Home > Coronary Artery Disease
disease occurs when fatty deposits called
plaque (say "plak") build up inside the coronary
arteries. The coronary arteries wrap around the heart and supply it with blood
and oxygen. When plaque builds up, it narrows the arteries and reduces the
amount of blood that gets to your heart. This can lead to serious problems,
Coronary artery disease
(also called CAD) is the most common type of heart disease. It is also the
number one killer of both men and women in the United States.
can be a shock to find out that you have coronary artery disease. Many people
only find out when they have a heart attack. Whether or not you have had a
heart attack, there are many things you can do to slow coronary artery disease
and reduce your risk of future problems.
Coronary artery disease is
caused by hardening of the arteries, or
atherosclerosis. Atherosclerosis occurs when plaque
builds up inside the arteries. (Arteries are the blood vessels that carry
oxygen-rich blood throughout your body.) Atherosclerosis can affect any
arteries in the body. When it occurs in the arteries that supply blood to the
heart, it is called coronary artery disease.
Plaque is a fatty
material made up of cholesterol, calcium, and other substances in the blood. To
understand why plaque is a problem, compare a healthy artery with an artery
When plaque builds
up in the coronary arteries, the heart doesn't get the blood it needs to work
well. Over time, this can weaken or damage the heart. If a plaque tears, the
body tries to fix the tear by forming a blood clot around it. The clot can
block blood flow to the heart and cause a heart attack.
Usually people with coronary artery disease don't
have symptoms until after age 50. Then they may start to have symptoms at times
when the heart is working harder and needs more oxygen, such as during
exercise. Symptoms include:
Less common symptoms include a fast heartbeat, feeling sick
to your stomach, and increased sweating. Some people don't have any symptoms.
In rare cases, a person can have a "silent" heart attack, without
To find out your risk for a heart attack in the next 10
years, use this
Interactive Tool: Are You at Risk for a Heart Attack?
To diagnose coronary artery disease, doctors
start by doing a physical exam and asking questions about your past health and
your risk factors. Risk factors are things that increase the chance that you
will have coronary artery disease.
Some common risk factors are
being older than 65; smoking; having high cholesterol, high blood pressure, or
diabetes; and having heart disease in your family. The more risk factors you
have, the more likely it is that you have coronary artery disease.
If your doctor thinks that you have coronary artery disease, you may have
tests, such as:
Your doctor may order other tests to look at blood flow to
your heart. You may have a
coronary angiogram if your doctor is considering a
procedure to remove blockages, such as angioplasty or bypass surgery.
on taking steps to manage your symptoms and reduce your risk for heart attack
and stroke. Some risk factors you can't control, such as your age and
family history. Other risk factors you can control,
such as high blood pressure, high cholesterol, and smoking. Lifestyle changes
can help lower your risks. You will likely take medicines and may have a
procedure to open your arteries.
Lifestyle changes are the first step for anyone with coronary artery disease.
These changes may stop or even reverse coronary artery disease. To improve your
Changing old habits may not be easy, but it is very
important to help you live a healthier and longer life. Having a plan can help.
Start with small steps. For example, commit to eating five servings of fruits
and vegetables a day. Instead of having dessert, take a short walk. When you
feel stressed, stop and take some deep breaths.
A cardiac rehab program can help you make lifestyle changes. In cardiac rehab, a team of
health professionals provides education and support to help you make new,
Medicines that are often prescribed for people with coronary artery disease
Procedures may be done to improve
blood flow to the heart.
To stay as healthy as
possible, it is important to:
Health Tools help you make wise health decisions or take action to improve your health.
Learning about coronary artery disease (CAD):
Living with heart disease:
Coronary artery disease is caused by the buildup of
plaque on the inside of your
coronary arteries. Plaque buildup can begin early in life and
happens over a lifetime.
Coronary artery disease typically begins when the inside walls of the
coronary arteries are damaged because of another health problem, such as:
Plaque, which is made up of excess cholesterol, calcium,
and other substances in your blood, builds up on the damaged inner walls of
your coronary arteries. This process usually occurs throughout the body and is
atherosclerosis, or "hardening of the arteries."
