Coronary artery disease (CAD), also known as coronary heart disease, is a condition in which the coronary arteries become obstructed by a build-up of plaque. Plaque is composed of cholesterol, fat, calcium, and other materials. When plaque accumulates in blood vessels, it is called atherosclerosis, and when atherosclerosis occurs in the coronary arteries, it is called coronary artery disease. Across the globe, CAD is a leading cause of death.
An artery is a blood vessel that transports blood away from the internal chambers of the heart, either to feed oxygenated blood to the tissues of the body or to pick up oxygen from the lungs. The coronary arteries run along the surface of the heart and feed oxygenated blood to the tissue of the heart. These vessels are elastic and allow blood to pass easily, if unobstructed. When plaque accumulates, however, the flow of oxygen rich blood may be blocked, which can cause angina or a heart attack.
Angina is the chest pain and pressure that occurs when a partial block of the blood vessel prevents enough oxygenated blood from reaching the heart muscle. Shoulder, neck, and jaw may also be experienced. A heart attack occurs when the coronary arteries are entirely blocked, causing a portion of the heart muscle to suffer damage or die. A heart attack presents with shortness of breath, nausea, and pain and pressure in the chest, as well as the neck, arms, back, and stomach.
Often, heart attacks occur due to a rupture of the plaque deposit that causes clotting agents known as platelets to rush to the site in an effort to repair the vessel. This causes further obstruction of the vessel. Coronary artery disease may also cause arrhythmia, an irregular beating of the heart, or heart failure.
Damage to the blood vessels is thought to be the major contributor to the development of coronary artery disease. Common causes of vessel damage are smoking, high cholesterol diets, diabetes, high stress levels, and radiation. Cellular waste, cholesterol, and fats then sticks to the damaged vessel, creating plaque.
Several factors can increase chances of coronary artery disease, including gender, age, obesity, high blood pressure, and family history. Males are more likely to develop coronary artery disease than females and older patients are much more prone to develop CAD than younger patients. A family history especially increases a patient’s risk if the patient’s family member developed CAD before age sixty. It is important to be aware of these risk factors, because CAD can go undiagnosed and unnoticed for long periods of time.
Coronary artery disease may be treated with lifestyle changes, medications, surgery, or a combination of these approaches. Doctors usually recommend lowering stress, a healthy diet, exercise, weight loss, and quitting smoking, if applicable. A doctor may also prescribe several types of drugs, including drugs to modify the amount of cholesterol in the blood so that there is a lower amount of bad cholesterol or a rise in good cholesterol. Other medications include blood thinners such as aspirin, beta blockers to decrease the heart’s need for oxygen, nitroglycerin tablets, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers.
In more severe cases, a doctor may need to try a surgical approach, such as angioplasty or coronary artery bypass. During an angioplasty, the surgeon inserts a balloon via a catheter into the blocked artery, inflates the balloon to compress the plaque and widen the vessel, and oftentimes implants a stent to hold the vessel open. During coronary artery bypass surgery, the surgeon grafts a vessel from another part of the body, typically the arm, leg or chest, so that blood can flow around the blocked artery.