Coronary artery
disease occurs when fatty deposits called
plaque (say "plak") build up inside the coronary
arteries. The coronary arteries wrap around the heart and supply it with blood
and oxygen. When plaque builds up, it narrows the arteries and reduces the
amount of blood that gets to your heart. This can lead to serious problems,
including
heart attack.
Coronary artery disease
(also called CAD) is the most common type of heart disease. It is also the
number one killer of both men and women in the United States.
It
can be a shock to find out that you have coronary artery disease. Many people
only find out when they have a heart attack. Whether or not you have had a
heart attack, there are many things you can do to slow coronary artery disease
and reduce your risk of future problems.
What causes coronary artery disease?
Coronary artery disease is
caused by hardening of the arteries, or
atherosclerosis. Atherosclerosis occurs when plaque
builds up inside the arteries. (Arteries are the blood vessels that carry
oxygen-rich blood throughout your body.) Atherosclerosis can affect any
arteries in the body. When it occurs in the arteries that supply blood to the
heart, it is called coronary artery disease.
Plaque is a fatty
material made up of cholesterol, calcium, and other substances in the blood. To
understand why plaque is a problem, compare a healthy artery with an artery
with atherosclerosis:
A healthy artery is like a rubber tube. It is smooth and
flexible, and blood flows through it freely. If your heart has to work harder,
such as when you exercise, a healthy artery can stretch to let more blood flow
to your body's tissues.
An artery with atherosclerosis is more like a clogged pipe.
Plaque narrows the artery and makes it stiff. This limits the flow of blood to
the tissues. When the heart has to work harder, the stiff arteries can't flex
to let more blood through, and the tissues don't get enough blood and oxygen.
When plaque builds
up in the coronary arteries, the heart doesn't get the blood it needs to work
well. Over time, this can weaken or damage the heart. If a plaque tears, the
body tries to fix the tear by forming a blood clot around it. The clot can
block blood flow to the heart and cause a heart attack.
What are the symptoms?
Usually people with coronary artery disease don't
have symptoms until after age 50. Then they may start to have symptoms at times
when the heart is working harder and needs more oxygen, such as during
exercise. Symptoms include:
Angina (say "ANN-juh-nuh" or "ann-JY-nuh"), which is pain or discomfort in the chest or other parts of the body.
Shortness of breath.
Heart attack. Too often, a heart attack is the first symptom of
coronary artery disease.
Less common symptoms include a fast heartbeat, feeling sick
to your stomach, and increased sweating. Some people don't have any symptoms.
In rare cases, a person can have a "silent" heart attack, without
symptoms.
To diagnose coronary artery disease, doctors
start by doing a physical exam and asking questions about your past health and
your risk factors. Risk factors are things that increase the chance that you
will have coronary artery disease.
Some common risk factors are
being older than 65; smoking; having high cholesterol, high blood pressure, or
diabetes; and having heart disease in your family. The more risk factors you
have, the more likely it is that you have coronary artery disease.
If your doctor thinks that you have coronary artery disease, you may have
tests, such as:
Electrocardiogram (EKG or ECG), which checks for problems with
the electrical activity of your heart. An EKG can also show signs of an old or
new heart attack.
Chest X-ray.
Blood tests.
Exercise electrocardiogram, commonly called a "stress test."
This test checks for changes in your heart while you exercise.
Your doctor may order other tests to look at blood flow to
your heart. You may have a
coronary angiogram if your doctor is considering a
procedure to remove blockages, such as angioplasty or bypass surgery.
How is it treated?
Treatment focuses
on taking steps to manage your symptoms and reduce your risk for heart attack
and stroke. Some risk factors you can't control, such as your age and
family history. Other risk factors you can control,
such as high blood pressure, high cholesterol, and smoking. Lifestyle changes
can help lower your risks. You will likely take medicines and may have a
procedure to open your arteries.
Lifestyle changes are the first step for anyone with coronary artery disease.
These changes may stop or even reverse coronary artery disease. To improve your
heart health:
Don't smoke. This may be the most important thing you can do.
Quitting smoking can quickly reduce the risk of heart attack or death.
Eat a heart-healthy diet that includes plenty of fish, fruits,
vegetables, beans, high-fiber grains and breads, and olive oil. See a dietitian
if you need help making better food choices.
