Coronary Artery Disease
(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease;
Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)
Coronary arteries bring oxygen rich blood to the heart muscle. Coronary
artery disease (CAD) is blockage of these arteries. If the blockage is
complete, areas of the heart muscle may be damaged. In severe case the
heart muscle dies. This can lead to a heart attack, also known as a
myocardial infarction (MI).
Coronary artery disease is the most common form of heart disease. It is
the leading cause of death worldwide.
Coronary Artery Disease
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Thickening of the walls of the arteries
feeding the heart muscle
Accumulation of fatty plaques within the
Sudden spasm of a coronary artery
Narrowing of the coronary arteries
Inflammation within the coronary
Development of a blood clot within the
coronary arteries that blocks blood flow
Major risk factors include:
Sex: male (men have a greater risk of
heart attack than women)
Age: 45 and older for men, 55 and older
Heredity: strong family history of heart
Obesity and being overweight
High blood pressure
Sedentary lifestyle—Poor fitness can
also increase your risk of CAD and
High cholesterol (specifically, high LDL
cholesterol, and low HDL cholesterol)
Metabolic syndrome (combination of high
blood pressure, abdominal obesity, and
Other risk factors may include:
Excessive alcohol use
A diet that is high in saturated fat, trans
fat, cholesterol, and/or
calories—Drinking sugary beverages on a
regular basis may increase your risk of
CAD may progress without any symptoms.
Angina is chest pain that comes and goes. It often has a
squeezing or pressure-like quality. It may radiate into
the shoulder(s), arm(s), or jaw. Angina usually lasts
for about 2-10 minutes. It is often relieved with rest.
Angina can be triggered by:
Exercise or exertion
A large meal
Chest pain may indicate more serious unstable angina or
a heart attack if:
It is unrelieved by rest or
Angina that begins at rest (with no
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 cause less classic chest pain.
It is likely to start with shortness of breath and
If you go to the emergency room with chest pain, some tests will be done
right away. The tests will attempt to see 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.
The doctor will ask about your symptoms and medical history. A physical
exam will be done.
Tests may include:
Blood tests—to look for certain substances in the blood
called troponins which help the doctor determine if you
are having a heart attack
Electrocardiogram (ECG, EKG)— records the heart's
activity by measuring electrical currents through the
heart muscle, and can reveal evidence of past heart
attacks, acute heart attacks, and heart rhythm problems
Echocardiogram —uses high-frequency sound waves
(ultrasound) to examine the size, shape, and motion of
the heart, giving information about the structure and
function of the heart
Exercise stress test —records the heart's electrical
activity during increased physical activity
Nuclear stress test—the heart is observed while
exercising and radioactive material highlights impaired
blood flow to help locate problem areas
Coronary calcium scoring—a type of x-ray called a CAT
scan that uses a computer to look for the presence of
calcium in the heart arteries
Coronary angiography —x-rays taken after a dye is
injected into the arteries to allows the doctor to look
for abnormalities in the arteries
Treatment may include:
This medicine is usually given during an attack of angina. It
can be given as a tablet that dissolves under the tongue or as a
spray. Longer-lasting types can be used to prevent angina before
an activity known to cause it. These may be given as pills or
applied as patches or ointments.
Other blood-thinning medicines include:
Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors
These may help prevent angina. In some cases, they may lower the
risk of heart attack.
Medications to Lower Cholesterol
Medicines, like statins, are often prescribed to people who have
CAD. Statins (eg, atorvastatin [Lipitor]) lower cholesterol
levels, which can help to prevent CAD events.
Patients with severe blockages in their coronary arteries may
benefit from procedures to immediately improve blood flow to the
Percutaneous coronary interventions (PCI)—such as
balloon angioplasty , in some 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
Some studies have shown that CABG may be more effective than
PCI. Lifestyle changes and intensive medicine may also be just
as effective as PCI.
Options for Refractory Angina
For patients who are not candidates for
revascularization procedures but have continued angina
despite medicine, options include:
Enhanced external counterpulsation
(EECP)—large air bags are inflated
around the legs in tune with the heart
beat. The patient receives 5 one-hour
treatments per week for seven weeks.
This has been shown to reduce angina and
may improve symptom-free exercise
(TMR)—surgical procedure done with laser
to reduce chest pain.
Researchers are also studying gene
therapy as a possible treatment.
To reduce your risk of getting coronary artery disease:
Maintain a healthy weight.
Eat a heart healthy diet that is low in
saturated fat , red meat and processed
meats, and rich in whole grains ,
fruits, and vegetables .
Begin a safe exercise program with the
advice of your doctor.
If you smoke, quit .
Treat your high blood pressure and/or
Treat high cholesterol or triglycerides.
Ask your doctor about taking a low-dose
aspirin every day.
In certain patients, taking rosuvastatin
(Crestor) may be another option. Talk to
American Heart Association http://www.americanheart.org/
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/
Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/
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Reviewer: Michael J. Fucci, DO
Review Date: 09/2012
Update Date: 00/92/2012