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Coronary artery disease is the buildup of plaque in the arteries that supply oxygen-rich blood to your heart. Plaque causes a narrowing or blockage that could result in a heart attack. Symptoms include chest pain or discomfort and shortness of breath. Treatments include lifestyle changes and medications that target your risk factors and/or possibly surgery.
Coronary artery disease is a narrowing or blockage of your coronary arteries usually caused by the buildup of fatty material called plaque. Coronary artery disease is also called coronary heart disease, ischemic heart disease and heart disease. Where are the coronary arteries? What do they do?Coronary arteries are the blood vessels that supply oxygen-rich blood to your heart muscle to keep it pumping. The coronary arteries are directly on top of your heart muscle. You have four main coronary arteries:
What happens to the arteries in coronary artery disease?Coronary artery disease is caused by atherosclerosis. Atherosclerosis is the buildup of plaque inside your arteries. Plaque consists of cholesterol, fatty substances, waste products, calcium and the clot-making substance fibrin. As plaque continues to collect on your artery walls, your arteries narrow and stiffen. Plaque can clog or damage your arteries, which limits or stops blood flow to your heart muscle. If your heart does not get enough blood, it can't get the oxygen and nutrients it needs to work properly. This condition is called ischemia. Not getting enough blood supply to your heart muscle can lead to chest discomfort or chest pain (called angina). It also puts you at risk for a heart attack. How does plaque build-up in the arteries?Coronary artery disease happens in everyone. The speed at which it develops differs from person to person. The process usually starts when you are very young. Before your teen years, the blood vessel walls start to show streaks of fat. As plaque deposits in your artery’s inner walls, your body fights back against this ongoing process by sending white blood cells to attack the cholesterol, but the attack causes more inflammation. This triggers yet other cells in the artery wall to form a soft cap over the plaque. This thin cap over the plaque can break open (due to blood pressure or other causes). Blood cell fragments called platelets stick to the site of “the injury,” causing a clot to form. The clot further narrows arteries. Sometimes a blood clot breaks apart on its own. Other times the clot blocks blood flow through the artery, depriving the heart of oxygen and causing a heart attack. The process of how plaque builds up in your coronary arteries. Who gets coronary artery disease?You have an increased risk of coronary artery disease if you:
If you have these risk factors, talk with your healthcare provider. They may want to test you for coronary artery disease.
You may not know you have coronary artery disease since you may not have symptoms at first. The buildup of plaque in your arteries takes years to decades. But as your arteries narrow, you may notice mild symptoms that indicate your heart is pumping harder to deliver oxygen-rich blood to your body. The most common symptoms are chest pain or shortness of breath, especially after light physical activity like walking up stairs, but even at rest. Sometimes you won’t know you have coronary artery disease until you have a heart attack. Symptoms of a heart attack include:
Symptoms of a heart attack in women can be slightly different and include:
What should I do if I have symptoms of coronary artery disease?Because the symptoms of coronary artery disease can be symptoms of a heart attack, you need to seek immediate help. Call 911 if you think you are having symptoms of a heart attack. If a blood clot in a coronary artery has broken loose and moved into your brain, it can cause a stroke, although this is rare. Symptoms of a stroke include:
If you experience any of these symptoms, call 911. Every minute you spend without treatment increases your risk of long-term damage.
First, unless your condition is an emergency (you’re having a heart attack or stroke), your cardiologist (heart doctor) will ask you about your symptoms, take your medical history, review your risk factors and perform a physical exam. Diagnostic tests may include:
Other diagnostic imaging tests may include:
Your healthcare provider will talk to you about the best treatment plan for you. Follow your treatment plan to reduce your risk of problems that can result from coronary artery disease, like heart attack and stroke. Lifestyle changes The first step in treating coronary artery disease is to reduce your risk factors. This involves making changes in your lifestyle.
