What Is Coronary Artery Disease? Symptoms and Causes

What is Coronary Artery Disease?

Coronary artery disease (CAD) is a condition in which the coronary arteries — blood vessels that supply blood to the heart muscle — become narrowed or blocked. This occurs due to the buildup plaque which is a combination of cholesterol and other fatty substances in the artery walls. 

The condition is called coronary heart disease, and the process of plaque buildup is called atherosclerosis. It leads to reduced blood supply to the heart. Narrowing of the coronary arteries can cause symptoms such as chest pain (angina) and shortness of breath. Heart attacks happen when there is a complete blockage of an artery.

Other names for coronary artery disease (CAD) are coronary heart disease and ischemic heart disease.

According to the National Heart, Lung, and Blood Institute, coronary artery disease (CAD) is the most common type of heart disease. The Centers for Disease Control and Prevention (CDC) estimates that approximately 1 in 20 adults or 5% of the U.S. population, have CAD. Every year, over 800,000 Americans have heart attacks — that’s one heart attack every 40 seconds.

Types of Coronary Artery Disease

There are three main types of coronary artery disease:

• Obstructive coronary artery disease, which develops due to plaque buildup and narrowing of the coronary arteries. This is the most common type of CAD.

• Nonobstructive coronary artery disease, in which no plaque builds up. The narrowing of a coronary artery is due to other causes such as coronary vasospasm (sudden tightening of a coronary artery), endothelial dysfunction (damage to the inner lining of the coronary artery), or myocardial bridging (compression of the coronary arteries by heart tissue).

• Spontaneous coronary artery dissection (SCAD), which is a tear in the wall of a coronary artery that slows down or stops blood flow to the heart. It causes sudden symptoms that resemble a heart attack.

The inadequate blood flow and oxygen to the heart caused by coronary artery disease can be presented in two forms:

• Stable ischemic heart disease is a chronic (long-term) type of CAD. There is a gradual narrowing of the coronary arteries over time, causing the heart muscle to receive less oxygen-rich blood. This can cause symptoms, such as angina attacks, but you can continue living with the condition for many years. 

• Acute coronary syndrome is a sudden worsening of coronary artery disease. It occurs due to rupture of a plaque in a coronary artery and the formation of a blood clot that blocks blood flow, causing a heart attack. Acute coronary syndrome is a medical emergency.

Common Misconceptions

Myth: Heart disease is only a problem in men.

Fact: Coronary heart disease is a leading cause of death in both men and women over the age of 65. Since the 1980s, the number of women who develop coronary artery disease has been increasing. Notably, the risk factors for coronary artery disease are different in women than men due to hormonal influences, a smaller heart size, and other risk factors.

Myth: Coronary artery disease only affects older adults.

Fact: CAD is more common in older adults. However, you can also develop a blocked artery in the heart at an early age. The CDC reports that 1 in 5 deaths from cardiovascular diseases occur in people younger than 65 years of age. 

Myth: Angioplasty and stenting or heart bypass surgery can fix heart disease.

Fact: Treating coronary artery disease with angioplasty and stenting or heart bypass surgery can open up narrowed arteries and restore blood flow to the heart muscle. This can relieve symptoms such as angina (chest pain) and improve quality of life. However, these procedures do not fix the underlying problem. You need to take steps to prevent coronary artery disease, such as correcting metabolic syndrome (high blood pressure, high cholesterol, and diabetes), stopping smoking, eating a heart-healthy diet, and getting regular exercise. Otherwise, the coronary arteries continue to build up fatty plaque, angina may return, and you could be at risk of a heart attack or stroke.

Importance of Early Detection

Early detection and treatment of cardiovascular disease can prevent serious complications like heart attacks, strokes, heart failure, and arrhythmias (heart rhythm abnormalities). 

Keep in mind that the main risk factors for coronary artery disease — high blood pressure, high blood cholesterol, and high blood glucose — do not cause any symptoms in the early stages. A healthy lifestyle can help you maintain heart health. Regular medical checkups and screenings can lead to an early diagnosis of coronary artery disease.

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What Causes Coronary Artery Disease?

As mentioned, the main cause of coronary artery disease is plaque buildup (accumulation of cholesterol and other substances) in the walls of the coronary arteries, leading to decreased blood flow to the heart muscle.

Major Risk Factors

The major risk factors for coronary artery disease are:

• Hypertension (high blood pressure)

• Hypercholesterolemia (high blood cholesterol)

• Diabetes (high blood sugar)

Lifestyle and Environmental Influences

Other risk factors for coronary artery disease that you can control include:

• Smoking or inhaling second-hand smoke.

• Obesity.

• Sedentary lifestyle, lack of exercise.

• An unhealthy diet with a high intake of saturated fats, trans fats, salt, and sugar.

• Lack of adequate restful sleep.

• High levels of emotional stress.

• Heavy alcohol use.

Related Conditions

A family history of coronary artery disease is associated with an increased risk of developing the condition. In addition, having certain other medical conditions can put you at a higher risk of coronary artery disease, for example:

• Chronic kidney disease.