Over time, plaque buildup
narrows the coronary arteries and can lead to
ischemia (insufficient blood flow to the heart
muscle). Ischemia (say "is-KEE-mee-uh") can weaken the heart muscle, but it
usually does not cause heart muscle cells to die.
muscle cells can die if blood flow is severely reduced or completely blocked
for a period of time. This can happen if plaque breaks apart and makes a clot
that blocks an artery. This can cause myocardial infarction, or
The most common symptoms of
coronary artery disease are:
Unfortunately, sometimes a
heart attack is the first sign of coronary artery
Some people who have coronary
artery disease and insufficient blood flow to the heart muscle (ischemia) do
not have any symptoms. This is called "silent ischemia." In rare instances, you
can even have a "silent heart attack," a heart attack without symptoms.
For men and women, the most common symptom is chest
pain or discomfort. But women are somewhat more likely than men to have other
symptoms like shortness of breath, nausea, and back or jaw pain.
Women are also more likely than men to delay seeking help for a possible
heart attack. Women delay for many reasons, like not being sure it is a heart
attack, or not wanting to bother others. But it is better to be safe than
sorry. If you have symptoms of a possible heart attack that last for 5 minutes,
call 911 right away.
Angina (say "ANN-juh-nuh" or "ann-JY-nuh") happens when there is not enough blood flow to the heart. Symptoms include:
Other symptoms include shortness of breath, nausea or vomiting, lightheadedness or sudden weakness, or a fast or irregular heartbeat.
Know what your angina feels like and what is typical for you so that you know when to call for help.
You may feel symptoms of angina in areas other than the chest.
Stable angina has a typical
pattern. You can likely predict when it will happen. It happens when your heart is working harder and needs more oxygen,
such as during exercise. Symptoms go away when you rest or take nitroglycerin.
Unstable angina is a change in your usual pattern of stable angina. It happens when blood flow to the heart is suddenly slowed by narrowed vessels or small blood clots. Unstable angina is a warning sign
that a heart attack may soon occur. It is an emergency. It may happen at rest or with light activity. It does not go away with rest or nitroglycerin.
Things that can increase
your risk for
coronary artery disease are called risk factors. Some
risk factors, such as your gender, your age, and your
family history, can't be changed. Other risk factors
for heart disease are tied to your lifestyle and habits. These often are things
you can change. Your chance of getting coronary artery disease rises with the
number of risk factors you have.
Women have unique risk factors for heart disease. These include using birth control pills, using hormone therapy, and having pregnancy-related problems.
Smoking, high cholesterol, high blood pressure, and lack
of exercise are risk factors you can reduce with lifestyle changes and
medicine. Diabetes and obesity can sometimes be prevented when lifestyle
changes are made early in life. To learn more, see Prevention.
Your doctor can help you find out your risk of getting coronary artery disease. If you know your blood pressure and cholesterol numbers, see the
Interactive Tool: Are You at Risk for a Heart Attack?
to calculate your risk of having a heart attack in the next 10 years.
Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.
Call 911 or other emergency services immediately if you have symptoms of a heart attack. These may include:
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.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
911 and taking an ambulance to the
hospital, you may be able to start treatment before you arrive at the hospital.
If any complications occur along the way, ambulance personnel are trained to
evaluate and treat them.
If an ambulance is not readily
available, have someone else drive you to the emergency room. Do not drive
yourself to the hospital.
If you witness a person become
unconscious, call 911 or other emergency
services and start CPR (cardiopulmonary resuscitation). The emergency operator
can coach you on how to perform CPR.
To learn more about CPR, see the
Cardiopulmonary Resuscitation (CPR) section of the topic
Dealing With Emergencies.
Many people are unsure whether they are having a heart attack, and so
they take a "wait and see" approach. Heart attack symptoms often vary. People
often discount their symptoms if they do not fit into the expected "extreme
chest pain" scenario. Some people are embarrassed or don't want to bother
others by calling for help if they think it may not be a heart attack. Even if
you're not sure it's a heart attack, you should still have it checked out.
Rapid treatment can save your life.
Call your doctor if:
To see if you are at risk for heart
disease, have symptoms of coronary artery disease, or require long-term care
for existing heart disease, see your
family doctor or
internist. For diagnosis of coronary artery disease,
you may see a
cardiologist. For ongoing care of stable angina, you
will likely see your family doctor or an internist. For angioplasty or surgery,
you will be referred to an interventional cardiologist or cardiovascular surgeon.
To find out if you have or are at
coronary artery disease, your doctor will do a
physical exam and check your risk based on your health and risk factors.
You may then have several different kinds of tests to check your risk for
getting heart disease. If your doctor thinks you have heart disease, you will
need more tests to make sure.
