Coronary artery disease: Impedance or blockage of one or more arteries that

supply blood to the heart, usually due to atherosclerosis (hardening of the

arteries). Abbreviated CAD. A major cause of illness and death, CAD begins
when hard cholesterol substances (plaques) are deposited within a coronary
artery. The plaques in the coronary arteries can lead to the formation of tiny
clots that can obstruct the flow of blood to the heart muscle, producing
symptoms and signs of CAD, including chest pain (angina pectoris), heart
attack (myocardial infarction), and sudden death. Treatment for CAD includes
bypass surgery, balloon angioplasty, and the use of stents.

Coronary Artery Disease Symptoms

Overview Possible Causes Care and Treatment When to Call the Doctor Resources
Dr. Nissen discusses symptoms of coronary artery disease.

The most common symptom of coronary artery disease is angina (also called angina pectoris).
Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness,
tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for
indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left
shoulder, arms, neck, back or jaw.

If you have angina or any of the symptoms listed below that last for more than 5 minutes, SEEK
EMERGENCY TREATMENT (CALL 9-1-1) WITHOUT DELAY. These symptoms could be
the signs of a heart attack (also called myocardial infarction or MI) and immediate treatment is
essential.

 Pain or discomfort in other areas of the upper body including the arms, left shoulder,
back, neck, jaw, or stomach
 Difficulty breathing or shortness of breath
 Sweating or "cold sweat"
 Fullness, indigestion, or choking feeling (may feel like "heartburn")
 Nausea or vomiting
 Light-headedness, dizziness, extreme weakness or anxiety
 Rapid or irregular heart beats
Shaded areas show where you may have symptoms

Symptoms of coronary artery disease in women:

Studies show that women's symptoms are less likely identified as heart disease related. The
symptoms of coronary artery disease and heart attack can be different for women than they are in
men. Women are also less likely to recognize the symptoms of a heart attack and seek treatment.
By learning and recognizing the symptoms, women can become assertive in their treatment. The
most common symptoms of heart disease in women are:

 Pain or pressure over the chest that travels to the arm or jaw
 A burning sensation in the chest or upper abdomen
 Shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea.

On average, symptoms of heart disease appear 10 years later in women than men. Women tend
to have heart attacks 10 years later than men do.

In addition, women often report their symptoms before having a heart attack, although the
symptoms are not typical "heart" symptoms. In a multi-center study of 515 women who had an
acute myocardial infarction (MI), the most frequently reported symptoms were unusual fatigue,
sleep disturbances, shortness of breath, indigestion and anxiety. The majority of women (78%)
reported at least one symptom for more than one month before their heart attack. Only 30%
reported chest discomfort, which was described as an aching, tightness, pressure, sharpness,
burning, fullness or tingling.

 More information on heart attack in women.

Types of Angina
Stable angina

A type of angina brought on by an imbalance between the heart's need for oxygen-rich blood and
the amount available. It is "stable," which means the same activities bring it on; it feels the same
way each time; and is relieved by rest and/or oral medications. Stable angina is a warning sign of
heart disease and should be evaluated by a doctor. If the pattern of angina changes, it may
progress to unstable angina.

Unstable angina

This type of angina is considered an acute coronary syndrome. It may be a new symptom or a
change from stable angina. The angina may occur more frequently, occur more easily at rest, feel
more severe, or last longer. Although this angina can often be relieved with oral medications, it
is unstable and may progress to a full-blown heart attack. Usually more intense medical
treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should
be treated as an emergency.

Variant angina (also called Prinzmetal's angina or coronary spasm)

A coronary artery can go into spasm, disrupting blood flow to the heart muscle (ischemia). It can
occur in people without significant coronary artery disease. However, two thirds of people with
variant angina have severe disease in at least one vessel, and the spasm occurs at the site of
blockage. This type of angina is not common and almost always occurs when a person is at rest.
You are at increased risk for coronary spasm if you have: underlying coronary artery disease,
smoke, or use stimulants or illicit drugs (such as cocaine). If a coronary artery spasm is severe
and occurs for a long period of time, a heart attack can occur.

What's the difference between angina and a heart attack?

Angina is a warning symptom of heart disease – but it is not a heart attack. The symptoms of a
heart attack (also called myocardial infarction or "MI") are similar to angina.

Angina

 Is brought on by a brief period of poor blood supply to the heart muscle.

