What is Coronary Artery Disease (CAD)?
Coronary artery disease (CAD), also known as Ischaemic heart disease, is a common type of heart disease. Coronary arteries supply blood to the heart muscle. CAD is characterised by reduced blood flow to the heart muscle due to blockage in the artery. Sudden occlusion of the artery causes acute coronary syndrome, where the patient presents with sudden-onset angina, and gradual occlusion causes symptoms over a period of time.
Types of Coronary Artery Disease
The main types of Coronary Artery Disease (CAD) are classified based on how the coronary arteries are affected and how the disease presents clinically:
Obstructive Coronary Artery Disease
Occurs when fatty plaques significantly narrow or block the coronary arteries, reducing blood flow to the heart muscle. This is the most common type of CAD.
Non-Obstructive Coronary Artery Disease
Plaque buildup is present but does not cause major blockage. However, it can still lead to chest pain, shortness of breath, and increased heart attack risk.
Microvascular Coronary Artery Disease (Small Vessel Disease)
Affects the tiny blood vessels of the heart rather than the major coronary arteries. It is more common in women and may not be detected on standard angiography.
Coronary Artery Spasm (Prinzmetal’s or Variant Angina)
Temporary tightening or spasm of a coronary artery that reduces blood flow, often causing chest pain at rest.
Chronic Coronary Syndrome
Long-standing, stable narrowing of coronary arteries that causes predictable symptoms like chest pain during exertion.
Acute Coronary Syndrome
A sudden reduction or complete blockage of blood flow to the heart, including conditions such as unstable angina and heart attack.
Coronary Artery Disease Symptoms
An individual may experience symptoms of coronary artery disease when the heart does not get sufficient oxygen-rich blood. Coronary artery disease symptoms may include:
1. Angina or chest pain
The most typical symptom of coronary artery disease is chest pain. The patient typically describes the pain as central squeezing, as if he/ she has been stabbed. Occasionally, it can radiate to the neck, back, and left arm. Some patient can also present as indigestion or heart burn.
Stable angina is temporary chest discomfort or pain that may come and go in predictable patterns. In women, the chest pain can be brief or sharp and felt in the back, arm, or neck.
2. Fatigue
When the heart cannot pump enough oxygen-rich blood to fulfil the body’s needs and requirements, an individual may experience unusual tiredness.
3. Shortness of breath
Some people may experience dyspnea or shortness of breath during light physical activity.
4. Palpitation
Some patients experience sudden rises in heartbeat; occasionally, the heartbeat may become so low that the patient may collapse.
Note: Coronary artery disease symptoms may not be noticeable at first. In some individuals, symptoms may occur when the heart is beating at a faster pace such as during exercise. As the coronary arteries narrow, these symptoms can get more frequent or severe.
Coronary Artery Disease Causes
Coronary artery disease is caused by a buildup of cholesterol, fats and other substances (plaque) in and on the heart's arteries. This condition is referred to as atherosclerosis. This plaque build-up can burst, causing a blood clot.
Some of the leading causes of coronary artery disease are:
Modifiable Causes of CAD
Non-modifiable Causes of CAD
- Age: The risk of narrowed and damaged arteries increases with age
- Gender: Men are at a greater risk of developing coronary artery disease
- Genetics: A family history of heart disease increases the risk of coronary artery disease. The risk of CAD is also higher if a person’s father or brother was diagnosed with heart disease before 55 or if your mother or sister developed CAD before 65.
Note: When grouped together, some of these risk factors can increase the risk of developing coronary artery disease (CAD). For example, a group of conditions, including high blood pressure, high body fat content, high blood sugar, and high triglycerides levels (metabolic syndrome), makes an individual more susceptible to CAD.
Coronary Artery Disease Diagnosis
A doctor may diagnose coronary artery disease through a physical examination and tests that may include:
- Measuring the blood pressure
- Ask in detail about the symptoms, medical history and family history
- This information will help determine the risk for coronary heart disease
Tests to Diagnose CAD and Assess Heart Function
1. Blood Tests
Check blood sugar levels, triglycerides and cholesterol in the blood.
2. Electrocardiogram (ECG/EKG)
In an EKG, electrodes are placed to study the heart's function. This helps determine heart health and diagnose CAD.
3. Echocardiogram
An echo test or echocardiogram uses sound waves to determine how well the blood flows to and from the heart.
