What is coronary artery disease?

Coronary artery disease: Overview

The heart is a muscle, and like any muscle, it needs blood to work well. Coronary artery disease occurs when the arteries that bring oxygen-rich blood to your heart have a buildup of plaque—deposits of fats and other substances. Plaque can reduce blood flow to the heart muscle. This can cause angina symptoms such as chest pain or pressure. A heart attack can happen if blood flow is completely blocked.

You can do a lot to improve your health and prevent a heart attack. Eating healthy food, not smoking, getting regular exercise, and taking your medicine are the main things you can do every day to stay healthy.

Coronary artery disease

Coronary artery disease happens when fatty deposits called plaque (say "plak") build up inside your coronary arteries. Those are the blood vessels that supply blood and oxygen to your heart muscle. Plaque buildup may reduce the amount of blood that gets to your heart.

Coronary artery disease can cause angina symptoms, such as chest pain or pressure. It can lead to a heart attack. Treatment for coronary artery disease can help relieve symptoms and lower your risk of a heart attack.

What happens when you have coronary artery disease?

Coronary artery disease is a lifelong disease. It can get worse over time. But treatment can help slow the disease, relieve symptoms, and prevent a heart attack.

Fatty deposits (plaque) may narrow the arteries and reduce blood flow to the heart muscle. When you're active, reduced blood flow may cause angina symptoms, such as chest pain or pressure. Symptoms can be stable and predictable for a long time. But symptoms might get worse if the disease gets worse.

A heart attack can happen if a plaque breaks open and a blood clot completely blocks the artery. After a heart attack, or with poor blood flow over time, your heart may get weaker and not pump as well as it should. This can lead to other heart problems such as atrial fibrillation and heart failure.

What are the symptoms of coronary artery disease?

The symptoms of coronary artery disease are angina and shortness of breath. Angina can feel like chest pain or pressure. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms. Symptoms typically happen when the heart works hard.

How is coronary artery disease treated?

Coronary artery disease is treated with healthy lifestyle changes and medicine. Treatment focuses on lowering your risk for heart attack and stroke and managing your symptoms. Sometimes angioplasty or bypass surgery is done to improve blood flow to the heart.

What procedures are used to treat coronary artery disease?

If your coronary artery disease symptoms get worse even though you are taking medicines, you may think about having a procedure to improve blood flow to your heart. These procedures include bypass surgery and angioplasty.

Coronary artery bypass graft surgery

Sometimes coronary artery bypass graft surgery is done 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 narrowed or blocked coronary artery. The grafted artery goes around (bypasses) the narrowed or blocked part of the artery. The bypass provides a new pathway for blood to your heart.

Angioplasty

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.

How can you prevent coronary artery disease?

  • Do not smoke. It may be the best thing you can do to prevent coronary artery disease. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Be active. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. You may want to walk or try other activities, such as running, swimming, cycling, or playing tennis or team sports.
  • Eat heart-healthy foods. Eat more fruits and vegetables and less food that contains saturated and trans fats. Limit alcohol, sodium, and sweets.
  • Stay at a healthy weight. Lose weight if you need to.
  • Manage other health problems such as diabetes, high blood pressure, and high cholesterol.

How is coronary artery disease diagnosed?

Your doctor will do a physical exam, a medical history, and possibly some tests to find out if you have coronary artery disease or are at risk for having it.

Medical history and physical exam

A medical history and physical exam are always a part of evaluating a person who has symptoms or risk factors for coronary artery disease. The history and physical exam help to guide further decisions about testing and treatment.

During the medical history, your doctor will ask questions about your symptoms, your personal health history, and your family medical history.

A complete physical exam will also be done. This includes checking your blood pressure and listening to your heart and lungs.

Tests

If your doctor thinks you may have coronary artery disease, you will have some tests. They include:

  • An electrocardiogram (EKG or ECG) to measure the electrical signals that control the heartbeat.
  • A chest X-ray to see your heart, lungs, and major blood vessels.
  • An exercise electrocardiogram to check for changes in your heart while you exercise. This is also called a "stress test."

You might have one or more imaging tests to look at your arteries and your heart. You might have these tests if your doctor needs more information for diagnosis or to help guide treatment.

These tests include:

  • Stress echocardiogram, cardiac perfusion scan, or other types of stress tests. These tests look at blood flow to the heart muscle and how well the heart is working.
  • CT angiogram to check blood flow in the coronary arteries.
  • Coronary angiogram. This is an invasive test to look at blood flow in the coronary arteries.