 Does not cause permanent damage to the heart.
 Symptoms last just a few minutes and are usually relieved by rest and/or medications.
Symptoms include chest pain or discomfort, shortness of breath, palpitations, faster heart
rate, dizziness, nausea, extreme weakness and sweating.
 Does not require emergency medical attention; however, it is important to call your
doctor if this is the first time you've experienced angina, if you have new symptoms or if
they become more frequent or severe.

Heart Attack
  Occurs when the blood supply to the heart muscle is blocked for an extended period of
time (often due to a clot forming in a blocked coronary artery).
 Could result in permanent damage to the heart muscle.
 Symptoms usually last more than a few minutes and include chest pain or discomfort that
lasts for more than a few minutes and does not completely resolve with nitroglycerin;
pain or discomfort in other areas of the upper body; difficulty breathing or shortness of
breath; sweating or "cold" sweat; fullness, indigestion or choking feeling; nausea or
vomiting; light-headedness; extreme weakness; anxiety; rapid or irregular heartbeats.
 Requires emergency medical attention if symptoms last longer than 5 minutes.

Overview

Coronary artery disease develops when the major blood vessels that supply your heart
with blood, oxygen and nutrients (coronary arteries) become damaged or diseased.
Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to
blame for coronary artery disease.

When plaque builds up, it narrows your coronary arteries, decreasing blood flow to your
heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness
of breath, or other coronary artery disease signs and symptoms. A complete blockage
can cause a heart attack.

Because coronary artery disease often develops over decades, you might not notice a
problem until you have a significant blockage or a heart attack. But there's plenty you
can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big
impact.

Symptoms

If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your
heart — especially when it's beating hard, such as during exercise. At first, the
decreased blood flow may not cause any coronary artery disease symptoms. As plaque
continues to build up in your coronary arteries, however, you may develop coronary
artery disease signs and symptoms, including:

 Chest pain (angina). You may feel pressure or tightness in your chest, as if
someone were standing on your chest. This pain, referred to as angina, usually
 occurs on the middle or left side of the chest. Angina is generally triggered by
physical or emotional stress.

The pain usually goes away within minutes after stopping the stressful activity. In
some people, especially women, this pain may be fleeting or sharp and felt in the
neck, arm or back.

 Shortness of breath. If your heart can't pump enough blood to meet your body's needs,
you may develop shortness of breath or extreme fatigue with exertion.

 Heart attack. A completely blocked coronary artery will cause a heart attack. The
classic signs and symptoms of a heart attack include crushing pressure in your
chest and pain in your shoulder or arm, sometimes with shortness of breath and
sweating.

Women are somewhat more likely than men are to experience less typical signs
and symptoms of a heart attack, such as neck or jaw pain. Sometimes a heart
attack occurs without any apparent signs or symptoms.

When to see a doctor

If you suspect you're having a heart attack, immediately call 911 or your local
emergency number. If you don't have access to emergency medical services, have
someone drive you to the nearest hospital. Drive yourself only as a last resort.

If you have risk factors for coronary artery disease — such as high blood pressure, high
cholesterol, tobacco use, diabetes, a strong family history of heart disease or obesity —
talk to your doctor. He or she may want to test you for the condition, especially if you
have signs or symptoms of narrowed arteries.

Request an Appointment at Mayo Clinic

Causes

Development of atherosclerosis
Coronary artery disease is thought to begin with damage or injury to the inner layer of a
coronary artery, sometimes as early as childhood. The damage may be caused by
various factors, including:

 Smoking

 High blood pressure

 High cholesterol

 Diabetes or insulin resistance

 Sedentary lifestyle

Once the inner wall of an artery is damaged, fatty deposits (plaque) made of cholesterol
and other cellular waste products tend to accumulate at the site of injury in a process
called atherosclerosis. If the surface of the plaque breaks or ruptures, blood cells called
platelets will clump at the site to try to repair the artery. This clump can block the artery,
leading to a heart attack.

Risk factors

Risk factors for coronary artery disease include:

 Age. Simply getting older increases your risk of damaged and narrowed arteries.

 Sex. Men are generally at greater risk of coronary artery disease. However, the risk for
women increases after menopause.

 Family history. A family history of heart disease is associated with a higher risk of
coronary artery disease, especially if a close relative developed heart disease at an early
age. Your risk is highest if your father or a brother was diagnosed with heart disease
before age 55 or if your mother or a sister developed it before age 65.

 Smoking. People who smoke have a significantly increased risk of heart disease.
Exposing others to your secondhand smoke also increases their risk of coronary artery
disease.