4. Exercise Stress Test
At times, CAD symptoms only show when an individual is active. During this type of test, you may be asked to walk or run on a treadmill or a stationary bike during an EKG.
5. Coronary Calcium Scan
A cardiac calcium scan, also known as a heart calcium scan, detects calcium deposits blocking the arteries and hampering the flow of blood.
6. Cardiac Catheterization
In this test, a cardiologist guides a catheter (thin and flexible tube) through a blood vessel in the arm or leg to reach the heart. A dye is then injected through a catheter, and X-ray videos are used to determine the condition of the heart.
7. CT (computed tomography) coronary angiogram
This type of test allows for a close-up look at the arteries, using a special dye injected into the brain before a CT scan.
Coronary Artery Disease Treatment
Depending on the severity of the condition, the treatment plan for CAD may include one or a combination of the following treatment options:
Medications
Medications for CAD treatment may include anticoagulants (blood thinners), anti-clotting medicines, beta-blockers, ACE inhibitors, calcium channel blockers, nitroglycerin, statins
Interventional Procedure
The interventional procedure may include Percutaneous Transluminal Coronary Artery (PTCA) stenting of the coronary artery (also commonly called coronary artery stenting) or Coronary Artery Bypass Grafting (CABG):
Percutaneous Transluminal Coronary Artery (PTCA)/ Coronary Artery Angioplasty
Also known as percutaneous coronary intervention (PCI), it is a minimally invasive procedure that aims to reopen blocked arteries and improve blood flow. It is either done through the artery in the leg or the hand. Catheters are placed through which the arteries of the heart are accessed. The blocked segment is then crossed with a wire. First, the blocked segment is ballooned with a balloon, and finally, a stent is placed in that segment so patency is maintained.
Most of the time, the patient does not require ventilatory support and is usually fit to go home the day after the procedure.
CABG (Coronary Artery Bypass Grafting)
CABG is a surgical method of treating coronary artery blockage in which a new passage is created by bypassing the blocked segment by opening the chest. The patient requires ventilatory support and may also require heart-lung support during the procedure. Usually, the patient requires 5-8 days of hospitalisation.
Prevention of Coronary Artery Disease (CAD)
It is not possible to completely prevent coronary artery disease because of some risk factors that can’t be controlled. However, it’s possible to lower the risk of coronary artery disease and prevent it from getting worse. The nine golden rules in the prevention of coronary artery disease are:
- Quit smoking
- Control diabetes
- Control BP
- Maintain healthy weight
- Exercise regularly
- Consume more fruits & vegetables
- Refrain/reduce alcohol intake
- Maintain healthy cholesterol levels
- Avoid stress
Article By Dr. Amit Kumar Chaurasia
Chief Cath Lab & TAVI (Unit I) - Cardiology
Artemis Hospitals
Frequently Asked Questions
How is coronary artery disease caused?
CAD is a common type of heart disease that affects the main blood vessels that supply blood to the heart, called the coronary arteries. It is caused by a buildup of cholesterol, fats, and other substances on the walls of the arteries around the heart, ultimately restricting blood flow to the heart.
Coronary artery disease also known as?
Coronary artery disease, commonly known as coronary heart disease or ischemic heart disease, is a cardiovascular condition caused by narrowing or blockage of coronary arteries due to plaque accumulation.
Can you still live a long life with coronary artery disease?
The survival rates of CAD vary depending on several factors, including the severity of the condition and the type of treatment. However, timely diagnosis and treatment can help individuals with CAD live long and productive lives.
What is the best treatment for coronary artery disease?
The best treatment for coronary artery disease depends on the severity of blockage and may include lifestyle changes and medications, angioplasty with stenting, or bypass surgery for advanced cases.
A cardiologist determines the most effective treatment after evaluating heart tests and overall patient health.
Does exercise prevent coronary artery disease?
Yes, regular exercise helps prevent coronary artery disease by improving heart health, lowering bad cholesterol, controlling blood pressure, managing weight, and reducing stress, all of which decrease the risk of artery blockage.
What foods clear arteries?
Certain foods that can help prevent clogging in the arteries and lower the risk of coronary heart disease include:
- Leafy greens
- Oats
- Berries
- Tomatoes
- Beans
- Fish
Which test confirms coronary artery disease?
A coronary angiogram is one of the best methods to diagnose coronary artery disease. It is a type of X-ray that is used to examine the coronary arteries supplying blood to the heart muscle.
