About Coronary Artery Disease

A form of heart disease, coronary artery disease (CAD) is a condition where one or more of the larger arteries supplying blood to the heart become narrowed, limiting the amount of blood to the heart muscle. It often develops slowly over several years, and can lead to a heart attack, abnormal heart rhythm (arrhythmia), and heart failure. CAD is the most common form of heart disease and is a leading cause of death in the United States for both men and women.

Types of CAD

  • Acute Coronary Syndrome (ACS)

  • Chronic Total Occlusion (CTO)

  • Obstructive CAD

  • Non-Obstructive CAD

  • Spontaneous Coronary Artery Dissection (SCAD)

A sudden and emergency form of CAD. This happens when the blockage or plaque in your coronary artery suddenly ruptures and forms a blood clot that blocks blood flow to the heart. This abrupt blockage causes a heart attack.
A severe form of obstructive CAD, CTO is a condition that occurs with a complete or near complete blockage in an artery for an extended period (90 days or more).
Also called ischemic heart disease, obstructive CAD often develops slowly overtime due to atherosclerosis, the build of cholesterol and fats (called plaque) in and along blood vessel walls. When the vessel becomes so narrow that not enough blood is given to the heart muscle, a heart attack occurs.
This condition occurs when the narrowing of the arteries or blood vessels happens from a cause other than plaque buildup, like coronary vasospasm (blood vessel constrictions or tightening) or endothelial disfunction, damage to the blood vessel lining.
This condition occurs when the inner wall of the coronary artery tears away from the outer wall, blocking blood flow to the heart. This condition often causes sudden heart attack symptoms and is typically considered a life-threatening emergency.

Symptoms

CAD can cause symptoms when the heart muscle cannot get enough blood due to blockages. Symptoms may be subtle or hard to recognize and may first begin when the heart is working hard, like during physical activity and exercise. Symptoms can include:

  • Chest discomfort or pain (angina), often brought on by activity that subsides with rest
  • Shortness of breath with exertion (activity)
  • A squeezing or pinching sensation in the chest
  • Fatigue
  • Sluggishness
  • Shortness of breath
  • A heart attack

If you experience chest pain along with pain in the arm, jaw, or below the breastbone, accompanied by sweating, nausea, or severe shortness of breath, you might be having a heart attack. Call 911 immediately.

Causes and Risk Factors

The causes of CAD can vary by the type diagnosed, but generally CAD is caused by:

  • Blockages in the arteries or blood vessels caused by the buildup of fat and cholesterol (plaque) within blood vessels
  • Damage to the inner lining of a blood vessel around the heart
  • Tightening or constriction of blood vessel around the heart
  • Microvascular dysfunction of the smaller blood vessels connected to the larger coronary arteries around the heart
  • Pressure affecting the blood vessel from close or adjacent heart muscle

SCAD can be caused by extreme physical or emotional stress, childbirth, high blood pressure, and certain genetic conditions.

The most common risk factors for developing CAD are:

  • A family history of heart disease
  • Having high LDL cholesterol or low HDL cholesterol
  • Being overweight or obese
  • Being over the age of 45 for men and the age of 55 for women
  • Living a sedentary lifestyle
  • High blood pressure
  • Unhealthy diet
  • Smoking tobacco or using nicotine products
  • Drinking alcohol in excess

CAD can be caused by various factors, including environmental and socioeconomic elements, but genetics also play a role. Recent studies suggest that 40-60% of CAD risk may be inherited. Researchers have found roughly 60 gene variants linked to the risk of developing CAD, though more research is needed to understand the role of genetics in CAD.

Diagnosing Coronary Artery Disease

To determine if you might be at risk for coronary artery disease, talk to your primary care doctor about your family and personal health history. They will do a physical exam and may order blood tests. If you are at risk or have symptoms, your doctor might refer you to a cardiologist.

For diagnosing CAD, your primary care doctor or cardiologist may suggest additional diagnostic tests, including:

  • Diagnostic Cardiac Catheterization

  • Cardiac CT Scan

  • Echocardiogram

  • Electrocardiogram

  • Exercise Stress Test

  • Nuclear Stress Test

  • Pharmacologic Stress Test

This procedure allows your cardiologist to test pressures inside your heart and look at how the coronary arteries are functioning. To view the arteries, a specialized cardiologist uses an imaging process called coronary angiography where contrast material and x-rays are used to see and photograph areas of the heart’s blood vessels as the contrast moves through. If needed, your cardiologist can also take a biopsy through the catheter as well.
Also referred to as coronary calcium scan, this non-invasive test uses x-rays from a CT scanner to show calcium and plaque buildup in your coronary arteries, that can narrow the arteries. Cardiac CT scans can be scheduled at a BayCare Imaging Center.
This non-invasive test/imaging study uses sound waves to produce images of the heart's chambers, valves and walls. It helps to show the heart’s overall function and structure. Echocardiograms can be scheduled at a BayCare Imaging Center.
Also referred to as an ECG or EKG, these non-invasive tests measure the heart's electrical activity and helps to show any heart rhythm (arrhythmias) issues and/or heart muscle damage. These tests are often performed in your cardiologist's office.
This test involves exercising on a treadmill, while being closely monitored, to see how well the heart is working. This test measures the heart's response to stress or exercise and can detect any coronary blockages. Stress tests can be performed at the following BayCare hospitals:
This version of a stress test involves the elements of a regular stress test but adds taking special images of the heart. A nuclear tracer is given through an IV and a special camera takes images of the heart as the tracer moves through it before and after exercise is completed. Nuclear stress tests can be performed by the following BayCare hospitals:
In this version of a stress test, instead of using exercise to test your heart, medication is given to increase your heart rate. Pharmacologic stress tests are performed under the close supervision of a medical team at these BayCare locations:

Treatment Options

Treatment options for CAD may vary but include medications, lifestyle changes, minimally invasive procedures and surgery.