 High blood pressure. Uncontrolled high blood pressure can result in hardening and
thickening of your arteries, narrowing the channel through which blood can flow.
  High blood cholesterol levels. High levels of cholesterol in your blood can increase the
risk of formation of plaque and atherosclerosis. High cholesterol can be caused by a high
level of low-density lipoprotein (LDL) cholesterol, known as the "bad" cholesterol. A low
level of high-density lipoprotein (HDL) cholesterol, known as the "good" cholesterol, can
also contribute to the development of atherosclerosis.

 Diabetes. Diabetes is associated with an increased risk of coronary artery disease. Type 2
diabetes and coronary artery disease share similar risk factors, such as obesity and high
blood pressure.

 Overweight or obesity. Excess weight typically worsens other risk factors.

 Physical inactivity. Lack of exercise also is associated with coronary artery disease and
some of its risk factors, as well.

 High stress. Unrelieved stress in your life may damage your arteries as well as worsen
other risk factors for coronary artery disease.

 Unhealthy diet. Eating too much food that has high amounts of saturated fat, trans fat,
salt and sugar can increase your risk of coronary artery disease.

Risk factors often occur in clusters and may build on one another, such as obesity
leading to type 2 diabetes and high blood pressure. When grouped together, certain risk
factors put you at an even greater risk of coronary artery disease. For example,
metabolic syndrome — a cluster of conditions that includes elevated blood pressure,
high triglycerides, low HDL, or "good," cholesterol, elevated insulin levels and excess
body fat around the waist — increases the risk of coronary artery disease.

Sometimes coronary artery disease develops without any classic risk factors.
Researchers are studying other possible factors, including:

 Sleep apnea. This disorder causes you to repeatedly stop and start breathing while you're
sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase
blood pressure and strain the cardiovascular system, possibly leading to coronary artery
disease.

 High sensitivity C-reactive protein. High sensitivity C-reactive protein (hs-CRP) is a

normal protein that appears in higher amounts when there's inflammation somewhere in
your body. High hs-CRP levels may be a risk factor for heart disease. It's thought that as
coronary arteries narrow, you'll have more hs-CRP in your blood.
  High triglycerides. This is a type of fat (lipid) in your blood. High levels may raise the risk
of coronary artery disease, especially for women.

 Homocysteine. Homocysteine is an amino acid your body uses to make protein and to
build and maintain tissue. But high levels of homocysteine may increase your risk of
coronary artery disease.

 Preeclampsia. This condition that can develop in women during pregnancy causes high
blood pressure and a higher amount of protein in urine. It can lead to a higher risk of heart
disease later in life.

 Alcohol use. Heavy alcohol use can lead to heart muscle damage. It can also worsen
other risk factors of coronary artery disease.

 Autoimmune diseases. Conditions such as rheumatoid arthritis and lupus (and other
inflammatory rheumatologic conditions) have an increased risk of atherosclerosis.

Complications

Coronary artery disease can lead to:

 Chest pain (angina). When your coronary arteries narrow, your heart may not receive
enough blood when demand is greatest — particularly during physical activity. This can
cause chest pain (angina) or shortness of breath.

 Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage
of your heart artery may trigger a heart attack. The lack of blood flow to your heart may
damage your heart muscle. The amount of damage depends in part on how quickly you
receive treatment.

 Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients
because of reduced blood flow, or if your heart has been damaged by a heart attack, your
heart may become too weak to pump enough blood to meet your body's needs. This
condition is known as heart failure.

 Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage
to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart
rhythms.
Prevention

The same lifestyle habits that can help treat coronary artery disease can also help
prevent it from developing in the first place. Leading a healthy lifestyle can help keep
your arteries strong and clear of plaque. To improve your heart health, you can:

 Quit smoking

 Control conditions such as high blood pressure, high cholesterol and diabetes

 Stay physically active

 Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains

 Maintain a healthy weight

 Reduce and manage stress

 CAD happens when the arteries that supply blood to heart muscle become hardened and
narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their
inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through
the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can
lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood
clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.
 Over time, CAD can also weaken the heart muscle and contribute to heart
failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the
body. Arrhythmias are changes in the normal beating rhythm of the heart.

Overview
Coronary artery disease (CAD) causes impaired blood flow in the arteries that
supply blood to the heart. Also called coronary heart disease (CHD), CAD is
the most common form of heart disease and affects approximately 16.5
million Americans over the age of 20.

It’s also the leading cause of death for both men and women in the United
States. It’s estimated that every 40 seconds, someone in the United States has
a heart attack.

A heart attack can come from uncontrolled CAD.

Causes of coronary artery disease
The most common cause of CAD is vascular injury with cholesterol plaque
buildup in the arteries, known as atherosclerosis. Reduced blood flow occurs
when one or more of these arteries becomes partially or completely blocked.