How are medicines used to treat coronary artery disease?

Medicines are an important part of your treatment for coronary artery disease. The medicines work in different ways to help lower your risk of having a heart attack or dying from coronary artery disease. Medicine can also help relieve your symptoms.

Medicines that may be used include ones that:

Lower blood pressure and the heart's workload.

These medicines include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and beta-blockers.

Prevent blood clots.

Aspirin and other blood thinners prevent blood clots from forming and causing a heart attack.

Lower cholesterol.

Statins and other cholesterol medicines may be used.

Relieve angina symptoms.

Stable angina can often be controlled with medicine such as nitrates, beta-blockers, and calcium-channel blockers.

Who can treat coronary artery disease?

Many types of doctors treat coronary artery disease. You may see a family doctor or an internist. You may also see a cardiologist, a cardiovascular surgeon, or an interventional cardiologist.

Coronary Artery Disease: Every Step Matters

Coronary artery disease: Taking care of your emotional health

Finding out that you have coronary artery disease can hit you hard. You may be surprised by the power of what you're feeling.

You're not alone. Coronary artery disease is a life-changing diagnosis. Most people feel many different emotions—anger, sadness, being overwhelmed, or something in between. When you're more aware of your emotional health, you'll be able to take better care of yourself and your heart.

Here are some steps you can take to care for your emotional health.

  • Feel the emotions inside your heart.

    When you feel anxiety, does your heart beat a little faster? At times you may even feel the weight of your sadness in your heart.

    Sometimes your emotions can keep you from taking the best care of your heart. That's because feeling anxious or sad can make it harder to care about eating well, exercising, or taking your medicines.

    But it's more important than ever now to take good care of yourself. You deserve to be as healthy as possible, inside and out.

  • Believe in how far you've come.

    You've been through hard times before. Each time, you may have felt a lot of different emotions, including fear, sadness, or even anger. And when it was over, you may have found a new sense of appreciation for who you are.

    And now you have coronary artery disease. It may be the biggest scare you've ever faced. But just as you've done in the past, believing in yourself as you face your fears will help you heal.

  • Ask for help.

    Feelings like fear, sadness, and worry can be symptoms of anxiety or depression.

    Here are two ways to know if your feelings are symptoms of something more.

    • Anxiety that interferes with daily life isn't normal. It may be a symptom of an anxiety disorder. Or it may be a symptom of depression.
    • Depression is a medical illness that affects how you feel, think, and act. It causes you to feel sad or hopeless much of the time.

    If any of this sounds like you, you're not alone. People with coronary artery disease are more likely to have symptoms of anxiety or depression.

    Talk to your doctor if you think you have symptoms of anxiety or depression. Treating your emotional health is good for your heart's health.

  • Explore what's in your heart.

    Writing about difficult feelings can help make it easier to understand them. And it can make it easier to talk to your doctor.

    First, think about what's at the heart of your emotions. You might ask yourself:

    • When I think about having heart disease, what kinds of feelings come up?
    • When in the past have I felt like this?
    • Looking back, how did I work through the feelings that time?

    Then, think about where you want to go from here. You might ask yourself:

    • What sorts of things do I really enjoy?
    • How could managing my coronary artery disease help me do more of these things?
    • Where do I think I will go from here? What might be my next step?

Coronary artery disease: Making your action plan for heart health

When you have coronary artery disease, there's a lot you can do to lower your risk for a heart attack or a stroke. You're probably already doing some of these things.

Writing an action plan helps you focus on taking good care of yourself. Here's how to get started.

  • Choose a heart-healthy goal.

    Here are six goals for heart health. Decide which of these you want to be your goals.

    • Take your medicines as prescribed.
    • Eat heart-healthy foods.
    • Be active.
    • Stay at a healthy weight. Lose weight if you need to.
    • Manage other health problems such as diabetes and high blood pressure.
    • Be smoke-free.

    If you're already doing one or more things on this heart-healthy list, give yourself credit. These are important steps to a healthier future.

  • Get answers to your questions.

    For example, if you choose "Eat heart-healthy foods" as your goal, you might wonder: What are the basics about heart-healthy eating? What can make it fun and easy? How do I make healthy choices when I eat out? What is the first small step I can take toward healthier eating?

    Talk with your doctor about how you can meet your goal. And ask for medical guidance like: What level of activity is right for me? What is a healthy weight for me? What is my target blood pressure?

  • Make a note about what you want to change and why.

    For example, you might say "I will eat more heart-healthy foods."

  • Break your big goal into smaller, short-term goals.