  • Lifestyle Changes

  • Medications

  • Percutaneous Coronary Intervention

  • Intravascular Brachytherapy

  • Coronary Intravascular Lithotripsy

  • Atherectomy

  • Coronary Artery Bypass Grafting

Your doctor may suggest changes to your lifestyle that can help you manage CAD, such as:

  • Eating a heart-healthy diet. Your doctor may give you more information about what foods to eat and what to avoid, such as those high in fats, cholesterol or salt (sodium).
  • Becoming more physically active and having an exercise routine. Always talk with your doctor before you start a new exercise.
  • Quit smoking. Smoking is a major cause of CAD and other forms of heart disease.
  • Losing weight or maintaining a healthy weight.
  • Avoiding alcohol.
  • Getting enough rest and sleep.

Different medications can be used to treat CAD symptoms, and they are usually prescribed or managed by a cardiologist:

  • Aspirin: This common medication helps thin the blood and prevent blood clots. It can be used alone or in combination with other medications.
  • Angiotensin-Converting Enzyme (ACE) Inhibitors: Drugs that prevent your body from changing the angiotensin hormone to angiotensin II and work by blocking the renin-angiotensin-aldosterone system (RAAS) to create a “widening” or dilating effect on blood vessels. ARC inhibitors may be used if CAD patients have additional conditions such as heart failure, diabetes or kidney disease. 
  • Angiotensin II Receptor Blockers (ARBs): For someone with CAD whose blood vessels already have narrowing, this medication works to prevent narrowing the blood vessels as well as keeping salt and fluid from building up in the body. These are often used as an alternative to ACE inhibitors.
  • Beta Blockers: Drugs that can help widen the blood vessels and help the heart beat slower.
  • Calcium Channel Blockers: Medications that block calcium to relax the muscles in the blood vessels.
  • Cholesterol lowering medications: These drugs are used to lower LDL cholesterol, preventing it from building up and forming plaque in the blood vessels.
  • Nitroglycerin: This medication relaxes and widens blood vessels. It’s often prescribed to help relieve or prevent chest pain for non-obstructive CAD.
Commonly known as angioplasty, percutaneous coronary intervention (PCI) is a minimally invasive procedure used to open blocked or narrowed heart arteries and restore blood flow to the heart. During the procedure, a catheter is inserted into the blocked artery. An interventional cardiologist uses the catheter to place a balloon or an intracoronary stent to widen the artery. Many of our BayCare Hospitals perform PCI procedures:

PCI for Chronic Coronary Total Occlusion (CTO): BayCare has specialists skilled in performing PCI for CTOs. This treatment is available at the following BayCare locations:

For people who have previously undergone PCI to clear a blocked blood vessel, a small percentage may experience "restenosis," where the vessel or stent begins to narrow again. This additional narrowing is often due to the formation of scar tissue. In such cases, IVBT may be considered as an additional treatment option. IVBT is a specialized procedure in which an interventional cardiologist, a radiation oncologist, and a radiation physicist collaborate to deliver targeted radiation through a catheter to the area of restenosis (re-narrowing). This radiation helps to inhibit the growth of scar tissue. IVBT is performed at the below BayCare location:

A coronary IVL procedure uses soundwaves to help break up calcium in narrowed or blocked blood vessels. A special catheter with a saline-filled balloon is inserted, and sonic sound waves are emitted to break up the calcium. This procedure can be performed on its own or alongside a PCI stenting procedure. Coronary IVL is performed at the below BayCare locations:

Atherectomy is a catheter-based procedure used to open blocked or narrowed blood vessels by removing the plaque buildup with special cutting devices or lasers. This minimally invasive procedure is available at the following BayCare Locations:

Coronary artery bypass grafting (CABG) is a type of open-heart surgery that improves blood flow to the heart by redirecting blood flow around the blocked or narrowed coronary arteries that supply blood to the heart. CABG is the most common form of open-heart surgery. BayCare has three top-rated, high quality open-heart surgery programs at the following locations:

Living With CAD

CAD is the most common type of heart disease, with an estimated 18 million Americans living with it. If you're diagnosed with CAD, it’s important to take an active role in your heart health. Talk with your primary care doctor or cardiologist about things you can do to make living with CAD easier, such as:

  • Watch your cholesterol levels: Talk with your doctor about routine cholesterol blood testing and taking lifestyle or medication steps to lower your cholesterol if needed.
  • Check your blood pressure often: High blood pressure (hypertension) can cause damage to your blood vessels and increase risks for a heart attack or stroke for those with CAD.
  • Take your medications as prescribed: Follow your doctor's instructions for any medications, including over-the-counter ones like aspirin. If you have questions, talk to your doctor regularly.
  • Track your symptoms: If you have symptoms, keep a record of when your symptoms appear and share them with your doctor. This can help you and your doctor design a better treatment plan for you.

Additional Resources

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BayCare HealthChat

What You Need to Know About Coronary Artery Disease (CAD)
April 14, 2021

Coronary artery disease (CAD), a narrowing of one or more arteries that supply blood to the heart, is a leading cause of death for men and women in the United States. In this podcast, interventional cardiologist Dr. Laura Mosher explains the risk factors and symptoms for CAD, how it is diagnosed and treatment options.Learn more about BayCare's heart and vascular services

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BayCare HealthChat

Coronary Artery Disease (CAD) Testing
October 13, 2021

Dr. Piyush Sovani explains coronary artery disease (CAD), including symptoms and who is at risk, preventative testing and understanding what the test results mean.

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