The four primary coronary arteries are located on the surface of the heart:

 right main coronary artery

 left main coronary artery

 left circumflex artery

 left anterior descending artery

These arteries bring oxygen and nutrient-rich blood to your heart. Your heart is
a muscle that’s responsible for pumping blood throughout your body.
According to the Cleveland Clinic, a healthy heart moves approximately 3,000
gallons of blood through your body every day.

Like any other organ or muscle, your heart must receive an adequate,
dependable supply of blood in order to carry out its work. Reduced blood flow
to your heart can cause symptoms of CAD.

Other rare causes of damage or blockage to a coronary artery also limit blood
flow to the heart.

Symptoms of CAD
When your heart doesn’t get enough arterial blood, you may experience a
variety of symptoms. Angina (chest discomfort) is the most common symptom
of CAD. Some people describe this discomfort as:
  chest pain

 heaviness
 tightness
 burning
 squeezing

These symptoms can also be mistaken for heartburn or indigestion.

Other symptoms of CAD include:

 pain in the arms or shoulders

 shortness of breath

 sweating
 dizziness

You may experience more symptoms when your blood flow is more restricted. If
a blockage cuts off blood flow completely or almost completely, your heart
muscle will start to die if not restored. This is a heart attack.

Don’t ignore any of these symptoms, especially if they are excruciating or last
longer than five minutes. Immediate medical treatment is necessary.

Symptoms of CAD for women

Women may also experience the above symptoms, but they’re also more
likely to have:

 nausea

 vomiting
 back pain
  jaw pain

 shortness of breath without feeling chest pain

Men have a higher risk of developing heart disease

than premenopausal women. Postmenopausal women by age 70 have the same
risk as men.

Due to decreased blood flow, your heart may also:

 become weak
 develop abnormal heart rhythms (arrhythmia) or rates
 fail to pump as much blood as your body needs

Your doctor will detect these heart abnormalities during diagnosis.

Risk factors for CAD

Understanding the risk factors for CAD can help with your plan to prevent or
decrease the likelihood of developing the disease.

Risk factors include:

 high blood pressure

 high blood cholesterol levels

 tobacco smoking
 insulin resistance/hyperglycemia/diabetes mellitus
 obesity

 inactivity
 unhealthy eating habits
  obstructive sleep apnea

 emotional stress
 excessive alcohol consumption
 history of preeclampsia during pregnancy

The risk for CAD also increases with age. Based on age alone as a risk factor,
men have a greater risk for the disease beginning at age 45 and women have
a greater risk beginning at age 55. The risk for coronary artery disease is also
higher if you have a family history of the disease.

Diagnosing CAD
Diagnosing CAD requires a review of your medical history, a physical
examination, and other medical testing. These tests include:

 Electrocardiogram: This test monitors electrical signals that travel

through your heart. It may help your doctor determine whether you’ve
had a heart attack.

 Echocardiogram: This imaging test uses ultrasound waves to create a

picture of your heart. The results of this test reveal whether certain
things in your heart are functioning properly.

 Stress test: This particular test measures the stress on your heart
during physical activity and while at rest. The test monitors your heart’s
electrical activity while you walk on a treadmill or ride a stationary bike.
Nuclear imaging may also be performed for a portion of this test. For
those unable to perform physical exercise, certain medications can be
used instead for stress testing.

 Cardiac catheterization (left heart catheterization): During this

procedure, your doctor injects a special dye into your coronary arteries
 through a catheter inserted through an artery in your groin or forearm.
The dye helps enhance the radiographic image of your coronary arteries
to identify any blockages.

 Heart CT scan: Your doctor may use this imaging test to check for
calcium deposits in your arteries.

What is the treatment for CAD?

It’s important to reduce or control your risk factors and seek treatment to lower
the chance of a heart attack or stroke, if you’re diagnosed with
CAD. Treatment also depends on your current health condition, risk factors,
and overall wellbeing. For example, your doctor may
prescribe medication therapy to treat high cholesterol or high blood pressure, or
you may receive medication to control blood sugar if you have diabetes.

Lifestyle changes can also reduce your risk of heart disease and stroke. For
example:

 quit smoking tobacco

 reduce or stop your consumption of alcohol

 exercise regularly

 lose weight to a healthy level

 eat a healthy diet (low in fat, low in sodium)

If your condition doesn’t improve with lifestyle changes and medication, your
doctor may recommend a procedure to increase blood flow to your heart.
These procedures may be:
  balloon angioplasty: to widen blocked arteries and smoosh down the
plaque buildup, usually performed with insertion of a stent to help keep
the lumen open after the procedure

 coronary artery bypass graft surgery: to restore blood flow to the

heart in open chest surgery

 enhanced external counterpulsation: to stimulate the formation of

new small blood vessels to naturally bypass clogged arteries in a
noninvasive procedure

What is the outlook for CAD?

