Coronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD) is blockage of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In severe case the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI).
Coronary artery disease is the most common form of heart disease. It is the leading cause of death worldwide.
Causes include:
Major risk factors include:
Other risk factors include:
CAD may progress without any symptoms.
Angina is chest pain that comes and goes. It often has a squeezing or pressure-like quality. It may radiate into the shoulder(s), arm(s), or jaw. Angina usually lasts for about 2-10 minutes. It is often relieved with rest. Angina can be triggered by:
Immediate medical attention is needed for unstable angina. CAD in women may cause less classic chest pain. It is likely to start with shortness of breath and fatigue.
If you go to the emergency room with chest pain, some tests will be done right away. The tests will attempt to see if you are having angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the severity of your disease.
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:
Treatment may include:
This medicine is usually given during an attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. Longer-lasting types can be used to prevent angina before an activity known to cause it. These may be given as pills or applied as patches or ointments.
A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Ask your doctor before taking aspirin daily.
These may help prevent angina. In some cases, they may lower the risk of heart attack.
These medications may prevent the progression of CAD. They may even improve existing disease.
Evidence shows that lowering cholesterol has a positive effect on prevention of CAD events.
Patients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:
Some studies have shown that CABG may be more effective than PCI. Lifestyle changes and intensive medication may also be just as effective as PCI. * 2 * 1
For patients who are not candidates for revascularization procedures but have continued angina despite medication, options include:
To reduce your risk of getting coronary artery disease:
RESOURCES:
American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/
Heart Healthy Kit: Public Health Agency of Canada
http://www.phac-aspc.gc.ca/
References:
Arora RR, Chou TM, et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol . 1999;33:1833-1840.
Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med . 2007;356:1503-1516.
Dambro MR. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
Fuster V, Hurst JW. Hurst's The Heart . 11th ed. New York, NY: McGraw-Hill;2004.
GWTG-CAD fact Sheet. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3040028 . Accessed July 20, 2008.
Lilly LS. Braunwald’s Heart Disease . 7th ed. Philadelphia, PA: Elsevier Saunders;2004.
What is coronary artery disease? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov . Accessed July 20, 2008.
* 1 4/10/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Mar 26.
* 2 11/7/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Bravata DM, Gienger AL, McDonald KM, et al. Systematic Review: The comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007 Nov 20.
* 3 1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry. 2008;165:515-523.
Last reviewed January 2009 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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