Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis.
Coronary artery disease (CAD) is the most common type of heart disease in the United States. It is sometimes called coronary heart disease or ischemic heart disease.
For some people, the first sign of CAD is a heart attack. You and your health care team may be able to help reduce your risk for CAD.
What causes coronary artery disease?
CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries) and other parts of the body.
Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes the inside of the arteries to narrow over time, which can partially or totally block the blood flow. This process is called atherosclerosis.
What are the symptoms of coronary artery disease?
Angina, or chest pain and discomfort, is the most common symptom of CAD. Angina can happen when too much plaque builds up inside arteries, causing them to narrow. Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body.
For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include
- Chest pain or discomfort (angina)
- Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold sweat
- Pain or discomfort in the arms or shoulder
- Shortness of breath
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way it should.
What are the risks for coronary artery disease?
Overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD, especially a family history of having heart disease at an early age (50 or younger).
To find out your risk for CAD, your health care team may measure your blood pressure, blood cholesterol, and blood sugar levels.
Learn more about heart disease risk factors.
How is coronary artery disease diagnosed?
If you’re at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD.
| Measures the electrical activity, rate, and regularity of your heartbeat. |
| Uses ultrasound (special sound wave) to create a picture of the heart. |
| Measures your heart rate while you walk on a treadmill. This helps to determine how well your heart is working when it has to pump more blood. |
| Uses x-rays to create a picture of the heart, lungs, and other organs in the chest. |
| Checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart (coronary arteries). |
| Monitors blockage and flow of blood through the coronary arteries. Uses X-rays to detect dye injected via cardiac catheterization. |
| A computed tomography (CT) scan that looks in the coronary arteries for calcium buildup and plaque. |
What is cardiac rehabilitation and recovery?
Cardiac rehabilitation (rehab) is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. In these people, cardiac rehab can help improve quality of life and can help prevent another cardiac event. Cardiac rehab is a supervised program that includes
- Physical activity
- Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
- Counseling to find ways to relieve stress and improve mental health
A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.
How can I be healthier if I have coronary artery disease?
If you have CAD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease:
- Lifestyle changes, such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity, reaching a healthy weight, and quitting smoking
- Medicines to treat risk factors for CAD, such as high cholesterol, high blood pressure, or an irregular heartbeat
- Surgical procedures to help restore blood flow to the heart
Microvascular angina is a type of angina (chest pain) that happens because of problems in the small blood vessels bringing oxygenated blood to the heart. If the heart muscle doesn’t get enough oxygen, it will be damaged and start to die. Microvascular angina can be treated with medicine and lifestyle changes.
Microvascular angina (chest pain) is a type of angina that is caused by problems in the smallest blood vessels of the coronary arteries. The coronary arteries, which surround your heart, bring a constant supply of oxygenated blood to the heart. The small vessels (called the coronary microvasculature) are a big part of your heart’s blood supply.
Microvascular angina was previously called cardiac syndrome X. Another name for it is microvascular coronary artery disease.
What is the difference between microvascular angina and typical, or classic, angina?
Typical, or classic, chest pain (angina) usually happens when you exercise or climb stairs or when you’re under stress. The discomfort lessens when you’re resting. This is also true for the type of microvascular angina that’s caused by microvascular angina. However the mechanism is different. In microvascular angina, functional problems with the vessels (known as endothelial dysfunction) cause chest pain. The endothelium is the tissue lining the blood vessels of the heart. In classic angina, the problem is with the large arteries of the heart, the epicardial coronary arteries. When these arteries are narrowed or blocked, it is known as coronary artery disease.
However, angina caused by spasms of the blood vessels can happen while you’re resting and not while you are working hard.
Who does microvascular angina affect?
Microvascular angina is more common in women than in men. Among the women who have microvascular angina, a majority are postmenopausal. Microvascular angina is also more common in people with diabetes or hypertension and those who smoke.
How does this condition affect my body?
Microvascular angina can sometimes cause myocardial ischemia. This means that the heart doesn’t get enough oxygenated blood. If this happens often enough, the heart muscle begins to die.
The signs and symptoms of microvascular angina may include:
- Discomfort in your chest that can feel like a heaviness, tightness, pressure or squeezing.
- Sweating.
- Nausea and dizziness.
- Stomach pain.
- Difficulty breathing.
- Being very tired (fatigue) and having low energy — although it’s very unusual for this to be the only symptom of microvascular angina.
