Coronary Heart Disease

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

When plaques build up, they narrow 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, it can go unnoticed until you have a heart attack. But there's plenty you can do to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.

Tests and diagnosis

The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:

  • Electrocardiogram (ECG).An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress.

In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.

  • Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
  • Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise.

Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.

Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. Trace amounts of radioactive material such as thallium are injected into your bloodstream. Special cameras can detect areas in your heart that receive less blood flow.

  • Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor may inject a special dye into your arteries (intravenously). This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart.

This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.

  • Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.

  • Magnetic resonance angiography (MRA). This procedure uses MRI technology, often combined with an injected contrast dye, to check for areas of narrowing or blockages — although the details may not be as clear as those provided by coronary catheterization.

Treatments and drugs

Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

Lifestyle changes

Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:

  • Quit smoking.
  • Eat healthy foods.
  • Exercise regularly.
  • Lose excess weight.
  • Reduce stress.

Drugs

Various drugs can be used to treat coronary artery disease, including:

  • Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
  • Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin.
  • Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
  • Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks.

Procedures to restore and improve blood flow

Sometimes more aggressive treatment is needed. Here are some options:

  • Angioplasty and stent placement (percutaneous coronary revascularization). Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls.

A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.

  • Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.