What Is Coronary Artery Disease (CAD)?

Coronary artery disease (CAD), also called coronary heart disease, is a type of heart disease that occurs when a buildup of cholesterol and other substances — known as plaque — causes the arteries supplying blood to the heart to harden and narrow.

Common Symptoms

• Chest Pain (Angina) This usually occurs in the middle or left side of the chest and can be triggered by stress, strong emotions, or physical activity. It may feel like a heaviness, tightness, pressure, or squeezing sensation, as if a large weight is pressing down on your chest.

• Shortness of Breath You may feel unable to catch your breath or breathe deeply.

• Fatigue You may feel unusually tired because the heart can’t sufficiently pump blood to supply the body’s oxygen needs.

• Heart Attack When the blockage in your heart’s arteries cuts off the blood supply fully, this causes a heart attack.

The symptoms of CAD may not be obvious at first. In the early stages, they may only be noticeable when the heart beats hard, for example, when you exercise.

As the arteries narrow more over time, symptoms can become more pronounced and occur more frequently.

Heart Attack

As plaque buildup gets more severe over time, an artery may become completely blocked, causing a heart attack.

• Discomfort or pain that can radiate to the jaw, teeth, shoulder, arm, neck, back, or sometimes the upper abdomen
• Squeezing pain or tightness in the chest
• Fatigue
• Cold sweats
• Dizziness
• Lightheadedness
• Shortness of breath
• Nausea

If you suspect you are having a heart attack, seek emergency assistance immediately. If you have any other symptoms of CAD, talk to your doctor.

• Smoking
• High blood pressure
• High LDL cholesterol
• Low HDL cholesterol
• Diabetes
• Physical inactivity
• Family history of CAD
• Obesity
• Stress
• Alcohol use
• Too little or too much sleep
• Biological sex; men are more likely than women to develop CAD

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• Elevated high-sensitivity C-reactive protein (hs-CRP), which is an indication of inflammation in the body
• Elevated triglycerides
• Elevated levels of homocysteine, a substance used to make protein and to build and maintain tissue
• Preeclampsia, a complication of pregnancy causing protein in the the urine and high blood pressure
• Other pregnancy complications
• Obstructive sleep apnea
• Certain autoimmune conditions, such as lupus or rheumatoid arthritis

If any risk factors for CAD apply to you — such as smoking or having high blood pressure — talk to your doctor.

Even if you don’t have any signs or symptoms of CAD, your doctor may want to treat you for conditions like high blood pressure or high cholesterol to help reduce your future risk.

• An electrocardiogram (ECG or EKG) to see if you’ve had a heart attack
• An echocardiogram to assess heart function
• An exercise stress test to gather information about your heart during physical activity
• A cardiac catheterization and angiogram to check blood flow through your heart
• A coronary calcium scan using a computerized tomography (CT) scan of your heart to check for calcium deposits in your arteries
• Magnetic resonance imaging (MRI) to detect problems with blood flow to the heart or damage to the tissue
• A cardiac positron emission tomography (PET) scan to assess blood flow to the heart through the coronary arteries

• Cholesterol-lowering drugs designed to reduce LDL (low-density lipoprotein, or “bad”) cholesterol levels
• Aspirin or another blood thinner to reduce your risk of blood clots
• Beta-blockers to lower your heart rate and blood pressure
• Nitroglycerin to control chest pain by dilating your coronary arteries to reduce areas of blockage and your heart’s demand for blood
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to lower your blood pressure
• Calcium channel blockers to relax blood vessels and lower blood pressure
• The antianginal agent ranolazine (Ranexa), which treats both CAD and the chest pain associated with it

In some cases CAD may require more aggressive treatment in the form of a surgical procedure, such as:

• Stents Small pieces of metal are placed in your coronary arteries to keep them open, improving blood flow.
• Angioplasty A cardiologist inserts a catheter into the narrowed part of your artery to place a deflated balloon. The surgeon then inflates the balloon to compress any deposits against your artery walls.
• Coronary Artery Bypass Surgery A surgeon creates a graft to bypass blocked coronary arteries using a blood vessel from another part of your body. This requires open-heart surgery.
• Transmyocardial Revascularization (TMR) A surgeon creates tiny holes in the muscles of the left ventricle (the left lower chamber of the heart), allowing increased blood flow to the heart to reduce angina.

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• Quitting smoking
• Eating a more balanced, heart-healthy diet
• Getting more physical activity
• Maintaining a moderate weight
• Taking steps to reduce stress

• Angina
• Heart attack
• Inability of the heart to pump enough blood (heart failure)
• Abnormal heart rhythm (arrhythmia)

However, with early diagnosis and treatment of CAD, it may be possible to stop or slow its progression and help prevent many of these complications.

The Takeaway

• Coronary artery disease (CAD), or coronary heart disease, occurs when plaque buildup reduces blood flow to the blood vessels of the heart.
• CAD is the leading cause of death for both sexes and most racial and ethnic groups in the United States.
• Risk factors for CAD include obesity, family history, physical inactivity, alcohol use, smoking, and diabetes.
• Treatments like medication, lifestyle changes, or surgical interventions can possibly reduce or stop the progression of CAD to prevent complications like heart attack.

Additional reporting by Brian P. Dunleavy.