What causes microvascular angina?
Microvascular angina may be caused by vessels that don’t widen the way that they should. It may also be caused by spasms in the vessels. This is known as primary microvascular angina.
There’s also a type of microvascular angina that is related to other heart diseases, like cardiomyopathy, or autoimmune diseases, such as connective tissue disease. This type is called secondary microvascular angina.
After talking to you about your symptoms and medical history, your provider might decide you have angina. If so, they will order tests that include:
These tests are used to diagnose blockages in larger arteries, but the small blood vessels of the coronary microvascular are too small to be seen directly. Instead, your provider looks for indirect evidence of microvascular disease such as reduced blood flow in the heart on MRI or PET. Microvascular disease might show up during stress tests or echocardiograms, but it might be the type that isn’t triggered by exertion.
It hasn’t always been easy to diagnose microvascular angina because it’s difficult to see inside the small blood vessels.
Treating any kind of angina, including microvascular angina, includes lifestyle changes and medications.
Lifestyle changes
These changes include:
- Stopping smoking. This is very important.
- Eating a heart-healthy diet focused on reducing the amount of fat and red meat you eat and increasing your intake of fruits, vegetables and fiber.
- Getting enough exercise.
- Reaching and staying at a healthy weight.
- Getting enough sleep and managing stress.
- Managing other health conditions like high blood pressure, high blood cholesterol and diabetes.
Medications
The usual medicines prescribed for typical angina and microvascular angina are:
- Calcium channel blockers.
- Beta blockers.
- Nitrates like nitroglycerin.
In rare cases, your provider might suggest that you take estrogen.
There are risks you can’t prevent, such as being female or having an autoimmune condition. However, you can make choices that may reduce your angina risk, including:
- Stopping smoking. This is the most important thing you can do for your overall health and for your heart’s health in particular.
- Reaching and maintaining a healthy weight.
- Eating a heart-healthy diet by reducing red meat consumption and increasing your intake of fruits, vegetables and fiber.
- Getting enough sleep and enough exercise.
- Learning ways to lower your stress like meditation or yoga.
Keeping your blood sugar levels, blood pressure and cholesterol in check and managing any other health condition.
Generally, the outlook for someone with microvascular angina is good, but you need to know you have it. Microvascular angina is sometimes not diagnosed correctly, or even at all.
If you do have microvascular coronary artery disease, it’s important that you do what you can to treat it and to improve your health in general. Take your medications. The lack of oxygen to the heart muscle can still result in heart damage significant enough to prove fatal.
If you have any type of chest pain, you should contact your healthcare provider. This is true if you do or don’t already have a diagnosis. It’s also true that you could have microvascular angina and a digestive disorder, so make sure you keep track of your symptoms and when you have them.
A note from Cleveland Clinic
If you have chest pain, especially if it happens while you’re working hard or under stress, see your provider. If you’re diagnosed with microvascular angina, make sure you follow treatment recommendations. Try to make small improvements every day in your lifestyle. Like your small vessels, small improvements are very important.
Last reviewed by a Cleveland Clinic medical professional on 10/12/2021.
References
- American Heart Association. Microvascular angina. (//www.heart.org/en/health-topics/heart-attack/angina-chest-pain/microvascular-angina) Accessed 11/17/2021.
- British Heart Foundation. All about microvascular angina. (//www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/all-about-microvascular-angina) Accessed 11/17/2021.
- Maas A, Milasinovic D, Berry C, Escaned J. Microvascular angina: diagnosis, assessment, and treatment. (//www.emjreviews.com/interventional-cardiology/article/microvascular-angina-diagnosis-assessment-and-treatment/) EMJ Int Cardiol. 2019;7[Suppl 1]:2-17. Accessed 11/17/2021.
- Park JJ, Park SJ, Choi DJ. Microvascular angina: angina that predominantly affects women. (//pubmed.ncbi.nlm.nih.gov/25750553/) Korean J Intern Med. 2015;30(2):140-147. doi:10.3904/kjim.2015.30.2.140. Accessed 11/17/2021.
- Villano A, Lanza GA, Crea F. Microvascular angina: prevalence, pathophysiology and therapy. (//pubmed.ncbi.nlm.nih.gov/29538142/) J Cardiovasc Med (Hagerstown). 2018;19:e36-e39. Accessed 11/17/2021.
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