Coronary Artery Disease
What is coronary artery disease?
Coronary artery disease is the most common type of heart disease. It's also the number one killer of both men and women in the United States.
When you have it, your heart muscle doesn't get enough blood. This can lead to serious problems, including heart attack .
It can be a shock to find out that you have coronary artery disease. Many people only find out when they have a heart attack. Whether or not you have had a heart attack, there are many things you can do to slow coronary artery disease and reduce your risk of future problems.
What causes coronary artery disease?
Coronary artery disease is caused by hardening of the arteries, or atherosclerosis . This means that fatty deposits called plaque (say "plak") build up inside the arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body.
Atherosclerosis can affect any arteries in the body. When it occurs in the ones that supply blood to the heart ( the coronary arteries ), it is called coronary artery disease.
When plaque builds up in the coronary arteries, the heart doesn't get the blood it needs to work well. Over time, this can weaken or damage the heart. If a plaque tears, the body tries to fix the tear by forming a blood clot around it. The clot can block blood flow to the heart and cause a heart attack .
What are the symptoms?
Symptoms can happen when the heart is working harder and needs more oxygen, such as during exercise. Symptoms include:
Less common symptoms include a fast heartbeat, feeling sick to your stomach, and increased sweating. Some people don't have any symptoms. In rare cases, a person can have a "silent" heart attack, without symptoms.
To find out your risk for a heart attack in the next 10 years, use this Interactive Tool: Are You at Risk for a Heart Attack?
How is coronary artery disease diagnosed?
Your doctor will do a physical exam and ask questions about your past health and your risk factors. Risk factors are things that increase the chance that you will have coronary artery disease.
Some common risk factors are being older than 65; smoking; having high cholesterol, high blood pressure, or diabetes; and having heart disease in your family.
If your doctor thinks that you have coronary artery disease, you may have tests to check how well your heart is working. These tests include an electrocardiogram (EKG or ECG), a chest X-ray, an exercise electrocardiogram, and blood tests. You may also have a coronary angiogram to check blood flow to the heart.
How is it treated?
Treatment focuses on lowering your risk for heart attack and stroke and managing your symptoms. Lifestyle changes, medicine, and procedures are used.
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Frequently Asked Questions
Coronary artery disease is caused by hardening of the arteries, or atherosclerosis . This means that fatty deposits called plaque build up inside the arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body.
Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart ( the coronary arteries ), it is called coronary artery disease.
To understand why plaque and atherosclerosis is a problem, compare a healthy artery with an artery with atherosclerosis:
A healthy artery is like a rubber tube. It is smooth and flexible, and blood flows through it freely. When your heart has to work harder, such as when you exercise, a healthy artery can stretch to let more blood flow to your body's tissues.
An artery with atherosclerosis is more like a clogged pipe. Plaque narrows the artery and makes it stiff. This limits the flow of blood to the tissues. When the heart has to work harder, the stiff arteries can't flex to let more blood through, and the tissues don't get enough blood and oxygen.
When plaque builds up in the coronary arteries, the heart doesn't get the blood it needs to work well. This is called ischemia (say "is-KEE-mee-uh"). Ischemia can cause symptoms such as chest pain or pressure. Over time, ischemia can weaken or damage the heart.
If a plaque tears, the body tries to fix the tear by forming a blood clot around it. The clot can block blood flow to the heart and cause a heart attack .
The most common symptoms of coronary artery disease are angina (say "ANN-juh-nuh" or "ann-JY-nuh") and shortness of breath when exercising or doing other vigorous activity. Women are somewhat more likely than men to have other symptoms like nausea and back or jaw pain.
Some people don't have any symptoms. This is called "silent ischemia." In rare cases, you can even have a "silent heart attack," a heart attack without symptoms.
What Increases Your Risk
Things that can increase your risk for coronary artery disease are called risk factors. Some risk factors, such as your gender, your age, and your family history , can't be changed. Other risk factors for heart disease are tied to your lifestyle and habits. These are often things you can change, like quitting smoking, eating heart-healthy foods, and getting more exercise.
