About Coronary Artery Disease

A blocked coronary artery can result in a heart attack. For both men and women, coronary artery disease is one of the leading causes of death in Canada.

Definition

Coronary artery disease (CAD) is a heart disease that causes an inadequate supply of blood to the heart muscle – a potentially damaging condition. Coronary artery disease is also referred to as coronary heart disease (CHD).

Cause

Coronary artery disease is caused by a buildup of fatty, waxy deposits on the inside of your arteries. These deposits are made up of cholesterol, calcium, and other substances in the blood. This buildup is called "atherosclerotic plaque" or simply "plaque." Plaque deposits can clog the coronary arteries and make them stiff and irregular. This is called "hardening of the arteries."

There can be a single blockage or multiple blockages, and they can vary in severity and location. These deposits slowly narrow the coronary arteries, causing your heart to receive less blood and oxygen. This decrease in blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage can cause a heart attack.

Symptoms

Because coronary artery disease (clogged arteries) can develop over many years, symptoms are often not felt until blockages are severe and life-threatening. You may first notice symptoms when your heart is working harder than usual, such as during exercise. However, these symptoms can also occur when you are resting and no activity is occurring.

Symptoms of coronary artery disease differ from person to person, but typical symptoms include:

• Chest discomfort or pain (angina)
• Shortness of breath
• Extreme fatigue with exertion
• Swelling in your feet
• Pain in your shoulder or arm
• Women may have atypical chest pain. It may be fleeting or sharp and noticed in the abdomen, back, or arm.

Women are somewhat more likely than men to experience other warning signs of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.

Talk to your doctor if you think you have symptoms of coronary artery disease. If you think you might be having a heart attack, seek immediate medical attention.

Risk Factors

Some hardening of the arteries occurs as a person grows older. However, certain risk factors can accelerate the process:

• Age (over age 45 for men, and over age 55 for women)
• Family history of heart disease
• Smoking
• High blood pressure
• High LDL "bad" cholesterol and low HDL "good" cholesterol
• Certain diseases, such as diabetes
• Being overweight or obese
• Lack of exercise
• Certain types of radiation therapy to the chest
• Stress

Men are at a higher risk of coronary artery disease than are women. A woman's risk increases after menopause. 

Diagnosis

If your doctor suspects you have coronary artery disease, he or she can refer you to a cardiologist that specialises in problems of the heart, arteries and veins.

When making a diagnosis, your doctor will ask about your symptoms, medical history and risk factors. Based on this information, your doctor may give you tests to see how healthy your arteries are. The most common tests include:

• Electrocardiogram (ECG or EKG)
• Echocardiogram (ECHO)
• Stress test
• Nuclear heart scan/nuclear stress test
• Electron beam computerised tomography (EBCT)
• Magnetic resonance angiography (MRA)
• Angiography
• Intravascular ultrasound (IVUS)
• X-ray
• Blood tests
• CT Angiography

Next: Managing Coronary Artery Disease