Get regular exercise on most, if not all, days of the week. Your
doctor can suggest a safe level of exercise for you. Walking is great exercise
that most people can do. A good goal is 30 minutes or more a day.
Lose weight if you need to and stay at a healthy weight.
Lower your stress level. Stress can hurt your heart.
Limit alcohol to 1 drink a day for women and 2 drinks a day for men.
Changing old habits may not be easy, but it is very
important to help you live a healthier and longer life. Having a plan can help.
Start with small steps. For example, commit to eating five servings of fruits
and vegetables a day. Instead of having dessert, take a short walk. When you
feel stressed, stop and take some deep breaths.
A cardiac rehab program can help you make lifestyle changes. In cardiac rehab, a team of
health professionals provides education and support to help you make new,
healthy habits.
Medicines that are often prescribed for people with coronary artery disease
include:
Statins to help lower cholesterol.
Beta-blockers or ACE inhibitors to lower blood pressure.
Aspirin or other medicines to reduce the risk of blood
clots.
Nitrates or other medicines to relieve your angina symptoms.
Procedures may be done to improve
blood flow to the heart.
Angioplasty is used to open blocked arteries. It isn't
major surgery. During angioplasty, the doctor guides a thin tube (called a
catheter) into the narrowed artery and inflates a small balloon. This widens
the artery to help restore blood flow. Often a small tube called a
stent is placed to keep the artery open. The doctor may use a
stent that is coated with medicine, called a drug-eluting stent. When the stent
is in place, it slowly releases a medicine that prevents the growth of new
tissue. This helps keep the artery open.
Bypass surgery, which is major surgery, may be used
if arteries are severely narrowed or blocked. It uses healthy blood vessels to
create detours around the narrowed or blocked arteries.
What else can you do?
To stay as healthy as
possible, it is important to:
See your doctor for regular follow-up appointments. This lets
your doctor keep track of your risk factors and adjust your treatment as
needed.
Take your medicines exactly as prescribed. Do not stop or
change medicines without talking to your doctor.
Keep nitroglycerin with you at all times, if your doctor
prescribed it for angina.
Tell your doctor about any angina symptoms such as chest pain you have had, even if they
went away.
Get the support you need to succeed in making lifestyle
changes. Ask family or friends to share a healthy meal or join a stop-smoking
program with you.
Ask for help if you think you are depressed.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems.
Coronary artery disease is caused by the buildup of
plaque on the inside of your
coronary arteries. Plaque buildup can begin early in life and
happens over a lifetime.
Coronary artery disease typically begins when the inside walls of the
coronary arteries are damaged because of another health problem, such as:
Plaque, which is made up of excess cholesterol, calcium,
and other substances in your blood, builds up on the damaged inner walls of
your coronary arteries. This process usually occurs throughout the body and is
called
atherosclerosis, or "hardening of the arteries."
Over time, plaque buildup
narrows the coronary arteries and can lead to
ischemia (insufficient blood flow to the heart
muscle). Ischemia (say "is-KEE-mee-uh") can weaken the heart muscle, but it
usually does not cause heart muscle cells to die.
But heart
muscle cells can die if blood flow is severely reduced or completely blocked
for a period of time. This can happen if plaque breaks apart and makes a clot
that blocks an artery. This can cause myocardial infarction, or
heart attack.
Symptoms
Symptoms of coronary artery disease
The most common symptoms of
coronary artery disease are:
Shortness of breath when exercising or during another vigorous
activity.
Unfortunately, sometimes a
heart attack is the first sign of coronary artery
disease.
Some people who have coronary
artery disease and insufficient blood flow to the heart muscle (ischemia) do
not have any symptoms. This is called "silent ischemia." In rare instances, you
can even have a "silent heart attack," a heart attack without symptoms.
Symptoms of heart attack
For men and women, the most common symptom is chest
pain or discomfort. But women are somewhat more likely than men to have other
symptoms like shortness of breath, nausea, and back or jaw pain.
Women are also more likely than men to delay seeking help for a possible
heart attack. Women delay for many reasons, like not being sure it is a heart
attack, or not wanting to bother others. But it is better to be safe than
sorry. If you have symptoms of a possible heart attack that last for 5 minutes,
call 911 right away.
