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By Stephanie Trelogan, MS Reviewed by Christopher Friedrich, MD,PhD and Andy Avins, MD The coronary arteries serve as the main blood supply for the heart muscle, which requires oxygen and other nutrients in order to function. Coronary artery disease (CAD) occurs when these arteries become narrowed or clogged. When the heart doesn't get enough oxygen, the muscle becomes injured, which usually causes chest pain called angina. If untreated, CAD can progress to the point where the coronary arteries are completely blocked, cutting off the heart's blood supply. This is what is commonly known as a heart attack, or in medical terminology, a myocardial infarction. You may have encountered the term coronary heart disease (CHD), which occurs when CAD results in permanent damage to the heart muscle. CHD and CAD are often used interchangeably; here, we will use CAD as a blanket term for both conditions.
What Are Blood Vessels Made of? What Causes CAD? Signs and Symptoms Factors That Increase Risk Screening Treatment
What Are Blood Vessels Made of? Blood vessels are tubes that transport blood throughout the body. All blood vessels have an inner lining called the endothelium, which is surrounded by connective tissue and thin layers of muscle. Although these muscles are not under our voluntary control, they play an important role in determining blood pressure. The tone of these muscles can be affected in the short term by exertion or excitement, and in the long term by factors such as smoking and diabetes.
What Causes CAD? CAD is caused by a narrowing of coronary arteries, called atherosclerosis. Blood flow becomes more and more restricted as the artery continues to narrow. Most commonly, atherosclerosis results when cholesterol and fat circulating in the bloodstream build up on the artery walls. The triggering event is an injury to the artery's inner lining; the injury can be caused by high blood pressure,diabetes, or other causes. The body's immune systemresponds to the injury, causing inflammation. Immune cells called macrophages are activated and try to heal the injury. This process creates a plaque within the artery wall made up of low density lipoprotein (LDL cholesterol), other fats, and macrophages. Some plaques are hard; others have just a thin cap on top of a soft, fatty core. If the cap ruptures, the underlying core will be exposed to the blood, triggering the formation of a blood clot. If the blood clot is large enough, blood flow in the artery will be completely blocked. This is what causes a heart attack. Signs and Symptoms Symptoms of CAD can range widely, from no symptoms at all, to mild intermittent chest pain, to pronounced and steady pain. In some people, symptoms can be severe enough to hinder their normal daily activities. A person experiencing angina may feel heaviness, tightness, pain, burning, pressure,
or if you have ever had chest pain. if you experience these symptoms. stroke. or fatigue • Palpitations. Similarly. you can control it to some extent by exercising regularly and eating a diet low in cholesterol and saturated fat. sweating. you should consult your doctor for further evaluation. However. neck or arms • Chest discomfort with lightheadedness. For high blood pressure that doesn't respond to these measures. or paleness Not all patients experiencing these symptoms have CAD. medication can keep it within healthy limits. If your parents developed CAD before age 50. The good news is. Even if you are genetically predisposed to develop CAD. or goes away and comes back • Pain that spreads to the shoulders. or jaws. Most people develop CAD after the age of 45 (in men) or 55 (in women). These sensations are usually localized to the left side of the body. including: • Smoking. fainting. some people (especially diabetics) have heart attacks without ever experiencing any of these symptoms. The worst thing you can do for your heart is smoke. However. Angina is often accompanied by shortness of breath. you should begin cholesterol screening earlier. cold sweat. neck. . exercising regularly. or shortness of breath Less common warning signs include. The risk of heart attack is twice as high for smokers as for nonsmokers. the most common warning signs include: • Uncomfortable pressure. or pain in the center of the chest that lasts more than a few minutes. no matter how long or how much you've smoked. Often blood pressure can be kept under control by limiting salt intake.) Although there is nothing you can do to change your family history of CAD. weakness. usually behind the breastbone but sometimes also in the arms. • Any chest pain unlike the pain described above • Stomach or abdominal pain • Nausea or dizziness (without chest pain) • Shortness of breath and difficulty breathing (without chest pain) • Unexplained anxiety. Although there is a genetic component to how much cholesterol is in your blood. These symptoms are usually brought on by exertion and relieved by rest. squeezing. High blood pressure can also increase your risk for heart attack. According to the American Heart Association. • High blood pressure. or other vascular diseases. and smokers who suffer a heart attack are more likely to die within an hour of the attack. • High cholesterol levels.. heart attack. It's never too late to stop smoking. and maintaining a healthy weight. Higher cholesterol levels increase the risk of CAD because cholesterol builds up on artery walls. a healthy lifestyle may allow you to live to old age without ever experiencing symptoms. Nevertheless. your risk of CAD will rapidly decline as soon as you quit smoking. nausea. you can also take medications to help manage your cholesterol. and sometime by nausea and sweating. ( For news about environmental factors that increase risk. If necessary. see Related News below. avoiding excessive alcohol intake.or squeezing. Factors That Increase Risk Your risk of developing CAD is a factor of both your genesand your environment. Studies of identical twins have revealed just how important it is to consider both genes and environment when assessing your risk of developing CAD. your risk increases if you have a family member who had CAD before age 50. Adults over 35 years of age should have their cholesterol levels measured at least once every five years. just because there is no CAD in your family doesn't guarantee that you won't develop it yourself.. you can control your environmental (nongenetic) risk factors. fullness.