• Obstructive sleep apnea.

• Certain autoimmune disease, such as rheumatoid arthritis and lupus.

• Preeclampsia and other pregnancy complications.

• Increased homocysteine or high-sensitivity C-reactive protein (hs-CRP) on blood tests.

What Are 5 Symptoms of Coronary Artery Disease?

Coronary artery disease symptoms develop because the heart muscle does not get enough nutrient- and oxygen-rich blood. Common CAD symptoms include:

• Angina (chest pain): It can feel like chest heaviness, tightness, pressure, or squeezing. Some people describe it like someone is standing on their chest. The pain is typically located in the middle and to the left side of the chest. Some people, especially women, may experience sharp, brief angina pain in the arm, neck, or back. Physical activity and strong emotions can trigger an angina attack. 

• Shortness of breath: Difficulty breathing or being unable to catch your breath, especially with exercise, is a symptom of CAD.

• Fatigue: When the heart cannot pump blood efficiently, it leads to decreased blood supply to every other part of the body, which can cause unusual tiredness. 

• Edema: Swelling in the hands and feet can occur because the heart is unable to pump blood effectively.

• Palpitations: A sensation of a racing heart can occur because damage to the heart muscles results in disruption of electrical signals and arrhythmia (abnormal heart rhythm).

What Are The Early Warning Signs of Coronary Artery Disease?

In the early stages, symptoms of coronary artery disease may not be noticeable. Over time, as the arteries become narrower, you may develop symptoms only when the heart is working hard and not getting enough blood, for example, when you’re exercising. As the coronary arteries narrow even further, your symptoms may get worse, occur more frequently, and happen even at rest. 

Heart Attack Symptoms

A complete blockage in a coronary artery causes a heart attack. This is a medical emergency. Call 911 or have someone drive you to the nearest hospital if you think you’re having a heart attack. Common symptoms of a heart attack include:

• Chest pain, tightness, pressure, or squeezing

• Pain that spreads to the shoulder, arm, neck, shoulder, back, jaw, teeth, or upper abdomen

• Shortness of breath

• Lightheadedness or dizziness

• Tiredness

• Cold sweats

• Nausea

• Heartburn

Note: The CDC says that 1 in 5 heart attacks are silent, where there is damage to the heart without the person being aware they had a heart attack.

Diagnosing Coronary Heart Disease

How Do You Know If You Have Coronary Artery Disease?

The most common symptom of coronary artery disease is chest pain (angina). This is a tightness, fullness, pressure, or squeezing pain in the chest that feels dull and aching, although some people, especially women can have a brief, sharp pain. The pain is usually located in the middle or to the left of the chest. Other symptoms of coronary artery disease can include shortness of breath and fatigue. These symptoms are often triggered by physical activity or strong emotions. People with more advanced CAD can develop leg swelling and palpitations.

However, many people don’t experience significant discomfort, chest pain, or shortness of breath in the early stages. Therefore, coronary artery disease is known as a “silent killer” since you aren’t aware of it until you have a heart attack. 

In fact, about 1 in 5 heart attacks are silent. Meaning, the person experiencing them may not have any of the hallmark symptoms of a heart attack. Instead, they may mistake them for heartburn or a strained chest muscle. 

Medical Evaluation 

Health care professionals can diagnose coronary artery disease based on symptoms, medical history, physical exam, and results of diagnostic testing.

Common Diagnostic Tests and Imaging

Some of the diagnostic tests and imaging studies done for diagnosing coronary artery disease include:

• Blood tests, such as blood glucose, blood cholesterol, high-sensitivity C-reactive protein (CRP), and homocysteine levels to check for risk factors for CAD.

• Electrocardiogram (ECG or EKG) to check electrical activity in the heart. This is a quick, painless test done using electrodes (sticky patches) placed on your chest that are connected with wires to a computer. ECG patterns can tell your healthcare provider if you are having or have had a heart attack.

• Echocardiogram (echo) to visualize the flow of blood through the heart using sound waves. Slow-moving parts indicate oxygen deficiency and can be a sign of CAD or heart attack. 

• Exercise stress test to see if your symptoms are triggered by physical activity. A stress test involves walking on a treadmill or riding a stationary bike to make your heart beat faster and checking how it performs. 

• Nuclear stress test to see blood flow through the heart using a radioactive material called a radiotracer or tracer which is injected intravenously (IV). Doctors then take images of your heart during exercise and at rest and observe the trace moving through your coronary arteries. 

• Heart CT (computed tomography) scan to see coronary artery calcium deposits that can cause blockages. An IV (intravenous or into a vein) dye is sometimes used — this is called a CT coronary angiogram — to obtain more detailed images.