Angina
Angina (say "ANN-juh-nuh" or "ann-JY-nuh") happens when there is not enough blood flow to the heart. Symptoms include:
Chest pain or pressure, or a strange feeling in the chest.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Other symptoms include shortness of breath, nausea or vomiting, lightheadedness or sudden weakness, or a fast or irregular heartbeat.
Know what your angina feels like and what is typical for you so that you know when to call for help.
You may feel symptoms of angina in areas other than the chest.
Stable angina has a typical
pattern. You can likely predict when it will happen. It happens when your heart is working harder and needs more oxygen,
such as during exercise. Symptoms go away when you rest or take nitroglycerin.
Unstable angina is a change in your usual pattern of stable angina. It happens when blood flow to the heart is suddenly slowed by narrowed vessels or small blood clots. Unstable angina is a warning sign
that a heart attack may soon occur. It is an emergency. It may happen at rest or with light activity. It does not go away with rest or nitroglycerin.
What Increases Your Risk
Things that can increase
your risk for
coronary artery disease are called risk factors. Some
risk factors, such as your gender, your age, and your
family history, can't be changed. Other risk factors
for heart disease are tied to your lifestyle and habits. These often are things
you can change. Your chance of getting coronary artery disease rises with the
number of risk factors you have.
Using hormone therapy after menopause. This risk is
higher for some women than others.
Women have unique risk factors for heart disease. These include using birth control pills, using hormone therapy, and having pregnancy-related problems.
Smoking, high cholesterol, high blood pressure, and lack
of exercise are risk factors you can reduce with lifestyle changes and
medicine. Diabetes and obesity can sometimes be prevented when lifestyle
changes are made early in life. To learn more, see Prevention.
Risk factors that you can't change
Family history. You're more at
risk if one or more of your close relatives have or had early CAD.
Being male. Men generally develop heart
disease 10 years earlier than women do. But women who have diabetes may develop
heart disease at a younger age. By age 60, heart disease is one of the leading
causes of death in both sexes.
Age. People over 65 are more likely to
have heart disease.
Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.
Call 911 or other emergency services immediately if you have symptoms of a heart attack. These may include:
Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Why wait for an ambulance?
By calling
911 and taking an ambulance to the
hospital, you may be able to start treatment before you arrive at the hospital.
If any complications occur along the way, ambulance personnel are trained to
evaluate and treat them.
If an ambulance is not readily
available, have someone else drive you to the emergency room. Do not drive
yourself to the hospital.
CPR
If you witness a person become
unconscious, call 911 or other emergency
services and start CPR (cardiopulmonary resuscitation). The emergency operator
can coach you on how to perform CPR.
To learn more about CPR, see the
Cardiopulmonary Resuscitation (CPR) section of the topic
Dealing With Emergencies.
Never wait if you have symptoms of a heart attack
Many people are unsure whether they are having a heart attack, and so
they take a "wait and see" approach. Heart attack symptoms often vary. People
often discount their symptoms if they do not fit into the expected "extreme
chest pain" scenario. Some people are embarrassed or don't want to bother
others by calling for help if they think it may not be a heart attack. Even if
you're not sure it's a heart attack, you should still have it checked out.
Rapid treatment can save your life.
Your angina symptoms are different, more frequent, or severe.
Who to see
To see if you are at risk for heart
disease, have symptoms of coronary artery disease, or require long-term care
for existing heart disease, see your
family doctor or
internist. For diagnosis of coronary artery disease,
you may see a
cardiologist. For ongoing care of stable angina, you
will likely see your family doctor or an internist. For angioplasty or surgery,
you will be referred to an interventional cardiologist or cardiovascular surgeon.
Exams and Tests
To find out if you have or are at
risk for
coronary artery disease, your doctor will do a
physical exam and check your risk based on your health and risk factors.
You may then have several different kinds of tests to check your risk for
getting heart disease. If your doctor thinks you have heart disease, you will
need more tests to make sure.
Tests to measure your risk for coronary artery disease
Other tests may help your doctor find out your risk for heart disease, especially when they are considered along with your other risk factors. But these tests are not helpful for everyone. Such tests may include:
Coronary calcium scan. This
test uses a special kind of X-ray to check for buildup of calcium in the
heart's arteries. The result is a number, or score. If you have a high score,
you may need more tests to check for heart disease or to find out how bad it
is.
