- Severe angina
- Angina that begins at rest
- Angina that lasts more than 15 minutes
Accompanying symptoms may include:
- Shortness of breath
Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms, but is likely to start with shortness of breath and fatigue.
How is CAD diagnosed?
If you go to the emergency room with chest pain, some tests will be done right away to help determine if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.
You will be asked about your symptoms and medical history, and a physical exam will be done. You also may need to have a blood test and/or pictures taken of your heart. The tests to do this may include:
- Coronary calcium scoring (performed by CT scan)
- Coronary angiography
You may need to have your heart function tested with one or more of these tests:
- Echocardiogram (ECG)
- Exercise stress test
- Nuclear stress test
How is coronary artery disease treated?
To treat your coronary artery disease, your doctor may recommend medication and/or special procedures like revascularization.
Medicinal treatment may include:
- Nitroglycerin: This medication is usually given during an attack of angina. It can be given either as a tablet that dissolves under the tongue or as a spray. Longer-lasting formulations can help to prevent angina before an activity that is known to cause it. These types come as pills or applied as patches or ointments.
- Blood-Thinning Medications: A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily. Other blood-thinning medications also may be prescribed, if needed.
- Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors: These medicines may help prevent angina and may lower the risk of heart attack.
- Medications to Lower Cholesterol: Medications, such as statins, are often prescribed to people who have CAD. Statins lower cholesterol levels, which can help prevent CAD events.
In addition to medicinal treatment, your doctor may recommend a procedure to help immediately improve blood flow to the heart muscle. This is known as revascularization:
- Percutaneous coronary interventions (PCI): PCI is often performed as a balloon angioplasty or, in most cases, a wire mesh stent is placed to hold the artery open.
- Coronary artery bypass grafting (CABG): Segments of vessels are taken from other areas of the body and are sewn into the heart arteries to reroute blood flow around blockages.
For patients who are not candidates for revascularization procedures, but have continued angina despite medication, options include:
- Enhanced external counterpulsation (EECP): Large air bags are inflated around the legs in tune with the heartbeat. The patient receives 5 one-hour treatments per week for 7 weeks. Many patients have reduced angina and are able to exercise longer without symptoms.
- Transmyocardial revascularization (TMR): Surgical procedure using lasers that can reduce chest pain.
Is there a way to prevent getting CAD?
In short, yes. Even if you have several risk factors, there are things that you can do to help reduce your chances of getting coronary artery disease:
- Maintain a healthy weight.
- Eat a heart healthy diet that is low in saturated fat, and red and processed meats, but rich in whole grains ,fruits, vegetables, and nuts.
- Begin a safe exercise program with the advice of your doctor.
- If you smoke, talk to your doctor about ways to quit.
- Treat your high blood pressure and/or diabetes.
- Treat high cholesterol or triglycerides.
- Ask your doctor about taking a low-dose aspirin every day.
- Find ways to reduce stress.