Coronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD) is blockage of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In a severe case, the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI).

Coronary artery disease is the most common form of heart disease. It is the leading cause of death worldwide.

Coronary Artery Disease

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Causes include:

• Thickening of the walls of the arteries that feed the heart muscle
• Build up of fatty plaques within the coronary arteries
• Sudden spasm of a coronary artery
• Narrowing of the coronary arteries
• Inflammation within the coronary arteries
• Development of a blood clot within the coronary arteries that blocks blood flow

Major risk factors include:

• Sex: male—men have a greater risk of heart attack than women
• Age: 45 and older for men, 55 and older for women
• Heredity: strong family history of heart disease
• Obesity and being overweight
• Smoking
• High blood pressure
• Inactive lifestyle
• High cholesterol, specifically, high LDL cholesterol and low HDL cholesterol
• Diabetes
• Metabolic syndrome —a combination of high blood pressure, abdominal obesity, and insulin resistance

Other risk factors may include:

• Stress
• Excessive alcohol use
• Depression
• A diet that is high in saturated fat, trans fat, cholesterol, and/or calories—Drinking sugary beverages on a regular basis may increase your risk of CAD.

CAD may progress without any symptoms.

Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:

• Exercise or exertion
• Emotional stress
• Cold weather
• A large meal

Chest pain may indicate more serious unstable angina or a heart attack if it includes the following:

• It is unrelieved by rest or nitroglycerin
• Severe angina
• Angina that begins at rest
• Angina that lasts more than 15 minutes

Accompanying symptoms may include:

• Shortness of breath
• Sweating
• Nausea
• Weakness

Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms. It is likely to start with shortness of breath and fatigue.

If you go to the emergency room with chest pain, some tests will be done right away. The tests will attempt to see if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• You may need to have your bodily fluids tested. This can be done with blood tests.
• You may need to have your heart function tested. This can be done with:
  • Electrocardiogram
  • Exercise stress test
  • Nuclear stress test
• You may need to have pictures taken of your heart. This can be done with:
  • Echocardiogram
  • Coronary calcium scoring—a type of x-ray called a CAT scan
  • Coronary angiography

To reduce your risk of getting coronary artery disease:

• Maintain a healthy weight.
• Eat a heart healthy diet that is low in saturated fat, red meat and processed meats, and rich in whole grains, fruits, and vegetables.
• Begin a safe exercise program with the advice of your doctor.
• If you smoke, quit.
• Treat your high blood pressure and/or diabetes.
• Treat high cholesterol or triglycerides.
• Ask your doctor about taking a low-dose aspirin every day.
• In certain patients, taking medication to treat high cholesterol may be another option. Talk to your doctor.
• Find ways to reduce stress.