Coronary Artery Disease – Symptoms and Causes

Overview

Coronary artery disease (CAD) is the most common heart condition in the United States. It affects millions of people each year.

This condition happens when the coronary arteries that supply blood to the heart become narrowed or blocked by plaque. The reduced blood flow can lead to serious health complications, including heart attacks.

CAD evolves progressively over the years. The primary cause is atherosclerosis, a process where fats, cholesterol, and other substances accumulate along artery walls.

As these deposits grow, they restrict blood flow to the heart, limiting its oxygen supply. This restriction forces the heart to work harder with less energy, creating strain on this vital organ.

Several risk factors contribute to the development of CAD:

Age-related factors:

• The risk increases as people get older
• Men generally face a higher risk initially
• Women’s risk increases significantly after menopause

Health conditions that increase risk:

• High blood pressure thickens arterial walls
• Elevated cholesterol levels
• Diabetes
• Obesity or being overweight

Lifestyle factors:

• Physical inactivity
• Chronic stress
• Poor dietary habits
• Tobacco use

Family history also plays a crucial role. If a close relative developed heart disease at an early age, an individual’s risk increases substantially.

Most people with early CAD don’t experience noticeable symptoms. However, as the condition progresses, common symptoms may include:

1. Chest pain or pressure (angina)
2. Shortness of breath, especially during activity
3. Extreme fatigue
4. Pain radiating to the shoulders or arms
5. Sweating

When an artery becomes completely blocked, a heart attack can occur. This medical emergency requires immediate attention. It’s important to note that many heart attacks produce minimal symptoms and may only be discovered during routine testing.

The diagnosis of coronary artery disease (CAD) generally adheres to a systematic methodology. Healthcare providers review medical history, conduct physical examinations, and order blood tests.

Based on initial findings, doctors may recommend additional testing, such as:

Test	What It Shows
Electrocardiogram (ECG)	Electrical activity of the heart
Echocardiogram	Heart structure and function using sound waves
Stress test	Heart performance during physical activity
Cardiac catheterization	Direct visualization of coronary arteries
Cardiac CT scan	Detailed images of the heart and blood vessels

Treatment strategies for CAD focus on both lifestyle modifications and medical interventions.

Lifestyle changes represent the foundation of treatment and include:

• Adopting heart-healthy eating habits
• Engaging in regular physical activity
• Maintaining a healthy weight
• Managing stress effectively
• Quitting tobacco use

These changes can significantly improve artery health and overall cardiac function. For many patients, medications also play an important role in management.

Common medications for CAD:

• Aspirin (reduces blood clotting)
• Cholesterol-modifying drugs
• Beta-blockers (reduce heart workload)
• Nitroglycerin (relieves angina)

In more severe cases, medical procedures may become necessary. Angioplasty is a procedure that uses a small balloon to widen narrowed arteries, often along with a stent to keep the artery open.

For extensive disease, coronary artery bypass surgery creates new pathways for blood flow around blocked arteries.

Living with CAD requires ongoing management and regular medical supervision. By working closely with healthcare providers and making consistent lifestyle improvements, most people with CAD can lead active, fulfilling lives.

Warning Signs

Coronary artery disease occurs when your heart doesn’t get enough oxygen-rich blood. You might not notice symptoms at first. They often appear during physical activity when your heart needs more oxygen.

Common symptoms include:

• Chest pain (Angina): A feeling of pressure, squeezing, or tightness in the middle or left side of your chest. It may feel like someone is standing on your chest. This pain often appears during activity or emotional stress.

• Breathing problems: You might feel like you can’t catch your breath, especially during physical activity.

• Unusual tiredness: When your heart can’t pump enough blood, you may feel extremely tired even after light activities.

Women, older adults, and people with diabetes may experience different symptoms, like:

• Brief pain in the neck or back
• Nausea
• Subtle discomfort rather than obvious chest pain

As your arteries continue to narrow, symptoms often become more frequent or severe.

If an artery becomes completely blocked, a heart attack can occur. Heart attack symptoms include:

• Chest pressure, tightness, or ache
• Pain spreading to the shoulder, arm, back, jaw, or upper abdomen
• Cold sweats
• Extreme fatigue
• Heartburn-like discomfort
• Nausea
• Shortness of breath

When to Get Medical Help

Call 911 immediately if you think you’re having a heart attack. Don’t drive yourself to the hospital unless absolutely necessary. Have someone take you to the nearest emergency room if ambulance service isn’t available.

If you have risk factors like smoking, high blood pressure, high cholesterol, diabetes, obesity, or family history of heart disease, talk with your healthcare provider. You might need tests to check for narrowed arteries even before symptoms appear.

