Coronary Artery Disease – Conditions

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Overview

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the heart’s’ blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can’t pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

Causes

The most common cause of CAD is a vascular injury with cholesterol plaque buildup in the arteries, known as atherosclerosis. Reduced blood flow occurs when one or more of these arteries becomes partially or completely blocked.

The cause depends on the type of coronary heart disease. The condition may also have more than one cause, including plaque buildup or problems that affect how the heart’s blood vessels work. Several factors can increase your risk of developing the disease, including:

  • Age.
  • Family history.
  • High blood pressure.
  • High cholesterol.
  • High cholesterol.
  • Poor diet.
  • Obesity or being very overweight.

Symptoms

An acute coronary event, such as a heart attack, may cause the following symptoms:

  • Angina, which can feel like pressure, squeezing, burning, or tightness during physical activity. The pain or discomfort usually starts behind the breastbone, but it can also occur in the arms, shoulders, jaw, throat, or back. The pain may feel like indigestion.
  • Cold sweats
  • Dizziness
  • Lightheadedness
  • Nausea or a feeling of indigestion
  • Neck pain
  • Shortness of breath, especially with activity
  • Sleep disturbances
  • Weakness

Women are somewhat less likely than men to experience chest pain. Instead, they are more likely to experience:

  • Dizziness
  • Fatigue
  • Nausea
  • Pressure or tightness in the chest
  • Stomach pain

Women are also more likely than men to have no symptoms of coronary heart disease.

Chronic (long-term) coronary heart disease can cause symptoms such as the following:

  • Angina
  • Shortness of breath with physical activity
  • Fatigue
  • Neck pain

The symptoms may get worse as the buildup of plaque continues to narrow the coronary arteries. Chest pain or discomfort that does not go away or happens more often or while you are resting might be a sign of a heart attack.

Diagnosis

In addition to a complete medical history and physical exam, tests for coronary artery disease may include the following:

  • Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart shows abnormal rhythms (arrhythmias) and detects heart muscle damage.
  • Stress test (also called treadmill or exercise ECG): This test is given while you walk on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease or to determine safe levels of exercise after a heart attack or heart surgery. This can also be done while resting using special medicines that can synthetically place stress on the heart.
  • Cardiac catheterization: With this procedure, a wire is passed into the coronary arteries of the heart, and X-rays are taken after a contrast agent is injected into an artery. It’s done to locate the narrowing, blockages, and other problems.

Treatment

Your treatment plan depends on how severe your disease is, the severity of your symptoms, and any other health conditions you may have. Possible treatments for coronary heart disease include heart-healthy lifestyle changes, medicines, or procedures such as coronary artery bypass grafting or percutaneous coronary intervention.

Lifestyle changes

  • Aiming for a healthy weight
  • Being physically active
  • Heart-healthy eating
  • Managing stress
  • Quitting smoking
  • Get enough good-quality sleep

Procedures

You may need a procedure or heart surgery to treat more advanced coronary heart disease.

  • Percutaneous coronary intervention (PCI) to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. A small mesh tube called a stent is usually implanted after PCI to prevent the artery from narrowing again.
  • Coronary artery bypass grafting (CABG) improves blood flow to the heart by using normal arteries from the chest wall and veins from the legs to bypass the blocked arteries. Surgeons typically use CABG to treat people who have severe obstructive coronary artery disease in multiple coronary arteries.
  • Transmyocardial laser revascularization or coronary endarterectomy to treat severe angina associated with coronary heart disease when other treatments are too risky or did not work.

When To See A Doctor?

It’s important to know your heart disease symptoms and what causes them. Call your doctor if you feel new symptoms or if the ones you’re used to are becoming more frequent or severe. Call for help if you or someone you’re with has chest pain, especially when it comes to things like shortness of breath, heart palpitations, dizziness, a fast heartbeat, nausea, or sweating.


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