• Cardiac catheterization and angiogram to see blockages in the heart arteries. This test involves inserting a catheter (a thin, long, flexible tube) through a blood vessel in the groin or wrist and guiding it to the heart. A dye is used to see blood flowing in the coronary arteries on X-ray and video — this is called an angiogram. Cardiac catheterization can be both diagnostic and therapeutic (it can be used to diagnose heart problems and for coronary artery disease treatment, i.e., opening a narrowed artery).

What Is The Best Treatment For Coronary Artery Disease?

The best treatment for coronary artery disease includes medications, surgical procedures, and lifestyle changes. Most people benefit from a combination of these CAD treatments.

Medications

Some of the medications used for preventing and treating coronary artery disease include:

• Daily aspirin at regular strength of 325 milligrams (mg) or low-dose (81 mg) (an antiplatelet drug that prevents blood clot formation). Your doctor will decide which dosing strategy suits you best. 

• Cholesterol lowering medications such as statins, for example, atorvastatin (Lipitor), simvastatin (Zocor), and others.

• Medications for high blood pressure, such as:

  • Beta-blockers such as atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), carvedilol (Coreg), and others.

  • Calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem), verapamil (Calan), and others

  • Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril (Zestril), enalapril (Vasotec), benazepril (Lotensin), and others

  • Angiotensin receptor blockers (ARBs) such as valsartan (Diovan), losartan (Cozaar), candesartan (Atacand), and others

• Medications for anginal chest pain, such as:

  • Nitroglycerin (Nitrostat) 

  • Ranolazine (Ranexa) 

Surgical Procedures

• Coronary angioplasty and stent placement: Also called percutaneous coronary intervention (PCI), this is a minimally invasive revascularization procedure that opens up clogged arteries in the heart. The surgeon uses a tiny balloon attached to a long flexible tube (catheter) to widen a narrowed artery and improve blood flow. A drug-eluting stent (wire mesh tube coated with medicine) can be left in place to keep the blood vessel open. 

• Coronary artery bypass graft (CABG) surgery: Surgeons can do a CABG, commonly called open heart surgery, to treat coronary artery disease. This involves taking a blood vessel from some other part of the body, such as your leg, arm, or chest, to create a new path for blood flow around a narrowed or blocked coronary artery. After coronary artery bypass surgery, your cardiologist may recommend cardiac rehabilitation. A cardiac rehab program includes education, counseling, and exercises to improve heart health after surgery.

Lifestyle Changes and Home Remedies

The following lifestyle modifications can help to prevent or slow the progression of coronary artery disease:

• Stop smoking. Nicotine causes tightening of blood vessels. Quitting can lower your risk of CAD and heart attacks. 

• Eat a heart-healthy diet, including fresh fruits and vegetables, whole grains, low-fat dairy, lean proteins, nuts, seeds, and healthy fats. Limit sugar, unsaturated fats, trans fats, salt, sugar, and processed foods. 

• Get regular physical activity. Exercise can help you maintain a healthy weight and lower your risk of high blood pressure, high cholesterol, and diabetes. Doctors recommend 30 to 60 minutes of exercise on at least 5 days of the week. Talk to your healthcare provider before starting any new exercise program. 

• Maintain a healthy body weight. Obesity is a risk factor for coronary artery disease. Losing just 5-10% of your initial weight can lower your risk. 

• Keep blood pressure under control. Hypertension is a major risk factor for CAD. A DASH diet is a good way to keep your blood pressure numbers in the normal range. 

• Get regular health screenings. This will allow your doctor to identify high cholesterol and high blood sugar and recommend lifestyle changes or medications to manage these risk factors. 

• Avoid or limit alcohol use. Moderate alcohol intake is no more than one drink per day for women and two drinks per day for men. 

• Get enough sleep. Experts recommend 7-9 hours of sleep each night for adults. 

• Manage emotional stress with relaxation techniques such as meditation, yoga, deep breathing, guided imagery, and progressive muscle relaxation. 

Can You Recover from Coronary Artery Disease?

There is no cure for coronary heart disease, but treatment can help to control the symptoms and lower the risk of serious complications such as heart attacks and strokes.

Can You Stop CAD From Progressing?

Besides being adherent to your medication regimen and treatment follow-up, you can prevent or slow the progression of coronary artery disease (CAD) with healthy lifestyle changes listed above, including eating a healthy diet, getting regular exercise, stopping smoking, ensuring adequate sleep, and practicing stress management. 

What Is The Life Expectancy With Coronary Artery Disease?

The life expectancy of a person with coronary artery disease depends on the extent of heart damage, how soon the condition is diagnosed and treated, and other factors like age, gender, and ethnicity. 

The American Heart Association (AHA) estimates that, on average, life expectancy is decreased by 10 years in people with heart failure and 16 years after a heart attack. People with multiple risk factors are at greater risk of reduced life expectancy.

Learn about heart failure medications for the elderly population.

Managing Health and Reducing Risk

Leading a healthy lifestyle can help to lower your risk of heart disease. Even small steps like eating healthier, going for a brisk 30-minute walk every day, quitting smoking, and limiting alcohol use can reduce cardiovascular risk by 20-30%.