Coronary Artery Disease

Plaque in the arteries of the heart can reduce blood flow, causing heart disease—the leading cause of death in the United States.

What is coronary artery disease?

Coronary Artery Disease (CAD) is the build-up of plaque in the arteries of the heart, which can reduce or block blood flow and lead to chest pain and shortness of breath. Left untreated, CAD can lead to heart failure, heart attack, and death.

What are the symptoms of CAD?

The most common symptoms include:

  • Chest pain (angina), pressure, heaviness, or discomfort in the middle or left side of the chest, especially during exercise or emotional stress
  • Pain, pressure, heaviness, or discomfort in the shoulder, arms neck, back, or jaw
  • Shortness of breath
  • Fatigue, especially when walking, climbing stairs, or exercising
  • Weakness or dizziness
  • Nausea
  • Irregular heartbeat (arrhythmia)
  • Heart attack

How is it diagnosed?

Physicians use a variety of tests to check the heart’s function and flow of blood through the coronary arteries, including:

  • Electrocardiogram (ECG) – to check the heart’s electrical signals
  • Stress test – to monitor symptoms during exercise
  • Echocardiogram – to check the heart’s pumping action
  • Angiogram – to check for blockages by injecting dye into the coronary arteries
  • Computerize tomography (CT) – to see calcium deposits that may be blocking the artery

What causes CAD?

Atherosclerosis, or the build-up of plaque in the body’s arteries, is thought to be due to damage or inflammation in the walls of the artery. It is still not clear how atherosclerosis starts, but is believed to originate and progress from a combination of factors such as:

  • High blood pressure
  • High LDL (“bad”) cholesterol
  • Low HDL (“good”) cholesterol
  • Smoking
  • Diabetes or insulin resistance
  • Obesity
  • Sedentary lifestyle
  • Inflammation
  • Genetic conditions

Men over 45 and post-menopausal women are at a higher risk for CAD.

How is CAD treated?

If the symptoms are not severe, a physician may prescribe lifestyle changes such as a eating a healthier diet, quitting smoking, exercising regularly, losing weight, and reducing stress. For more severe blockages, treatments include:

  • Medications – to lower LDL or “bad” cholesterol
  • Daily aspirin – to thin the blood and reduce its ability to clot
  • Beta blockers – to slow the heart rate, decrease blood pressure, and reduce the heart’s demand for oxygen
  • Nitroglycerin – to control chest pain by dilating the coronary arteries
  • Angioplasty and stent placement – inserting a catheter into the diseased artery and inflating a balloon to compress the plaque against the artery walls; a small mesh tube (stent) may be placed to keep the artery open
  • Atherectomy – inserting a catheter into the diseased artery and using a device to remove the blockage
  • Coronary bypass surgery – using a blood vessel from another part of the body to re-route or bypass the blockage, a procedure usually reserved for those with multiple blockages

How many people are affected by CAD?

Cardiovascular disease is the leading cause of death in the United States—nearly 1 in 4 deaths—or more than cancer, chronic lung disease, or diabetes combined.

CAD is the most common type of heart disease, and costs the U.S. more than $108 billion in health care services, medications, and lost productivity.

References:

Coronary Artery Disease,” Mayo Clinic, accessed online 01.05.16.
Coronary Artery Disease – Coronary Heart Disease,” American Heart Association, accessed online 01.06.16.
Curtis M. Rimmerman, “Coronary Artery Disease,” Cleveland Clinic Center for Continuing Education, February 2013, accessed online 01.06.16.