The main tests your doctor uses to check your risk for
getting heart disease include:
Your doctor will use your blood pressure, cholesterol, and other risk factors such as your age and if you smoke, to know your risk of heart disease.
If you know your blood pressure and cholesterol levels, you can check your risk for a heart attack:
Other tests may help your doctor find out your risk for heart disease, especially when they are considered along with your other risk factors. But these tests are not helpful for everyone. Such tests may include:
Sometimes doctors schedule routine tests because they think that's what patients expect. But experts say routine heart tests can be a waste of time and money. See the topic Heart Tests: When Do You Need Them?
your doctor thinks you may have heart disease, you will need some tests to make
sure. Most often, the first tests include:
Other tests may include:
coronary artery disease focuses on taking steps to
manage symptoms and reduce the risk of heart attack and stroke. For
Keep these questions in mind
as you think about your treatment options:
Lifestyle changes are the first
step for anyone with
coronary artery disease. But sometimes lifestyle
changes are not enough. You may also need medicines. If you take medicines, take them on a schedule and take the correct dose. Taking medicines properly can help you prevent a heart attack or stroke.
When you're first diagnosed
with heart disease, your doctor will strongly advise you to make lifestyle
changes. These include quitting smoking, eating a heart-healthy diet, and
getting regular exercise. These healthy habits can slow or even stop the
disease and improve the quality and length of your life.
Quit smoking and avoid secondhand smoke. Quitting smoking is the best thing you can do to reduce your
risk of future problems. When you quit, you quickly lower your risk of a heart attack.1
If you smoke, try to quit. Medicines and counseling can help you quit for good.
Eat a heart-healthy diet. This can help you keep your disease from getting
worse. A chart that compares heart-healthy diets(What is a PDF document?) can help you see what foods are suggested in each plan. A heart-healthy diet means:
Start an exercise program (if
your doctor says it's safe). Try walking, swimming, biking, or jogging for at
least 30 minutes on most, if not all, days of the week. You may need to start
slow and build up to this amount. Any activity you enjoy will work, as long as
it gets your heart rate up. In people with heart disease, exercise can help lower the chance of a heart attack.
One Man's Story:
"I've had to work at keeping my
weight under control, and that has really helped my cholesterol. When you have
heart disease, you learn to eat better for the rest of your life. And if you
don't, you're asking for trouble.—Alan
Read more about Alan and the lessons he's learned about diet and exercise.
Aspirin or other antiplatelets. Your doctor will probably recommend that you
aspirin or other antiplatelets every day. Antiplatelet medicine can reduce the risk of
having a heart attack in people with heart disease.
Cholesterol. Your doctor may prescribe a
medicine to lower your cholesterol, such as a
Heart medicines. Your doctor may prescribe medicines that lower blood pressure or decrease your heart's workload. These medicines include:
Angina medicines. If you have angina, your doctor may prescribe medicine, such as nitroglycerin, to relieve your symptoms.
After you start treatment for
coronary artery disease, your doctor will want to keep
track of how you are doing. He or she will want to know if you've made
lifestyle changes and if they have helped. For example, your
cholesterol, and weight will be checked. These
measures will help your doctor find out if lifestyle changes are working.
If you take medicines, your doctor will want to know if you feel
any side effects. If you take medicine for angina (chest pain or discomfort), your
doctor will want to know how well it works. Does the medicine ease your pain
quickly? Do you get chest pain less often?
You will likely need to
keep taking medicines that lower your cholesterol and blood pressure and that
reduce your risk of having a heart attack. Your doctor will also want to check
how well these medicines work for you. If they're not working, he or she may
want you to try a different dose or take a different kind of medicine.
Talk to your doctor about
cardiac rehabilitation. In cardiac rehab, a team of
health professionals provides education and support to help you build new,
healthy habits such as eating right and getting more exercise. For keeping your heart healthy and your arteries
open, making these changes is just as
important as getting treatment.
coronary artery disease gets worse even with
treatment. If you start to have abnormal heart rhythms (arrhythmias), your doctor might suggest a
pacemaker or medicines to control your heart
If your angina symptoms get worse even though you are
taking medicines, you may need procedures to improve blood flow to your heart.
They are also done when the coronary arteries are severely blocked. These
angioplasty with or without stenting and
coronary artery bypass graft surgery.
When deciding between bypass surgery and angioplasty, your doctor will
think about several things, such as how many arteries are blocked and whether
you have diabetes.