    Make these specific and within your reach. They should be things you know you can do.

    For example: "Week 1, I'll add a fruit to my daily breakfast. Week 2, I'll add a vegetable to lunch or dinner each day."

  • Plan ahead for handling what might get in your way.

    For example: "I'll put fruit for breakfasts on my shopping list. Same goes for baby carrots that I can bring to work. That will help stop me from being tempted to buy chips from the snack machine."

  • Include in your plan all the medicines you take.

    Write down the type of medicine you take, what it's used for, the dose, and when to take it.

    Also include any specific heart-health information, like your healthy weight range and your target blood pressure. And note if you need to pay attention to angina symptoms.

How does your family history put you at risk for coronary artery disease?

You’re more likely to have coronary artery disease if you have one or more close relatives who had early coronary artery disease. For men, this means being diagnosed before age 55. For women, it means being diagnosed before 65.

Things that increase your risk include:

Inherited risk factors.

A tendency to develop some risk factors for coronary artery disease, such as high cholesterol and high blood pressure, may be related to certain inherited genes. Inherited lipid disorders can contribute to atherosclerosis and may lead to early coronary artery disease. Experts are working to understand exactly why the disease runs in families.

Lifestyle factors.

Along with inherited genes, lifestyle choices are probably a large part of the increased risk seen in some families. People who smoke expose their family to secondhand smoke. This increases the risk of heart disease in their family members. Children of parents who smoke are more likely to smoke than children of nonsmokers. Dietary habits may also play a role. Families who eat fatty diets are more likely to develop coronary artery disease than those who eat more balanced diets. Changing these behaviors may greatly reduce your chance of having coronary artery disease.

Coronary artery disease: Making a plan to be active and safe

If you have coronary artery disease, make a plan with your doctor before you start a new activity or exercise program. Together you can create a plan that will keep you active, healthy, and safe.

  • Get tests, if you need them, before you get active.

    Your doctor may do tests to check how much activity your heart can safely handle. These tests may include an electrocardiogram (ECG or EKG) and maybe a stress test. Then your doctor can suggest a safe level of exercise based on your condition and the stage of your disease.

  • Ask your doctor if a cardiac rehab program is right for you.

    Cardiac rehab can help you get and stay active. Your rehab team will design an exercise program just for you. It will be based on your health and goals.

  • Choose activities that you enjoy or want to try.

    Your doctor can help you choose activities that will help your heart and are safe for you. An exercise program usually consists of stretching, activities that increase your heart rate (aerobic exercise), and strength training (lifting light weights). You may try walking, swimming, biking, or jogging. Any activity you enjoy will work, as long as it gets your heart rate up.

  • Plan how you will start getting active.

    With your doctor, plan how often, how long, and how hard you will be active. Even if you can only do a small amount of exercise, it's better than not doing any exercise at all.

  • Check your heart rate (pulse).

    Learn how to check your pulse or use a heart rate monitor. Your doctor may give you a range of how fast your heart rate should be when you exercise. Your doctor can also help you find out what your target heart rate is. Your target rate may be different from a person's who doesn't have heart disease. This is even more likely if you take medicine that affects your heart rate, such as beta-blockers.

  • Know what activities to avoid.

    Avoid exercises that require or encourage holding your breath, such as push-ups, sit-ups, and isometric exercises. (An isometric exercise is simply tightening a muscle or holding it against an immovable object.) Also avoid heavy lifting.

  • Know when to avoid exercising outside.

    Don't exercise outdoors in extreme temperatures or high humidity or poor air quality. Have a plan for indoor activities. For example, when the weather is bad, you can exercise indoors at a gym or walk at a mall.

  • Know the warning signs that mean you should stop and rest.

    Stop and rest if you have palpitations, angina symptoms (such as chest pain or pressure), or trouble breathing, or if you feel dizzy or lightheaded.

How can you help someone with coronary artery disease do daily activities?

If someone you care about has trouble with daily activities, there are ways you can help. First, ask them what they need. You could help with grocery shopping and preparing healthy meals. Or offer to run errands or drive to doctor appointments. To help organize medicines, you could fill a pillbox each week.

Coronary Artery Disease: Getting Back on Track

Where can you find support when you have coronary artery disease?

Having support can make a big difference when you're trying to manage heart disease. But you might have a hard time asking for the help and support you need. Sometimes it may be up to you to ask. Often people want to help but they're unsure about what to do.

Listen for people around you to ask, "How can I help?"

You can also try thinking back to other times when you've needed someone. Was there somebody who stood by you? How did they help?

