Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) is blockage of the arteries that feed the heart muscle. If the blockage is complete, areas of the heart muscle may be damaged and/or die from lack of oxygen. This can lead to a heart attack, or myocardial infarction. Coronary artery disease is the most common form of heart disease.

Causes

Causes include:
  • Thickening of the walls of the arteries feeding the heart muscle
  • Accumulation of fatty plaques within the coronary arteries
  • Narrowing of the coronary arteries
  • Development of a blood clot within the coronary arteries that blocks blood flow

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Male
  • Age: 65 or older
  • Obesity
  • Smoking
  • High blood pressure
  • Sedentary lifestyle
  • High blood cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
  • High blood triglycerides
  • Diabetes
  • Stress
  • Family members with early heart disease

Symptoms

CAD may progress without any noticeable symptoms.

Symptoms include:
  • Angina – intermittent chest pain that is often squeezing, heavy pain, especially with:
    • Exercise or exertion
    • Emotional stress
    • Cold weather
    • A large meal
  • Pain in the left shoulder, left arm, or jaw
  • Shortness of breath
  • Sweating
  • Nausea
  • Weakness
  • Inability to do usual activities, due to above symptoms
  • Heart attack (myocardial infarction)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

Blood Tests – to look for certain substances in the blood; helps the doctor determine what is happening with your heart

Urine Tests – to look for certain substances in the urine; helps the doctor determine what is happening with your heart

Electrocardiogram (ECG, EKG) – records the heart's activity by measuring electrical currents through the heart muscle

Echocardiogram – uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart

Exercise stress Test – records the heart's electrical activity during increased physical activity

Thallium Stress Test – thallium is used to scan the myocardium, the middle layer of the heart

Nuclear Scanning – radioactive material is injected into a vein and observed as it is absorbed by the heart muscle

Electron-beam CT Scan – a type of x-ray that uses a computer to make pictures of the inside of the heart

Coronary Angiography – x-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities in the arteries.

Treatment

Treatment may include:

Lifestyle Modifications
  • If you smoke, quit.
  • Eat a healthful diet, low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Begin a safe exercise program with the advice of your doctor.
  • Lose weight if necessary.
Nitrate Medications

Nitroglycerin is usually given during an acute attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. There are also longer-lasting types that can be used to prevent angina before you participate in an activity known cause it. These may be given 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. Warfarin is also used. Ask your doctor before taking aspirin daily.

Beta-blockers, Ace-inhibitors, Calcium-channel Blockers, Digitalis-type Medications

These may help prevent angina.

Cholesterol-lowering Medications

May prevent the progression of coronary artery disease, and may even improve existing coronary artery disease.

Surgery

Patients with severe blockages in their coronary arteries may benefit from:
  • Coronary bypass graft
  • Atherectomy
  • Balloon angioplasty with or without stenting

Prevention

To reduce your chance of getting coronary artery disease:
  • Maintain a healthy weight.
  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, quit.
  • Eat a healthful diet, low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Appropriately treat your high blood pressure and/or diabetes.
  • Ask your doctor if you should take cholesterol-lowering medications.