Coronary artery disease can lead to
heart failure and the need for other medicines. These
medicines can help you feel better and prevent your heart failure from getting
coronary artery disease gets worse, you may want to think about
palliative care. Palliative care is a kind of care for
people who have diseases that do not go away and often get worse over time. It
is different from care to cure your illness, which is called curative
Palliative care focuses on improving your quality of
life—not just in your body, but also in your mind and spirit. Some people
combine palliative care with curative care.
Palliative care may
help you manage symptoms or side effects from treatment. It can also help you
and your family to:
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
For more information, see the
You can slow or even prevent
coronary artery disease by taking steps towards a heart healthy lifestyle. Many people already have. More people are adopting healthy
habits such as eating right, exercising more, and not smoking. Doing these
things can also help reduce risk factors such as
high cholesterol and
high blood pressure.
To reduce your risk of heart disease, it's
control your cholesterol and
manage your blood pressure. Quitting smoking, changing
the way you eat, and getting more exercise can help. But if these things don't
work, you may need to take medicines as well.
If you're already at risk
for heart disease, taking daily
aspirin may reduce your chances of having a stroke or
a heart attack. That's because a daily aspirin lowers your risk of getting
blood clots. Blood clots can lead to a heart attack in people with heart
disease. Clots can also cause heart attacks in people who have other problems
that can lead to heart disease, such as
high blood pressure, and
Taking aspirin has
some risks. Talk with your doctor before starting aspirin treatment.
You can have
coronary artery disease and not know it. Sometimes the
disease is found during an electrocardiogram or stress test. Often a
heart attack is the first sign of heart
When you do know that you have
heart disease, you may wonder how it spreads over time and what you can do to
slow its progress. It's important to take care of yourself. Making healthy
lifestyle changes can reduce your chances of heart attack and
stroke. Take your medicines as your doctor prescribes.
If your heart disease gets worse, your arteries will narrow, and less
blood will flow to your heart. You may start to have chest pain or discomfort (angina) when
you exercise or feel stressed. This is called
stable angina. Most people are able to control stable
angina by resting or
In some cases,
sudden and serious problems can happen. New blockages that form in the arteries
of the heart can become unstable. They can suddenly tear and cause blood clots to
form. These clots block blood flow to your heart, causing a heart attack or
If your heart disease
is severe, or if your chest pain and other symptoms can't be controlled with
medicines, you may need to think about other treatment, such as:
These treatments, along with making changes like eating
right and not smoking, can help you live a longer, healthier life. If your
disease becomes much worse, it can lead to serious medical problems. Many
important end-of-life decisions can be made while you are active and able to
communicate your wishes.
Over time, you may have other health problems
caused by coronary artery disease. Low blood flow can make it harder for your
heart to pump. This can lead to
heart failure or
atrial fibrillation. Atrial fibrillation increases the
risk of stroke.
Narrow coronary arteries don't
just cause problems for your heart. They can also affect blood vessels throughout your body.
problems occur in arteries that bring blood to your heart, brain, and arms and
legs (peripheral arterial disease).
A diagnosis of
coronary artery disease can be hard to accept and
understand. If you don't have symptoms, it may be especially hard to recognize
that heart disease is serious and can lead to other health problems.
It's important to talk with your doctor to learn about the disease and
what you can do to help manage it and prevent it from getting worse.
lifestyle changes can delay and maybe even reverse heart disease. Quitting
smoking, eating a low-fat and low-cholesterol diet, getting regular
exercise, and staying at a healthy weight are important steps you can take to keep your disease from
To learn more, see Prevention.
Depression and heart disease are linked. People with heart disease are more likely to get depressed. And if a person has both depression and heart disease, he or she may not stay as healthy as possible. This can make depression and heart disease worse.
If you think you may have depression, talk to your doctor. Take this short quiz to check your symptoms:
Interactive Tool: Are You Depressed? For more information, see
Whether you are recovering from a heart attack or
changing your lifestyle so you can avoid one, emotional support from friends
and family is important. Think about joining a heart disease support group. Ask
your doctor about the types of support that are available where you live.
Meeting other people with the same problems can help you know you're not alone.
Family and friends can also offer practical help, such as help around the house or cooking meals.
It's also important to:
Many people have trouble correctly
taking their medicines for
coronary artery disease. Often, they need to take
several medicines at different times of the day. And some people struggle to
afford the medicines. But medicines are often a key part of treatment, and
people who do not take them as prescribed have an increased risk of
complications and death.