Women have unique risk factors for heart disease. These include using birth control pills, using hormone therapy, and having pregnancy-related problems.
Your chance of getting coronary artery disease rises with the number of risk factors you have.
To learn how to lower your risk, see Prevention.
What's your risk?
Your doctor can help you find out your risk of getting coronary artery disease. And you can use the Interactive Tool: Are You at Risk for a Heart Attack? if you know your blood pressure and cholesterol numbers.
When to Call a Doctor
Do not wait if you think you are having a heart attack. Some people aren't sure whether they're having one, or they don't want to bother others, so they wait. But getting help fast can save your life.
Call 911 or other emergency services immediately if you have symptoms of a heart attack or are with someone who has symptoms. Symptoms may include:
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. By taking an ambulance, you may be able to start treatment before you arrive at the hospital.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.
Call your doctor if:
Who to see
To see if you are at risk for heart disease, have symptoms of heart disease, or need long-term care for existing heart disease, see your family doctor or internist . For diagnosis of coronary artery disease, you may see a cardiologist . For ongoing care of stable angina, you will likely see your family doctor or an internist. For angioplasty or surgery, you will be referred to an interventional cardiologist or cardiovascular surgeon .
Exams and Tests
Your doctor will do a physical exam and a number of tests to find out your risk for coronary artery disease and to diagnose it.
To find out your risk for coronary artery disease
If you know your blood pressure and cholesterol levels, you can use this tool:
Sometimes doctors schedule heart tests because they think that's what patients expect. But some heart tests may not be needed. If your doctor recommends a test, ask what it is for and why you need it. See the topic Heart Tests: When Do You Need Them?
To diagnose coronary artery disease
If your doctor thinks you may have heart disease, you will need some tests to make sure. Most often, the first tests include:
Other tests may include:
Treatment focuses on lowering your risk for heart attack and stroke and managing your symptoms. Lifestyle changes, medicine, and procedures are used.
Lifestyle changes are the first step for anyone with coronary artery disease. Healthy habits can slow or even stop the disease and improve the quality and length of your life. These habits include:
A cardiac rehabilitation program can help you make these changes.
It's also important to manage any health problems you have. If you have high blood pressure, high cholesterol, or diabetes, be sure you're doing everything you can to keep these conditions under control.
To learn what you can do, see Living With Heart Disease.
You will probably have to take several medicines. These include:
If your angina symptoms get worse even though you are taking medicines, you may think about having a procedure to improve blood flow to your heart. These include angioplasty with or without stenting and bypass surgery. They are done when the coronary arteries are severely blocked.
If your coronary artery disease gets worse, you may want to think about palliative care. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. It may help you manage symptoms or side effects from treatment.
If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
You can help prevent coronary artery disease by taking steps toward a heart-healthy lifestyle. A heart-healthy lifestyle can also help you reduce risk factors such as high cholesterol and high blood pressure.
Control your cholesterol and blood pressure
To reduce your risk of heart disease, you'll need to control your cholesterol and manage your blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work well enough, you may need to take medicines too.
Use aspirin to prevent heart attack and stroke
If you're already at risk for heart disease, taking daily aspirin may reduce your chances of having a stroke or a heart attack. That's because a daily aspirin lowers your risk of getting blood clots. Blood clots can lead to a heart attack in people with heart disease. Clots can also cause heart attacks in people who have other problems that can lead to heart disease, such as diabetes, high blood pressure, and high cholesterol.
Taking aspirin has some risks. Talk with your doctor before starting aspirin treatment.
Stress can hurt your heart. Keep stress low by talking about your problems and feelings, rather than keeping your feelings hidden. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.
Coronary artery disease most often begins when the inside walls of the coronary arteries are damaged because of another health problem, such as high cholesterol, high blood pressure, diabetes, or smoking. This damage can lead to atherosclerosis, or hardening of the arteries.
If your heart disease gets worse, your arteries will narrow, and less blood will flow to your heart. You may start to have angina symptoms, such as chest pain or discomfort when you exercise or feel stressed. This is called stable angina .