Sometimes doctors schedule routine tests because they think that's what patients expect. But experts say routine heart tests can be a waste of time and money. See the topic Heart Tests: When Do You Need Them?
Tests to diagnose coronary artery disease
If
your doctor thinks you may have heart disease, you will need some tests to make
sure. Most often, the first tests include:
Echocardiogram and stress echocardiogram. This test uses ultrasound to see areas of poor blood
flow in the heart. It can also check how well your heart is working after a
heart attack. The test can help your doctor find out how much blood your heart
is pumping during each heartbeat (ejection fraction).
Coronary angiogram. This is an X-ray
test that creates pictures of the blood flow through your
coronary arteries. It allows your doctor to see any
blockage or narrowing of the artery. It's done using a soft, thin tube
(catheter) that is put in a blood vessel in the arm or groin and gently moved
into the heart.
CT angiogram. CT (computed tomography) angiograms use X-rays to get detailed pictures of the heart and its blood vessels.
Treatment Overview
Treatment for
coronary artery disease focuses on taking steps to
manage symptoms and reduce the risk of heart attack and stroke. For
example:
If your doctor agrees, take a low-dose aspirin each day to reduce
your risk of heart attack or stroke.
If you can't control your
high blood pressure and
high cholesterol with healthier habits, you may need
to take medicines. They can help you manage these health problems and lower
your risk.
Your doctor may also suggest medicines if your angina symptoms make it hard to do everyday activities.
If medicines don't help your angina, your doctor may suggest
procedures to improve blood flow to the heart.
Angioplasty with or without
stent placement is one way to open clogged coronary
arteries. Or sometimes
coronary artery bypass graft surgery may be
needed.
No matter what kind of treatment you get, healthy habits such as
quitting smoking, eating a heart-healthy diet, and getting regular exercise are
important.
Keep these questions in mind
as you think about your treatment options:
Will this treatment improve my symptoms?
Will this treatment help prevent future heart problems?
Am I likely to live longer with this treatment?
What are the risks of this treatment?
Initial treatment
Lifestyle changes are the first
step for anyone with
coronary artery disease. But sometimes lifestyle
changes are not enough. You may also need medicines. If you take medicines, take them on a schedule and take the correct dose. Taking medicines properly can help you prevent a heart attack or stroke.
Lifestyle changes
When you're first diagnosed
with heart disease, your doctor will strongly advise you to make lifestyle
changes. These include quitting smoking, eating a heart-healthy diet, and
getting regular exercise. These healthy habits can slow or even stop the
disease and improve the quality and length of your life.
Quit smoking and avoid secondhand smoke. Quitting smoking is the best thing you can do to reduce your
risk of future problems. When you quit, you quickly lower your risk of a heart attack.1
If you smoke, try to quit. Medicines and counseling can help you quit for good.
Eat a heart-healthy diet. This can help you keep your disease from getting
worse. A chart that compares heart-healthy diets(What is a PDF document?) can help you see what foods are suggested in each plan. A heart-healthy diet means:
Eat more fruits, vegetables, whole grains, and other high-fiber
foods.
Choose foods that are low in saturated fat, trans fat, and
cholesterol.
Limit salt.
Stay at a healthy weight by balancing the calories you eat with
how much physical activity you get.
Eat more foods that are high in omega-3 fatty acids, such as
fish.
Start an exercise program (if
your doctor says it's safe). Try walking, swimming, biking, or jogging for at
least 30 minutes on most, if not all, days of the week. You may need to start
slow and build up to this amount. Any activity you enjoy will work, as long as
it gets your heart rate up. In people with heart disease, exercise can help lower the chance of a heart attack.
One Man's Story:
Alan, 73
"I've had to work at keeping my
weight under control, and that has really helped my cholesterol. When you have
heart disease, you learn to eat better for the rest of your life. And if you
don't, you're asking for trouble.—Alan
Aspirin or other antiplatelets. Your doctor will probably recommend that you
take
aspirin or other antiplatelets every day. Antiplatelet medicine can reduce the risk of
having a heart attack in people with heart disease.
Cholesterol. Your doctor may prescribe a
medicine to lower your cholesterol, such as a
statin.
Angina medicines. If you have angina, your doctor may prescribe medicine, such as nitroglycerin, to relieve your symptoms.
