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Overview

What Is Coronary Artery Disease?

Coronary artery disease is a type of heart disease in which plaque builds up inside the coronary arteries, the blood vessels that supply the heart muscle. This buildup can narrow or block the arteries and reduce the flow of oxygen-rich blood to the heart. Coronary artery disease often develops gradually, and it can affect adults of many ages. It is also called coronary heart disease or ischemic heart disease.

Symptoms

Coronary Artery Disease Symptoms

Coronary artery disease symptoms may appear when the heart needs more oxygen, often during physical activity or emotional stress. Some people have no noticeable symptoms until the disease is advanced or a sudden event occurs. Symptoms can vary, especially in older adults, women and people with diabetes.

  • Pressure, squeezing or tightness in the chest (angina).
  • Shortness of breath, especially during activity.
  • Pain or discomfort spreading to the arm.
  • Pain or discomfort spreading to the jaw or back.
  • Unusual or unexplained fatigue.
  • Nausea or an upset stomach.
  • Lightheadedness or feeling faint.

ACT QUICKLY

Possible heart attack symptoms

Seek emergency help for new, severe, persistent or worsening chest discomfort, especially if it occurs with shortness of breath, sweating, fainting, or pain in the arm, jaw, back or shoulder. Do not drive yourself if you may be having a heart attack.

Causes

Causes of Coronary Artery Disease

Coronary artery disease usually begins when cholesterol, inflammatory cells, calcium and other materials collect in the wall of a coronary artery. This buildup forms atherosclerotic plaque, which can make the artery narrower and reduce oxygen delivery to the heart. This process is the main cause of atherosclerotic heart disease and may progress over many years.

When Plaque Suddenly Blocks Blood Flow

Plaque can sometimes become unstable and rupture, causing a blood clot to form and suddenly block blood flow. Coronary artery disease usually develops gradually, but coronary artery spasm and other less common conditions can also reduce blood flow to the heart.

Risk Factors

Risk Factors for Coronary Artery Disease

Nonmodifiable factorsModifiable factors
Increasing age.Smoking or exposure to tobacco smoke.
A family history of heart disease.High blood pressure.
Inherited conditions that affect cholesterol or blood vessels.High cholesterol.
Sex-related risk patterns and hormonal changes.Diabetes or high blood sugar.

Risk factors can add together, increasing the likelihood of heart disease and other cardiovascular disease. Having one or more risk factors does not mean someone will definitely develop coronary artery disease, but it is a reason to discuss prevention and risk assessment with a healthcare professional.

Complications

Complications of Coronary Artery Disease

  • Angina can cause recurring chest pressure or discomfort when the heart does not receive enough oxygen-rich blood.
  • A heart attack can occur when blood flow through a coronary artery becomes suddenly blocked.
  • Heart failure can develop when reduced blood flow or prior heart damage weakens the heart’s pumping ability.
  • Abnormal heart rhythms can interfere with how efficiently the heart beats.
  • Cardiac arrest occurs when the heart suddenly stops pumping blood effectively.
  • Severe coronary artery disease can result in death.

Diagnosis

How Coronary Artery Disease Is Diagnosed

Clinicians diagnose coronary artery disease by reviewing symptoms, medical history and risk factors and performing a physical examination. They may check blood pressure, cholesterol, glucose and other relevant measures. The results help determine which tests can show how the heart is working and whether blood flow through the coronary arteries is reduced.

  • An electrocardiogram records the heart’s electrical activity and may show signs of a current or previous heart problem.
  • An echocardiogram uses sound waves to show the heart’s structure, movement and pumping function.
  • Exercise or medication stress testing assesses how the heart performs when it works harder.
  • Coronary CT angiography uses imaging to look for narrowing or blockages in the coronary arteries.
  • Cardiac catheterization with coronary angiography uses contrast material and X-ray imaging to show blood flow through the coronary arteries.

Treatment & Management

Coronary Artery Disease Treatment and Management

Coronary artery disease treatment is individualized according to symptoms, test results, overall health and the degree of artery narrowing. Treatment may relieve symptoms, prevent heart attacks, slow plaque progression and improve quality of life. A healthcare professional can help select and adjust the most appropriate plan.

ApproachPurpose and examples
Lifestyle changes and risk-factor controlStopping smoking, eating a heart-healthy diet, being physically active as advised, and managing blood pressure, cholesterol, diabetes and weight.
MedicinesStatins can lower cholesterol; blood pressure medicines can reduce strain on the heart; antiplatelet medicines can lower clotting risk; and anti-anginal medicines can help relieve chest discomfort.
Revascularization proceduresAngioplasty with stenting can widen a narrowed artery, while coronary artery bypass surgery creates a new route for blood to flow around blocked arteries.

Prevention

Preventing Coronary Artery Disease

  • Do not smoke, and seek support to quit smoking if needed.
  • Follow a heart-healthy eating pattern with vegetables, fruits, whole grains and appropriate sources of protein.
  • Be physically active as advised by a healthcare professional.
  • Maintain a healthy weight or work toward gradual, sustainable weight loss if recommended.
  • Manage blood pressure, cholesterol and diabetes.
  • Get adequate, regular sleep.
  • Attend recommended medical visits and discuss changes in your heart disease risk.

There is no single routine screening test recommended for every symptom-free adult. Prevention focuses on assessing personal risk and managing factors that can be changed with help from a healthcare professional.

Outlook and Prognosis

Outlook and Prognosis

Coronary artery disease is usually a long-term condition rather than a one-time illness. However, symptoms and future risk can often be reduced with appropriate treatment and sustained lifestyle changes. The outlook varies from person to person and may improve when risk factors are consistently managed.

  • The extent of artery narrowing affects how much blood flow to the heart is limited.
  • A history of heart attack can affect heart function and future risk.
  • Heart pumping function helps indicate how well the heart is working.
  • Other medical conditions can influence complications and treatment choices.
  • Not smoking is associated with better long-term heart health.
  • Taking prescribed medicines consistently supports risk-factor control.
  • Control of blood pressure, cholesterol and diabetes can influence outcomes.

When Should You See a Doctor

When Should You See a Doctor?

  • Arrange a prompt medical appointment for recurring chest pressure or discomfort with activity.
  • Seek medical advice for unexplained shortness of breath.
  • Discuss declining exercise tolerance with a healthcare professional.
  • Arrange an evaluation for new or persistent fatigue without a clear explanation.
  • Ask about your risk if you have multiple coronary artery disease risk factors.

EMERGENCY CARE

Get emergency help

Call emergency services immediately for chest discomfort that is severe, new, persistent or worsening. Emergency symptoms can also include trouble breathing, fainting, cold sweating, or pain spreading to the arm, jaw, back or shoulder.

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