In some cases, sudden and serious problems can happen. New blockages that form in the arteries of the heart can become unstable. They can suddenly tear and cause blood clots to form. These clots block blood flow to your heart, causing a heart attack or unstable angina .
Complications of heart disease
Over time, you may have other health problems caused by coronary artery disease. Low blood flow can make it harder for your heart to pump. This can lead to heart failure or atrial fibrillation . Atrial fibrillation increases the risk of stroke.
Living With Heart Disease
A diagnosis of coronary artery disease can be hard to accept and understand. If you don't have symptoms, it may be especially hard to recognize that heart disease is serious and can lead to other health problems.
It's important to talk with your doctor to learn about the disease and what you can do to help manage it and keep it from getting worse.
Your doctor may suggest that you attend a cardiac rehabilitation (rehab) program. In cardiac rehab, you will get education and support that help you build new, healthy habits, such as eating right and getting more exercise.
Medicines are an important part of your treatment.
Get help for depression
Depression and heart disease are linked. People with heart disease are more likely to get depressed. And if a person has both depression and heart disease, he or she may not stay as healthy as possible. This can make depression and heart disease worse.
Manage other health problems
To reduce your risk of heart attack or stroke, you will need to control other health problems you may have. These problems include high cholesterol and high blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work well enough, you may also need to take medicines.
Other steps to stay healthy
Medicines are an important part of your treatment. Using them correctly can lower your risk of having a heart attack or dying from coronary artery disease.
Medicine to lower blood pressure and the heart's workload
Medicine to prevent blood clots from forming and causing a heart attack
Aspirin, ibuprofen, and naproxen are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and inflammation. But only aspirin will reduce your risk for heart attack or stroke. Don't substitute ibuprofen or naproxen for low-dose aspirin therapy. If you need to take an NSAID for a long time, talk with your doctor to see if it is safe for you.
Medicine to lower cholesterol
Medicine to manage angina symptoms
Stable angina can often be controlled with medicine such as:
If you take nitrates
Do not use erection-enhancing medicines such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) if you take nitroglycerin or other nitrates for angina. Combined, these two drugs can cause a serious drop in blood pressure. Talk to your doctor. There are other medicines that may work instead to ease your angina.
For more help with controlling angina, see:
Help taking your medicines
Medicine is a powerful tool to help you manage your heart disease. To get the most of your medicines, take them as prescribed. This may be hard because of how many you have to take and their cost. You may also worry about side effects.
You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.
Sometimes coronary artery bypass graft surgery is needed to improve blood flow to the heart. During this surgery, a doctor connects (grafts) a healthy artery or vein from another part of your body to the blocked coronary artery . The grafted artery goes around (bypasses) the blocked part of the artery. The bypass provides a new pathway for blood to your heart.
If you have surgery, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.
Angioplasty is a procedure that widens the coronary artery to improve blood flow to the heart. It is done using a thin, soft tube called a catheter, which is inserted in your artery.
Angioplasty is not surgery. It doesn't use large cuts (incisions) or require anesthesia to make you sleep.
Most of the time, stents are placed during angioplasty. The stent keeps the artery open . When stents are used, there is a smaller chance that the artery will become narrow again.
Atherectomy might be done during angioplasty. Atherectomy is done to shave away and maybe remove plaque in a narrowed artery. It is only done in certain cases.
If you decide to have angioplasty, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.
If your heart disease is advanced and your life will most likely be shortened by the illness, talk to your doctor about whether you want to be revived (resuscitated) when your illness progresses and your breathing stops. You may want to learn more about aggressive life-sustaining medical treatment and whether it is right for you.
For more information, see:
Other Places To Get Help
Last Revised: April 5, 2012
Author: Healthwise Staff
Roger VL, et al. (2012). Heart disease and stroke statistics—2012 update: A report of the American Heart Association. Circulation, 125(1): e2–e220. Also available online: http://circ.ahajournals.org/content/125/1/e2.full .
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