Coronary artery disease involving native coronary artery

Coronary artery disease (CAD) is the most common type of heart disease. Although it’s the top cause of death in the U.S., there is a lot you can do to prevent or treat it.

The trouble starts when a waxy substance called plaque builds up inside the arteries that supply blood to the heart muscle. It can take decades to block the blood flow, but it can eventually cause a heart attack or failure.

What Causes CAD?

Starting as early as childhood, plaque -- a combination of cholesterol, fat, and other substances -- starts to stick to the walls lining your blood vessels.

It builds up over time. That makes arteries become harder and narrower, which doctors call “atherosclerosis.“

In some cases, plaque can break or rupture. As a result, blood cells called platelets will try to repair the artery, forming a blood clot.

Like gunk in a clogged drainpipe, this buildup prevents a free flow of blood through the arteries. Blood carries oxygen and nutrients to the heart. If you don’t get enough, it can lead to shortness of breath and chest pain (angina).

Without enough oxygen, the heart can become weaker. This can lead to an irregular heartbeat (arrhythmia). It can also cause heart failure, which means the heart can’t pump enough blood throughout the body to meet the body's needs.

If a plaque grows so large that it stops blood flow to the heart muscle, you could have a heart attack.  Most of the time, however, heart attacks happen from the smaller plaques that rupture.

What Are the Symptoms?

In the early stages, you may not have any symptoms. But as the plaque continues to build up and curbs blood flow to the heart muscle, you may notice that you’re short of breath or fatigued, especially during exercise.

The most common symptom of CAD is angina, or chest pain. Some people mistake it for heartburn or indigestion.

With angina, your chest feels uncomfortable. You may also experience the feeling in the shoulders, arms, back, or jaw. You may feel:

• Tightness
• Discomfort
• Pressure
• Heaviness
• Squeezing
• Burning
• Aching
• Numbness
• Fullness

If you have any of the following symptoms, call 911 immediately:

• Chest pain, especially in the center or left side of the chest, which lasts for a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. Some people mistake it for indigestion or heartburn.
• Discomfort in any part of your upper body. It could be in one or both arms, the shoulders, neck, jaw, or upper part of the stomach.
• Shortness of breath with or without chest discomfort
• Nausea or vomiting with lightheadedness, dizziness, or cold sweat

Women often have different heart attack symptoms than men. While the most common red flag is still chest pain, women are more likely to have other symptoms, such as shortness of breath, extreme fatigue, nausea, vomiting, and back or jaw pain.

What Puts Me at Risk?

Coronary artery disease (CAD) becomes more likely as you get older or if it runs in your family. But you can manage many other risk factors, including:

• High cholesterol and triglycerides
• High blood pressure
• Smoking
• Metabolic syndrome
• Diabetes
• Obesity and overweight
• Lack of exercise
• Stress, depression, and anger
• Unhealthy diet
• Too much alcohol
• Sleep apnea

Diagnosis

Your doctor will give you a checkup and talk with you about your symptoms, risks, and family history. You may also get tests such as:

• Electrocardiogram (ECG or EKG), which measures the heart’s electrical activity and can assess heart damage
• Stress test -- Usually, this involves walking on a treadmill or pedaling a stationary bike in a doctor’s office while your EKG, heart rate, and blood pressure are monitored. 
• Chest X-ray
• Blood tests to check on your levels of blood sugar, cholesterol, and triglycerides (a type of fat in the blood)
• Cardiac catheterization in which a doctor guides a very thin, flexible tube (called a catheter) through a blood vessel in your arm or leg to reach your heart. The doctor injects dye through the catheter and then uses X-ray videos to see inside your heart.

Treatment

Depending on your case, your plan may include:

Lifestyle changes: These time-tested methods sound familiar for a reason -- they work!

• Favor foods that are low in trans fats, saturated fats, simple sugars, and sodium.
• If you smoke, quit.
• Be active every day, ideally for 30 minutes or more a day (first, ask your doctor if there are any limits on what you can do).
• Work to stick to a healthy weight. 
• Learn effective ways to manage your stress.

Medications: If these lifestyle changes aren’t enough, you may also need to take medicines to help your heart be healthier. They can include blood thinners (anticoagulants), aspirin and other anti-clotting medicines, ACE inhibitors, beta blockers, nitroglycerin, calcium channel blockers, certain immunosuppressants, statins, or PCSK9s. 

Angioplasty: This procedure can open blocked or narrowed arteries without opening up your chest. In angioplasty, a doctor threads a thin, flexible tube with a balloon through your blood vessels until it reaches the blocked artery. The doctor then inflates the balloon, which stretches the artery open so more blood can flow. In many cases, a tiny tube called a stent is also inserted to keep the blood vessel open. You’ll typically be in and out of the hospital in a day.  

Coronary artery bypass grafting is a type of surgery in which doctors use blood vessels from other parts of your body to make a detour around blockages in your coronary arteries. It’s a major operation and you’ll probably need to be in the hospital for at least 5 days.

Prevention

Fortunately, there are a number of things you can do to reduce your chances of getting CAD.

Get wise to your risk. Speak to your doctor about getting your cholesterol, blood pressure, and blood sugar checked. If you have high cholesterol, high blood pressure, or diabetes, it’s important to manage those conditions.

Aim for a healthy weight. If you’re not sure what your target weight should be, ask your doctor. And if you have a lot of weight to lose, remember that even a modest amount of weight loss helps.

Avoid cigarette smoke. If you smoke, quit. Steer clear of secondhand smoke.

Limit your alcohol. One or two drinks may have some heart benefits, but too much is risky. Men should have no more than two alcoholic drinks and women should have no more than one per day. 

Eat smart. Eat whole foods and avoid trans fats, which can be found in many baked goods and deep-fried and processed foods. Get plenty of fiber-rich foods, such as fruits and veggies, whole grains, and beans. Limit salt and aim to have two servings of fatty fish, such as salmon, tuna, or mackerel, a week. They’re high in heart-healthy omega-3 fats.

Exercise regularly. You’ll want to get at least 30 minutes of moderate-intensity exercise (like hiking or going for a bike ride that makes your heart beat faster but not race) on 5 or more days a week. Speak with your doctor before you begin a new exercise routine.

Manage your stress level. Use strategies such as exercise, meditation, and other healthy activities that relax you.