Here are more ideas of who you can ask and what they might do:

Friends and family.

The people in your life can offer encouragement and understanding. They can also help with day-to-day tasks.

A counselor.

A counselor can help you work through the emotions that can come with heart problems.

Your care team.

Your team may include your doctor, a nurse specialist, a dietitian, an exercise therapist, and a physical therapist. They are dedicated to helping you stay healthy, feel better, and manage your medicines.

It might help to try writing a list of what you need. Then match your needs to the people in your life. For example, list people you know who might be able to help you manage your medicines, take care of a pet, or go with you to doctor visits.

Cardiac rehab

Another place to find support is by doing cardiac rehabilitation (rehab). This program is designed to help people make heart-healthy changes.

You may find that cardiac rehab is a safe, nurturing, and helpful place to heal. And it can be a good way to connect with others who know what you're going through.

What causes coronary artery disease?

Coronary artery disease is caused by a process called hardening of the arteries, or atherosclerosis.

Atherosclerosis occurs when fatty deposits called plaque build up inside arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body. When plaque builds up in the arteries that supply blood to the heart muscle (the coronary arteries), it is called coronary artery disease. Over time, the plaque may narrow the arteries and reduce blood flow to the heart muscle.

What is coronary artery disease?

Coronary artery disease, or heart disease, is a heart problem that happens when fatty deposits called plaque (say "plak") build up inside coronary arteries of your heart. Those are the blood vessels that supply blood and oxygen to your heart muscle. This process of plaque buildup is called hardening of the arteries, or atherosclerosis.

Plaque buildup may reduce blood flow to the heart muscle. Like any muscle, the heart needs blood to work well. Poor blood flow can cause angina symptoms, such as chest pain or pressure. If the plaque breaks apart, it can cause a heart attack.

How are stress and coronary artery disease connected?

There seems to be a link between long-term stress and developing coronary artery disease. But it's not clear that long-term stress actually causes heart disease. Managing stress, though, can be good for your heart. Many of the ways you can choose to manage stress—like exercise—also benefit your heart.

How can you manage stress when you have coronary artery disease?

Everyone has some stress. But stress can be bad for your heart. If you have heart disease, stress can lead to angina symptoms and maybe a heart attack.

Taking steps to manage stress can improve your health and life.

  • Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.
  • Try to change the situation that is causing your stress, if you can. Or maybe you can change your reaction to that situation.

No single method of managing stress works for everyone. You may need to try several methods to find one that works for you. You may need to combine a few methods to get the best results.

Coronary artery disease: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have symptoms of a heart attack. These may include:
    • Chest pain or pressure, or a strange feeling in the chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
    • Lightheadedness or sudden weakness.
    • A fast or irregular heartbeat.
    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.
  • You have angina symptoms (such as chest pain or pressure) that do not go away with rest or are not getting better within 5 minutes after you take a dose of nitroglycerin.
  • You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

  • You are having angina symptoms, such as chest pain or pressure, more often than usual, or they are different or worse than usual.
  • You have new or increased shortness of breath.
  • You are dizzy or lightheaded, or you feel like you may faint.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

Coronary artery disease: How can you tell your doctor about depression and anxiety?

Many people wonder if their symptoms of anxiety or depression are problems their doctor needs to know about while treating their heart disease. Because your emotional health affects your physical health, it's important to tell your doctor about all of your symptoms.

The sooner you and your doctor have talked about your symptoms and your options for treatment, the sooner you can start to feel better. And when you feel better, it might be easier to do the things that are good for your heart.

Thinking about your feelings and symptoms

Before talking to your doctor, take some time to think about your feelings and symptoms. As you think about anxiety or depression, try to picture how you're experiencing them in your daily life. If you find it hard to think about your feelings as symptoms of your emotional health, that's okay. You could ask someone you trust and who knows you well to tell you what he or she may have noticed. Sometimes hearing another person's view can give you new insight.

It may help you to write about your feelings or symptoms. Having specific examples will help you and your doctor talk about your emotional health and heart disease.

What your doctor may ask about depression

Your doctor may ask if over the past 2 weeks you've had symptoms like:

  • You have felt down, depressed, or hopeless.
  • You have had little interest or pleasure in doing things.

What your doctor may ask about anxiety

Your doctor may ask if over the past few weeks you've had symptoms like:

  • Feeling anxious or worried most days about things like work, relationships, health, or money.
  • Finding it hard to stop or control the worry. This may make it hard to do your daily activities.

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