Coronary Artery Disease

Coronary artery disease (CAD), also known as ischemic heart disease, occurs when blood flow is obstructed due to narrowing of the arteries. The narrowing is caused by a buildup of plaque (a sticky substance made of cholesterol, fat, calcium, and other materials). The restriction of blood flow should not be overlooked, as it can come with serious, life-threatening issues such as chest pain, heart failure, and arrhythmias. In addition, CAD is known as a “silent killer,” meaning you may be asymptomatic and unaware you are suffering from it. Leaving CAD unaddressed can cause serious complications in the future.

Buildup of plaque in the arteries is known as atherosclerosis. This is the most common cause of coronary artery disease. When plaque buildup narrows the arteries, blood flow is restricted to the heart, making the risk for cardiovascular issues high. Also plaque can rupture, leading to blood clots forming over the bursted area of plaque which can cause complete blockage of the arteries, a condition called myocardial infarction or a “heart attack.” Blockages in arteries in other areas of the body can cause stroke, vascular dementia, erectile dysfunction, or limb loss. 

There are many risk factors for plaque buildup / atherosclerosis. These include high cholesterol levels, high blood pressure, diabetes, smoking, obesity, stress, and family history of heart disease. The risk of CAD increases with age. 

There are many symptoms of coronary artery disease, and these symptoms occur on a spectrum: some people may have no symptoms, others may have chest pain with exercise or in more severe cases, chest pain at rest. Detecting CAD can be difficult when symptoms appear subtly. However, symptoms become more noticeable as the coronary arteries continue to narrow. Typically, symptoms include chest pain, shortness of breath, fatigue, indigestion, heart palpitations, and swelling of the hands and feet. When patients experience these symptoms, receiving a diagnosis is critical. Physical exams can assess blood pressure and other vital signs. Tests such as electrocardiogram (ECG or EKG), stress tests, coronary calcium scans, MRIs, or blood tests can be performed to confirm the diagnosis. In addition, lifestyle factors such as previous medical conditions, family history, or current symptoms of an individual may be assessed. Early detection of CAD is critical to prevent potentially life threatening complications.

There are many treatment options for CAD to prevent the progression of atherosclerosis. The first line treatment is lifestyle changes (such as improving diet and exercise regimens, quitting smoking, and getting rid of stress). One study at Johns Hopkins found that amongst patients with CAD, those with higher fitness levels have 75% lower risk of death than those who have lower fitness levels. Medications also can help decrease risk of acute coronary syndrome or stroke. 

Despite the various symptoms that can occur in some patients with CAD, a myocardial infarction or MI (commonly known as heart attack) may be the first sign for some people. When patients have an MI, treatment options include stenting or coronary bypass grafting surgery (CABG). Patients who undergo stenting procedures often have to be on lifelong antiplatelet therapy with medications like aspirin. In the short term, cardiac rehabilitation is helpful for patients recovering from CABG. Cardiac rehabilitation is a supervised program that includes physical activity, education about healthy living, and counseling to find ways to relieve stress and improve mental health. 

It is important to seek a medical professional if you suspect you have coronary artery disease or it runs in your family. Early detection can help CAD treatment options be more effective, ensuring that the plaque buildup doesn’t progress. Coronary artery disease can be stressful, but it is crucial to take care of your physical and mental health through it all. Don’t be afraid to reach out to a doctor or a medical professional for guidance and support through this disease. Furthermore, a support group could immensely help, as talking to others who understand what you're going through may provide some tips or extra knowledge about CAD.

Written by Jordyn Poplawski

Edited by Mallory Kane MD 

References

U.S. Department of Health and Human Services. (n.d.). What is atherosclerosis?. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/atherosclerosis 

Professional, C. C. medical. (2024, May 1). What is oxidative stress?. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/oxidative-stress 

Mayo Foundation for Medical Education and Research. (2024, June 14). Coronary artery disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613 

Coronary artery disease: Prevention, treatment and research. Johns Hopkins Medicine. (2023, October 30). https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronary-artery-disease-prevention-treatment-and-research