What is coronary artery disease?

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 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.

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.

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.

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.

• 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.

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.

Taking heart medicines can be hard to get used to—especially if you take several pills every day.

If you're struggling with it, changing your thinking might help. What you tell yourself about your medicines can help you feel better about them.

• If taking medicine makes you feel like a sick person: Try to think of yourself as someone who wants to stay well. Medicine can keep you feeling well. Remember the people and activities that you want to stay healthy for.
• If you don't feel better from the medicine: This is because heart medicines help your body in ways you don't always feel. Taking medicines now may pay off in a healthier and longer life.
• If you forget to take your medicine: Try using a calendar, a phone alert, or a pill box to remind yourself.

If you have other challenges, write them down. Can you think of some ways you might handle them?

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.

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.

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.

At first, the news that you have heart disease probably put you on a path to a healthier you—like being more active or eating healthier foods.

But as time has passed, do you find that you've gotten off that path? Maybe work or family got in the way of exercise. Or you were just too busy to plan healthy meals.

Slips like these happen to everyone when they make new habits.

A detour doesn't mean that you're lost. With a little problem solving, you can find your way again.

Remember your reason for change

Before you jump right into problem solving, try to recall the reasons that first inspired your path to change.

Here are a few reasons that people make healthy choices:

• To help their hearts stay healthy
• To gain more time with their families
• To improve the quality of their lives

Are any of these reasons the same as yours? You may have your own reason for moving forward.

Look back to go forward

Chances are, you've solved plenty of problems in the past. These might be things like finishing a project with a difficult person at work, or moving to a new town and learning your way around.

Having to find your way to a solution can be tough. But even though it was hard, you probably knew that you'd get through it and figure it out. And you did!

So when you've gotten off your path, thinking of yourself as an experienced problem solver may help you get back on track.

Find your own path back

Thinking about solutions can help you feel better about starting again.

For example, if your problem is finding enough time to walk, maybe your solution is to take a few short walks during your day. Or if it's been hard to remember to take your medicines, what would help you remember? You could try things like using a pillbox or setting an alarm on your smartphone.

Can you think of some solutions that might work for you?

If you're having a hard time coming up with a solution now, it's okay. Keep thinking. With a little time, some ideas should start to come to you. You can also brainstorm with a friend.

And just like at the start of your journey, you don't need to renew all your changes at once. It takes time and patience to get back on track. Take it a step at a time, and you'll get there.

Explore your barriers and solutions

Many people find that writing down their barriers and solutions helps them succeed. Here are a few questions you can ask yourself. Try writing down your ideas.

• What heart-healthy habits have I stopped doing?
• Which habit do I feel most confident about focusing on?
• What barriers might get in my way?
• Looking at just one of my barriers, what are some ways to get around it?
• What is my favorite solution? (Start it with "I will ... ." Make this first solution easy to do. That way, you can experience and build on success right away.)

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.

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.

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.

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.

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.

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.