If you have symptoms of coronary artery disease, your doctor may
prescribe some of the following medicines to control symptoms and, in some
cases, slow the progression of the disease:
Stable angina can often be controlled
with medicine such as:
For more help with controlling angina, see:
If angina symptoms become worse, your doctor may need to adjust your
medicines. But if angina symptoms still get worse and medicines don't help, you
may need angioplasty or bypass surgery. For angina that gets worse quickly or
occurs at rest (unstable angina), you may need hospitalization and
stenting, or bypass surgery. For more information, see
Heart Attack and Unstable Angina.
Do not use erection-enhancing medicines such as sildenafil
(Viagra), tadalafil (Cialis), or vardenafil (Levitra) if you take nitroglycerin
or other nitrates for angina. Combined, these two drugs can cause a serious
drop in blood pressure.
If you are taking an erection-enhancing
medicine and seek treatment for angina, tell the doctor about your use of this
medicine so you don't get nitroglycerin or another type of nitrate. There are
other medicines that may work instead to ease your chest pain.
Aspirin, ibuprofen, and naproxen
are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and
inflammation. But only aspirin will reduce your risk for heart attack or
stroke. Don't substitute ibuprofen or naproxen for
low-dose aspirin therapy. If you need to take an NSAID
for a long time, talk with your doctor to see if it is safe for you.
The goals of surgery for
coronary artery disease are to:
Many people with heart disease can be treated by lifestyle
changes and medicine or
angioplasty. But sometimes
coronary artery bypass graft surgery is needed. It uses healthy blood vessels to create detours around
narrowed or blocked arteries. Most of the time, bypass surgery is an open-chest
To learn more about angioplasty, see Angioplasty
and Other Treatment.
Coronary artery bypass graft surgery improves 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 blocked coronary artery. The grafted artery goes around (bypasses)
the blocked part of the artery. The bypass provides a new pathway for blood to
Your treatment will depend in part
Surgery isn't right for everyone. Making lifestyle changes and taking
medicine or having angioplasty can work just as well for some people. And these
carry fewer risks than surgery.
No matter what treatment you
receive, you'll still need to make changes in the way you eat and how much you
exercise. These changes, along with not smoking, will give you the best chance
of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.
If you're thinking about surgery, ask your doctor how many
heart surgeries your surgeon and the hospital perform each year. Find out how
that number compares with heart surgeries done at other hospitals. People who
have bypass surgery at hospitals that do many heart surgeries tend to have
The goal of
angioplasty is to open blood vessels and increase
blood flow to the heart. It is done when arteries are narrowed or blocked from
coronary artery disease. Angioplasty can be done with
or without a small, expandable tube called a
Angioplasty is not surgery. It is done using a thin,
soft tube called a catheter that's inserted in your artery. 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.
Your doctor may use a bare metal stent or a drug-eluting stent. Drug-eluting stents are coated with medicine that helps keep the artery open after angioplasty.
Atherectomy might be done during angioplasty. But it is only done in certain
cases. Atherectomy is done to shave away and maybe remove plaque in a narrowed artery.
Your treatment will depend in part on:
No matter what treatment you receive, you'll still need
to make changes in the way you eat and how much you exercise. These changes,
along with not smoking, will give you the best chance of living a longer,
healthier life. A cardiac rehabilitation program can help you make these healthy changes.
Although treatment for
coronary artery disease is increasingly successful at
prolonging life and reducing complications and hospitalization, the disease can
lead to a
heart attack, a
stroke, and other fatal conditions. It's a good idea
to think about end-of-life decisions before these events happen, while you are
still active and able to talk about your wishes.
When you are
diagnosed with coronary artery disease, your doctor will discuss treatment
options with you. If your heart disease is advanced and your life will most
likely be shortened by the illness, your doctor may talk to you about whether
you want to be revived (resuscitated) when your illness progresses and your
breathing stops. You may want to learn more about aggressive life-sustaining
medical treatment and whether it is right for you.
Many other decisions about end-of-life issues, such as
writing a living will and estate planning, can be made in advance, leaving
valuable time for spending with loved ones and on other important matters.
more information, see:
The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.
The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
WomenHeart: The National Coalition for Women with Heart Disease is
a nonprofit organization dedicated to reducing heart disease, death, and
disability among women. The coalition also sponsors a network of support
groups, a bulletin board, a newsletter, and other services.
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May 9, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Robert A. Kloner, MD, PhD - Cardiology
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