Coronary Artery Disease

What is coronary artery disease?

Coronary artery disease (CAD) is narrowing of the arteries to your heart caused by a buildup of plaque. Plaque is made up of cholesterol and other substances. The narrowing in your arteries decreases the amount of blood that can flow to your heart. This causes your heart to get less oxygen.

What increases your risk for coronary artery disease?

• Age 40 years or older.
• A family history of CAD.
• Smoking or regular exposure to secondhand smoke.
• A medical condition, such as high blood pressure, high cholesterol, or diabetes.
• Obesity or lack of exercise.

What are the signs and symptoms of coronary artery disease?

You may not have any symptoms of CAD. The most common symptom is chest pain, also called angina. Angina may feel like burning, squeezing, or crushing tightness in your chest. The pain may spread to your neck, jaw, or shoulder blade. You may have other symptoms along with chest pain. These include nausea, vomiting, sweating, fainting, and hands and feet that are cold to the touch.

How is coronary artery disease diagnosed?

Your healthcare provider will ask you if you have a family history of CAD. He will also ask about your symptoms and about the medicines you are taking. You may need any of the following:

• Blood tests will check for high cholesterol or other medical conditions that may have led to CAD.
• An EKG records the electrical activity of your heart. It is used to check your heart rhythm, and it may show if there is damage to your heart.
• An echocardiogram is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
• An exercise stress test helps healthcare providers see the changes that take place in your heart during exercise. An EKG is done while you ride an exercise bike or walk on a treadmill. Healthcare providers will ask if you have chest pain or trouble breathing during the test. An exercise test may be combined with an echocardiogram or nuclear isotope imaging. Nuclear isotopes are very small amounts of radioactive material that are injected into your bloodstream. Images show areas of your heart that have decreased blood flow.
• A stress test with medicine may be done if you cannot do the exercise stress test. You are given medicine that causes your heart to work harder. You will be connected to a stress test machine. This test is combined with the echocardiogram or nuclear isotope imaging.
• An angiography, CT scan, or MRI may be done to take pictures of your blood vessels and arteries. The pictures may show how narrow or blocked your blood vessels are. You may be given contrast liquid to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.

Which medicines are used to treat coronary artery disease?

• Blood pressure medicines are given to lower your blood pressure. These medicines may include ACE inhibitors and beta-blockers. ACE inhibitors help keep your blood vessels relaxed and open. This helps keep blood flowing into your heart. Beta-blockers keep your heart pumping strongly and regularly. This helps keep your heart from working too hard to get oxygen.
• Cholesterol medicines help lower blood cholesterol levels.
• Nitrates, such as nitroglycerin, relax the arteries of your heart so it gets more oxygen. They help to relieve your chest pain.
• Antiplatelets, such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
• Blood thinners keep clots from forming in your blood. Clots may cause heart attacks, strokes, or death. This medicine makes it more likely for you to bleed or bruise.
• Do not take certain medicines without asking your healthcare provider first. These include NSAIDs, herbal or vitamin supplements, or hormones (estrogen or progestin).

What can you manage your coronary artery disease?

• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause heart and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
• Exercise regularly. Exercise at least 30 minutes each day, on most days of the week. Exercise helps to lower high cholesterol and high blood pressure. It can also help you maintain a healthy weight. Ask your healthcare provider about the kind of exercise you should do and how to get started.
• Maintain a healthy weight. If you are overweight, talk to your healthcare provider about how to lose weight. A weight loss of 10 percent can improve your heart health.
• Eat heart-healthy foods. Include fresh fruits and vegetables in your meal plan. Choose low-fat foods, such as skim or one percent fat milk, low-fat cheese and yogurt, fish, chicken (without skin), and lean meats. Eat two 4-ounce servings of fish high in omega-3 fats each week, such as salmon, fresh tuna, and herring. Do not eat foods that are high in sodium, such as canned foods, potato chips, salty snacks, and cold cuts. Put less table salt on your food.
• Limit or do not drink alcohol. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
• Manage other health conditions. Follow your healthcare provider’s advice on how to manage other conditions that can affect your heart health. These include diabetes, high blood pressure, and high cholesterol. You may need to take medicines for these conditions and make other lifestyle changes.
• Ask if you should have a flu vaccine. The flu can be dangerous for a person who has CAD. The flu vaccine is available every year in the fall.

Call 911 for any of the following:

• You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest that lasts longer than five minutes or returns.
  • Discomfort or pain in your back, neck, jaw, stomach, or arm.
  • Trouble breathing.
  • Nausea or vomiting.
  • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing.

When should you contact your healthcare provider?

• You have chest pain that is more frequent, or you have chest pain at rest.
• You have questions or concerns about your condition or care.