Medications Your healthcare provider will recommend medications to best manage your risk factors for heart disease. Types of heart-related medications that may be selected for you include:
If you have diabetes and coronary artery disease, you’ll be prescribed medications to lower your blood sugar level. It's important to take all medications as prescribed, including those for heart disease and all other health conditions. Talk to your healthcare provider if you have any questions or concerns about which medications to take or how to take them. Procedures and surgery Interventional procedures are nonsurgical treatments to get rid of plaque buildup in the arteries and prevent blockages. Common procedures are balloon angioplasty and stenting. These procedures are done with a long, thin tube called a catheter. It is inserted into an artery in the wrist or the top of the leg through a small incision and guided to the blocked or narrowed area of the artery. The balloon widens the diameter of the artery to restore blood flow to the heart. A stent (a small metal spring-like scaffold) is left in place to keep your artery open. Coronary artery bypass graft (CABG) surgery involves creating a new path for blood to flow when there is a blockage in the coronary arteries. In most cases, the surgeon removes blood vessels from your chest, arm or leg, and creates a new pathway to deliver oxygen-rich blood to the heart. If traditional treatment options are not successful, your cardiologist may recommend other treatment options, such as enhanced external counterpulsation (EECP). In this procedure, inflatable cuffs (like blood pressure cuffs) are used to squeeze the blood vessels in your lower body. This helps improve blood flow to the heart and helps create natural bypasses (collateral circulation) around blocked coronary arteries. Enhanced external counterpulsation is a possible treatment for those with chronic stable angina who can’t have an invasive procedure or bypass surgery and don't get relief from medication. Collateral circulation around a blocked coronary artery. What are the complications of coronary artery disease?Coronary artery disease can lead to the following other heart conditions: You can reduce your chance of developing these heart conditions if you follow your cardiologist’s treatment plan.
You can certainly make changes that will lower your chance of developing coronary artery disease, but this condition is not 100% preventable. This is because there are two kinds of risk factors: Those that can’t be changed (nonmodifiable) and those that can be (modifiable). Nonmodifiable risk factors include older age, male gender, a family history of heart disease and genetic factors. See the question, “who gets coronary artery disease” earlier in this article for more information. However, there are many risk factors that you can modify. These are mostly lifestyle changes like losing weight if you’re overweight, stopping smoking if you smoke, keeping your blood pressure and cholesterol level at their goal numbers and managing diabetes. See “lifestyle changes” under the treatment section of this article for more examples. Keep in mind that the more risk factors you have, the higher the chance of having heart disease. Fortunately, you can choose to help yourself and reduce the risk of disease by taking control over your risk factors that can be changed.
Technically coronary artery disease can’t be cured. If you’ve been diagnosed with coronary artery disease, follow your healthcare provider’s treatment plan to help prevent your condition from getting worse. Your treatment plan may include procedures and surgery to increase the blood supply to your heart, lifestyle changes to target your risk factors and medications. If your coronary artery disease has led to a heart attack, your healthcare provider can recommend a cardiac rehabilitation program to reduce your risk of future heart problems, regain strength and improve the quality of your life. It's important to keep all follow-up appointments and have all tests ordered by your healthcare provider. These are needed to keep track of your condition, monitor how well your treatment plan is working and make adjustments if needed.
Acute coronary syndrome is the name given to types of coronary disease that are associated with a sudden blockage in the blood supply to your heart. Some people have symptoms before they have acute coronary syndrome, but you may not have symptoms until the condition occurs. Some people never have any symptoms. Changes caused by acute coronary syndrome can be seen on an electrocardiogram (ECG) and in blood tests. Acute coronary syndrome is defined by the location of the blockage, length of time the artery is blocked and amount of damage and is defined as:
These are life-threatening conditions that require emergency medical care. How is angina different from a heart attack?Both angina and heart attack are a consequence of coronary artery disease. The symptoms of a heart attack (myocardial infarction/MI) are similar to angina. But, angina is a warning symptom of heart disease, not a heart attack.
A note from Cleveland Clinic Coronary artery disease is a narrowing or blockage of your coronary arteries usually caused by the buildup of fatty material called plaque. Coronary artery disease can lead to angina and heart attack. Fortunately, if you know the risk factors and symptoms for disease, you can be seen at regular intervals and your management plan can be adjusted. There’s a lot you can do to prevent or slow the progression of coronary artery disease. Work with your healthcare provider to make lifestyle changes that will help you live your life to the fullest.
Last reviewed by a Cleveland Clinic medical professional on 06/21/2021. References
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