Everyone’s outlook for CAD is different. You have better chances of
preventing extensive damage to your heart the earlier you can start your
treatment or implement lifestyle changes.

It is important to follow your doctor’s instructions. Take medications as

directed and make the recommended lifestyle changes. If you have a higher
risk for CAD, you can help to prevent the disease by reducing your risk factors.

Physical activity or exercise can improve your health and reduce the risk of developing several
diseases like type 2 diabetes, cancer and cardiovascular disease. Physical activity and exercise
can have immediate and long-term health benefits. Most importantly, regular activity can
improve your quality of life. A minimum of 30 minutes a day can allow you to enjoy these
benefits.

Benefits of regular physical activity

If you are regularly physically active, you may:

 reduce your risk of a heart attack
 manage your weight better
 have a lower blood cholesterol level
 lower the risk of type 2 diabetes and some cancers
 have lower blood pressure
 have stronger bones, muscles and joints and lower risk of developing osteoporosis
 lower your risk of falls
 recover better from periods of hospitalisation or bed rest
 feel better – with more energy, a better mood, feel more relaxed and sleep better.

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A healthier state of mind

A number of studies have found that exercise helps depression. There are many views
as to how exercise helps people with depression:
 Exercise may block negative thoughts or distract you from daily worries.
 Exercising with others provides an opportunity for increased social contact.
 Increased fitness may lift your mood and improve your sleep patterns.
 Exercise may also change levels of chemicals in your brain, such as serotonin, endorphins and
stress hormones.

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Aim for at least 30 minutes a day

To maintain health and reduce your risk of health problems, health professionals and
researchers recommend a minimum of 30 minutes of moderate-intensity physical
activity on most, preferably all, days.
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Physical activity guidelines

Australia’s physical activity and sedentary behaviour guidelines state that:

 Doing any physical activity is better than doing none. If you currently do no physical activity,
start by doing some, and gradually build up to the recommended amount.
 Be active on most, preferably all, days every week.
 Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to
150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent
combination of both moderate and vigorous activities, each week.
 Do muscle strengthening activities on at least two days each week.
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Ways to increase physical activity

Increases in daily activity can come from small changes made throughout your day,
such as walking or cycling instead of using the car, getting off a tram, train or bus a stop
earlier and walking the rest of the way, or walking the children to school.
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Do we really need to take 10,000 steps a day?

Regular walking produces many health benefits, including reducing our risk of heart
disease, type 2 diabetes and depression. We often hear 10,000 as the golden number
of steps to strive for in a day.

Do we really need to take 10,000 steps a day?

See your doctor first

It is a good idea to see your doctor before starting your physical activity program if:
 you are aged over 45 years
 physical activity causes pain in your chest
 you often faint or have spells of severe dizziness
 moderate physical activity makes you very breathless
 you are at a higher risk of heart disease
 you think you might have heart disease or you have heart problems
 you are pregnant.

Pre-exercise screening is used to identify people with medical conditions that may put
them at a higher risk of experiencing a health problem during physical activity. It is a
filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks
for you.

Print a copy of the adult pre-exercise screening tool (pdf) and discuss it with your
doctor, allied health or exercise professional.

Where to get help

 Your GP (doctor)
 Registered exercise professional
 Fitness Australia Tel. 1300 211 311
 Exercise physiologist
 Physiotherapist
 Prevent and better control some risk factors for heart disease: blood cholesterol,
diabetes and hypertension.
 Improve muscle and bone health (osteoporosis prevention)
 Improve sleep.
 Control weight.
 It Can Make You Feel Happier. ...
 It Can Help With Weight Loss. ...
 It Is Good for Your Muscles and Bones. ...
 It Can Increase Your Energy Levels. ...
 It Can Reduce Your Risk of Chronic Disease. ...
 It Can Help Skin Health. ...
 It Can Help Your Brain Health and Memory.
Being physically active means you:

 Have more vitality

 Are in better shape
 Have better mental health
 Can manage stress better
 Have more self esteem
Physical activity helps:
 Prevent and better control some risk factors for heart disease: blood cholesterol, diabetes and hypertension
 Improve muscle and bone health (osteoporosis prevention)
 Improve sleep
 Control weight