Causes

Coronary artery disease develops when fatty deposits, cholesterol, and other substances accumulate in the heart’s artery walls.

This process, known as atherosclerosis, creates plaque that narrows arteries and restricts blood flow to the heart. Sometimes, plaque can rupture, forming dangerous blood clots.

Several factors contribute to atherosclerosis development:

• Diabetes or Insulin Resistance
• High Blood Pressure
• Insufficient Physical Activity
• Tobacco Use or Smoking

These risk factors damage the inner layers of arteries, making them more vulnerable to plaque buildup.

Narrowing of the coronary arteries by plaque reduces the heart’s oxygen-rich blood supply, which can cause chest pain or serious complications.

Risk Factors

The likelihood of developing coronary artery disease depends on several factors. These can be divided into factors you cannot change and those you can control.

Unchangeable Risk Factors

• Age plays a significant role. As people grow older, their risk increases due to natural artery changes over time.
• Sex differences affect risk levels. Men typically face higher risks earlier in life. Women’s risk increases after menopause.
• Family history significantly impacts your chances. If your close relatives (parents, siblings, or children) developed heart disease early in life, your risk is higher. This is especially concerning if:
  • Your father or brother had heart disease before age 55
  • Your mother or sister developed heart disease before age 65

Controllable Risk Factors

• Smoking dramatically increases heart disease risk. Both direct smoking and exposure to secondhand smoke harm your heart health.
• High blood pressure damages arteries over time, making them hard and stiff, which leads to atherosclerosis (artery narrowing).
• Cholesterol imbalances contribute to artery blockages:
  • Too much LDL (“bad”) cholesterol increases risk
  • Too little HDL (“good”) cholesterol raises risk
• Diabetes, particularly Type 2, shares risk factors with coronary artery disease and significantly increases your chances of developing heart problems.
• Obesity contributes to heart disease both directly and by increasing the likelihood of other risk factors like diabetes and high blood pressure.
• Chronic kidney disease creates conditions that promote coronary artery disease.
• Physical inactivity weakens the heart and contributes to other risk factors. Regular exercise helps protect heart health.
• Stress may damage arteries directly while worsening other risk factors.
• Diet choices affect heart health:

Foods to Limit	Why
Saturated fats	Raise cholesterol levels
Trans fats	Damage artery walls
High-sodium foods	Increase blood pressure
Sugary foods	Contribute to obesity and diabetes

• Alcohol consumption, especially heavy drinking, can damage heart muscle and worsen other risk factors.
• Sleep patterns matter for heart health. Both too little sleep (less than 6 hours) and too much sleep (more than 9 hours) have been linked to increased heart disease risk.

Risk Factor Combinations

Risk factors often appear together and can multiply each other’s effects. For example, metabolic syndrome combines several conditions:

• High blood pressure
• High blood sugar
• Excess abdominal fat
• High triglyceride levels

Additional Potential Risk Factors

Understanding these risk factors helps identify who might need more aggressive prevention strategies.

• Obstructive sleep apnea causes breathing interruptions during sleep, leading to oxygen level drops that strain the heart.
• Elevated high-sensitivity C-reactive protein (hs-CRP) indicates inflammation that may contribute to heart disease.
• High triglycerides, a type of blood fat, may increase your risk, particularly in women.
• Elevated homocysteine levels in the blood have been associated with a higher coronary artery disease risk.
• Pregnancy complications like preeclampsia, gestational diabetes, or pregnancy-related high blood pressure increase future heart disease risk.
• Autoimmune conditions such as rheumatoid arthritis and lupus are associated with increased atherosclerosis risk.

Complications

Coronary artery disease (CAD) can lead to several serious health problems:

Angina (Chest Pain)

• Occurs when heart muscles don’t receive enough oxygen
• May feel like pressure, squeezing, or burning in the chest
• Can be triggered by physical activity or emotional stress

Heart Attack

Blood clots can form in narrowed arteries, blocking blood flow to parts of the heart. Without quick treatment, this can cause permanent heart muscle damage. The severity depends on:

• Which arteries are blocked
• How long blood flow is interrupted
• How quickly medical help is received

Heart Failure

When coronary arteries narrow over time, the heart can become weak or stiff. This makes it harder for the heart to pump effectively, causing:

• Shortness of breath
• Fatigue
• Fluid buildup in the lungs and legs

Arrhythmias

Poor blood flow to the heart can disrupt electrical signals, leading to irregular heartbeats. These rhythm problems can range from harmless to life-threatening, depending on their type and severity.