Ongoing treatment
After you start treatment for
coronary artery disease, your doctor will want to keep
track of how you are doing. He or she will want to know if you've made
lifestyle changes and if they have helped. For example, your
blood pressure,
cholesterol, and weight will be checked. These
measures will help your doctor find out if lifestyle changes are working.
If you take medicines, your doctor will want to know if you feel
any side effects. If you take medicine for angina (chest pain or discomfort), your
doctor will want to know how well it works. Does the medicine ease your pain
quickly? Do you get chest pain less often?
You will likely need to
keep taking medicines that lower your cholesterol and blood pressure and that
reduce your risk of having a heart attack. Your doctor will also want to check
how well these medicines work for you. If they're not working, he or she may
want you to try a different dose or take a different kind of medicine.
Talk to your doctor about
cardiac rehabilitation. In cardiac rehab, a team of
health professionals provides education and support to help you build new,
healthy habits such as eating right and getting more exercise. For keeping your heart healthy and your arteries
open, making these changes is just as
important as getting treatment.
Treatment if the disease gets worse
Sometimes
coronary artery disease gets worse even with
treatment. If you start to have abnormal heart rhythms (arrhythmias), your doctor might suggest a
pacemaker or medicines to control your heart
rate.
If your angina symptoms get worse even though you are
taking medicines, you may need procedures to improve blood flow to your heart.
They are also done when the coronary arteries are severely blocked. These
procedures include
angioplasty with or without stenting and
coronary artery bypass graft surgery.
When deciding between bypass surgery and angioplasty, your doctor will
think about several things, such as how many arteries are blocked and whether
you have diabetes.
Coronary artery disease can lead to
heart failure and the need for other medicines. These
medicines can help you feel better and prevent your heart failure from getting
worse.
Palliative care
If your
coronary artery disease gets worse, you may want to think about
palliative care. Palliative care is a kind of care for
people who have diseases that do not go away and often get worse over time. It
is different from care to cure your illness, which is called curative
treatment.
Palliative care focuses on improving your quality of
life—not just in your body, but also in your mind and spirit. Some people
combine palliative care with curative care.
Palliative care may
help you manage symptoms or side effects from treatment. It can also help you
and your family to:
Cope with your feelings about living with a long-term
disease.
Make future plans around your medical care.
Understand your disease and how to support you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
You can slow or even prevent
coronary artery disease by taking steps towards a heart healthy lifestyle. Many people already have. More people are adopting healthy
habits such as eating right, exercising more, and not smoking. Doing these
things can also help reduce risk factors such as
high cholesterol and
high blood pressure.
Lifestyle changes
Quit smoking. Avoid secondhand smoke too. Quitting smoking may be the best thing you can do to
prevent heart disease. Smokers who quit cut their risk of heart disease by half
after 1 year. You can cut your risk even more by staying away from cigarettes
for good. After 15 years of not smoking, your risk of death from heart disease
is the same as if you had never smoked at all.2
Exercise. There are lots of ways that
exercise boosts your health. It can improve cholesterol and blood pressure. It
can also help you reach a healthy weight. Try to exercise for at least 30
minutes on most, if not all, days of the week. Talk to your doctor before
starting an exercise program.
To reduce your risk of heart disease, it's
important to
control your cholesterol and
manage your blood pressure. Quitting smoking, changing
the way you eat, and getting more exercise can help. But if these things don't
work, you may need to take medicines as well.
If you're already at risk
for heart disease, taking daily
aspirin may reduce your chances of having a stroke or
a heart attack. That's because a daily aspirin lowers your risk of getting
blood clots. Blood clots can lead to a heart attack in people with heart
disease. Clots can also cause heart attacks in people who have other problems
that can lead to heart disease, such as
diabetes,
high blood pressure, and
high cholesterol.
Taking aspirin has
some risks. Talk with your doctor before starting aspirin treatment.
Manage stress. Stress can hurt your heart.
Keep stress low by talking about your problems and feelings, rather than
keeping your feelings hidden. Try different ways to reduce stress such as exercise, deep breathing, meditation, or
yoga.
You can have
coronary artery disease and not know it. Sometimes the
disease is found during an electrocardiogram or stress test. Often a
heart attack is the first sign of heart
disease.
