Coronary artery 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, including heart attack.
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 Canada and the United States.
It 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 with atherosclerosis:
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 symptoms.
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 examination 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.
Treatment focuses 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 heart health:
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, healthy habits.
Medicines that are often prescribed for people with coronary artery disease include:
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.
|Decision Points focus on key medical care decisions that are important to many health problems.|
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Learning about coronary artery disease (CAD):
Living with heart disease:
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 called 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.
But heart 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 heart attack.
The most common symptoms of coronary artery disease are:
Unfortunately, sometimes a heart attack is the first sign of coronary artery disease.
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, light-headedness 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.
Risk factors that you can't change include:
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.
By calling 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, general practitioner, or internist. For diagnosis of coronary artery disease, you may see a cardiologist or internist. For ongoing care of stable angina, you will likely see your family doctor, general practitioner, or 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 risk for coronary artery disease, your doctor will do a physical examination 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?
If 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:
Treatment for coronary artery disease focuses on taking steps to manage symptoms and reduce the risk of heart attack and stroke. For example:
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 second-hand smoke. Quitting smoking 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 counselling 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
Aspirin or other antiplatelets. Your doctor will probably recommend that you take 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 statin.
Heart medicines. Your doctor may prescribe medicines that lower blood pressure or decrease your heart's workload. These medicines include:
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 blood pressure, 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.
Sometimes 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 rate.
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 procedures include 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 worse.
Hospice palliative care
If your coronary artery disease gets worse, you may want to think about hospice 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 treatment.
Hospice palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine hospice palliative care with curative care.
Hospice 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 hospice 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 topic Hospice Palliative Care.
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 important to 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 diabetes, high blood pressure, and high cholesterol.
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 disease.
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 taking nitroglycerin.
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 unstable angina.
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
Most often, 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.
Making healthy 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 getting worse.
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.
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 urgent angioplasty, stenting, or bypass surgery. For more information, see the topic Heart Attack and Unstable Angina.
Do not use erection-enhancing medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) 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 non-steroidal 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 procedure.
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 heart.
Your treatment will depend in part on:
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 better results.
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 stent.
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.
For more information, see:
|Canadian Cardiovascular Society|
|222 Queen Street|
|Ottawa, ON K1P 5V9|
The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.
|Canadian Association of Cardiac Rehabilitation|
|1390 Taylor Avenue|
|Winnipeg, MB R3M 3V8|
The Canadian Association of Cardiac Rehabilitation (CACR) is a professional organization that promotes research in cardiac disease prevention and rehabilitation. The CACR website includes articles on topics related to cardiac disease.
|Dietitians of Canada|
|480 University Avenue|
|Toronto, ON M5G 1V2|
The Dietitians of Canada website provides a wide range of food and nutrition information, including fact sheets on frequently asked food and diet questions, quizzes and other tools to assess your diet habits, and meal planning guides.
|Heart and Stroke Foundation of Canada|
|222 Queen Street|
|Ottawa, ON K1P 5V9|
The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.
|U.S. National Heart, Lung, and Blood Institute (NHLBI)|
|P.O. Box 30105|
|Bethesda, MD 20824-0105|
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
- Roger VL, et al. (2012). Heart disease and stroke statistics—2012 update: A report of the American Heart Association. Circulation, 125(1): e2–e220. Also available online: http://circ.ahajournals.org/content/125/1/e2.full .
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|Primary Medical Reviewer||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
|Specialist Medical Reviewer||Robert A. Kloner, MD, PhD - Cardiology|
|Last Revised||May 24, 2013|
Last Revised: May 24, 2013
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