The history and physical exam are extremely sensitive and specific tests for determining whether symptoms are due to CAD. during. The dye is visible on the x-ray. CAD can often be managed with a number of lifestyle changes and medications. Areas with decreased blood flow will take up less radioactive material than areas with normal blood flow. or even how stress affects a person. • .. then your doctor may then use a combination of diagnostic procedures to measure the extent and severity of any CAD. may be required. and after exercise. The amount of nuclear material that is taken up by heart muscle is then recorded using a scanning camera. the other tests are usually performed first. research has indicated that managing stress may profoundly reduce the risk of CAD. Another type of stress test employs echocardiography during exercise to allow the doctor to visualize how the heart performs under stress. inadequate blood flow. A special dye is injected through this catheter and a series of x-rays are taken. You may want to pay special attention to genetic risk factors if: • Other people in your family have developed CAD early in life (i. and enlargement of the heart. Although these environmental risk factors increase every person's chance of developing CAD. Most doctors believe that high levels of stress can also increase the risk of CAD. An EKG can detect abnormal heart beats. see Related News below.e. • Diabetes. an EKG is recorded before. usually in the arm. • A stress test (also called a treadmill test) can be useful because some problems only show up when the heart is working hard and oxygen demands are higher. there is no one simple test for CAD. invasive interventions. A small amount of radioactive material is injected into a vein.) • An electrocardiogram (ECG or EKG) records the heart's electrical activity as it contracts and rests. promote injury to the inside of blood vessels. thin tube is inserted into a major artery in leg or arm and then threaded all the way into the coronary arteries. A long. People who are too heavy for their height more likely to develop CAD. both of which are CAD risk factors. before age 45 in men or before age 55 in women) • Multiple people in your family have or have had CAD A genetic syndrome or familial diagnosis has been identified in your family Screening Because symptoms can vary widely. This test allows doctors to see blockages in the coronary arteries. If the history and physical exam suggest CAD. In more severe cases. such as surgery or balloon angioplasty. High blood glucose can cause elevated levels of blood fats and cholesterol. • Cardiac catheterization (or coronary angiography) is the most definitive test for CAD. In a stress test. This is difficult to prove because there is no way to accurately measure how much stress a person has. But even after its onset. Diabetes can make CAD worse in many different ways. This is because extra weight increases blood pressure and cholesterol. However. so it is possible to determine if a blockage is present and how serious it is.Obesity and inactivity. Treatments Your best bet is to prevent CAD before it starts. Your doctor will always begin by taking a careful medical history and performing a thorough physical exam. they put you at particular risk if you also have family members with CAD. and to rule out other possible causes of symptoms. and affect the immune system. areas of heart muscle damage. (For recent news about screening. • Stress. • Nuclear scanning can identify regions of the heart in which blood flow is limited. but since it is more risky. even with no other risk factors.
Physical exercise is a great way to help lose weight. bypassing the blockage. In this operation. Furthermore. Coronary angioplasty can break open blockages in the coronary arteries. be sure to check with your doctor before beginning any exercise program. If you've recently been diagnosed with CAD and you smoke. a blood vessel taken from the leg or chest is grafted onto the coronary artery. including fish oil and olive oil. Depending on how many arteries are blocked. Studies have shown that extremely low-fat diets may actually reverse the progress of CAD. nitroglycerine. see Related News below. losing weight can help reduce high blood pressure. may actually be beneficial. especially statins (HMG Co-A reductase inhibitors). Aspirin reduces the tendency to form blood clots. The balloon is inflated and deflated to improve the passage for blood flow. and increase levels of HDL (the "good" cholesterol). Coronary bypass surgery is the most definitive treatment. The catheter is removed. Medications can be prescribed to manage different aspects of CAD. Eating less fat should also help you lose weight. A cardiologist inserts a catheter with a tiny balloon at its tip through an arm or leg vein. If you are overweight. For recent news about medications for CAD. another risk factor for atherosclerosis and heart disease. and calcium channel blockers) can control symptoms of angina. surgeons may need to perform more than one bypass. A variety of medications (beta-blockers. Cholesterol can be controlled using a variety of medications. However. A healthy diet low in cholesterol and fat (especially saturated fat) can help reduce blood cholesterol levels. if you already have CAD. some oils. • • . lower blood pressure. Medications can also be helpful for managing high blood pressure. And several studies have shown that drinking red wine in moderation may also reduce your risk. but a device called a "stent" is often inserted to keep the artery open. and then threads it into the coronary artery. the most important thing is to stop smoking.• • • • Stop smoking.
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