When you do know that you have
heart disease, you may wonder how it spreads over time and what you can do to
slow its progress. It's important to take care of yourself. Making healthy
lifestyle changes can reduce your chances of heart attack and
stroke. Take your medicines as your doctor prescribes.
If your heart disease gets worse, your arteries will narrow, and less
blood will flow to your heart. You may start to have chest pain or discomfort (angina) when
you exercise or feel stressed. This is called
stable angina. Most people are able to control stable
angina by resting or
taking nitroglycerin.
In some cases,
sudden and serious problems can happen. New blockages that form in the arteries
of the heart can become unstable. They can suddenly tear and cause blood clots to
form. These clots block blood flow to your heart, causing a heart attack or
unstable angina.
If your heart disease
is severe, or if your chest pain and other symptoms can't be controlled with
medicines, you may need to think about other treatment, such as:
These treatments, along with making changes like eating
right and not smoking, can help you live a longer, healthier life. If your
disease becomes much worse, it can lead to serious medical problems. Many
important end-of-life decisions can be made while you are active and able to
communicate your wishes.
Complications of heart disease
Over time, you may have other health problems
caused by coronary artery disease. Low blood flow can make it harder for your
heart to pump. This can lead to
heart failure or
atrial fibrillation. Atrial fibrillation increases the
risk of stroke.
Most often,
problems occur in arteries that bring blood to your heart, brain, and arms and
legs (peripheral arterial disease).
Living With Heart Disease
A diagnosis of
coronary artery disease can be hard to accept and
understand. If you don't have symptoms, it may be especially hard to recognize
that heart disease is serious and can lead to other health problems.
It's important to talk with your doctor to learn about the disease and
what you can do to help manage it and prevent it from getting worse.
Have healthy habits
Making healthy
lifestyle changes can delay and maybe even reverse heart disease. Quitting
smoking, eating a low-fat and low-cholesterol diet, getting regular
exercise, and staying at a healthy weight are important steps you can take to keep your disease from
getting worse.
Do cardiac rehab. Your doctor may suggest that you attend a
cardiac rehabilitation (rehab) program. In cardiac rehab, you will get education and support that help you build new, healthy habits,
such as eating right and getting more exercise
Control angina. Most people are able to
control angina (including chest pain or discomfort) by taking medicines as prescribed and
nitroglycerin when needed. To learn more, see the topic
Quick Tips: Taking Charge of Your Angina.
Manage stress and anger. Stress and anger can also hurt your heart.
They might make your symptoms worse. Try different ways to reduce stress such as exercise, deep breathing, meditation, or
yoga.
Get help for depression
Depression and heart disease are linked. People with heart disease are more likely to get depressed. And if a person has both depression and heart disease, he or she may not stay as healthy as possible. This can make depression and heart disease worse.
If you think you may have depression, talk to your doctor. Take this short quiz to check your symptoms:
Interactive Tool: Are You Depressed? For more information, see
the topic
Depression.
Get support
Whether you are recovering from a heart attack or
changing your lifestyle so you can avoid one, emotional support from friends
and family is important. Think about joining a heart disease support group. Ask
your doctor about the types of support that are available where you live.
Meeting other people with the same problems can help you know you're not alone.
Take your medicines exactly as directed. Do not stop taking your medicine unless your doctor tells you to.
Keep your blood sugar in your target range if you have diabetes.
Get a flu vaccine every year.
Drink alcohol in moderation, if you drink. This means having 1
drink a day for women or 2 drinks a day for men.
Seek
help for sleep problems. Your doctor may want to check for
sleep apnea, a common sleep problem in people who have
heart disease.
Medications
Many people have trouble correctly
taking their medicines for
coronary artery disease. Often, they need to take
several medicines at different times of the day. And some people struggle to
afford the medicines. But medicines are often a key part of treatment, and
people who do not take them as prescribed have an increased risk of
complications and death.
Medicines to treat symptoms and prevent complications
If you have symptoms of coronary artery disease, your doctor may
prescribe some of the following medicines to control symptoms and, in some
cases, slow the progression of the disease:
Angiotensin II receptor blockers (ARBs) lower your
blood pressure and reduce the strain on your heart. If you cannot tolerate
certain side effects of an ACE inhibitor, your doctor may prescribe an ARB
instead.
Angiotensin-converting enzyme (ACE) inhibitors lower
your blood pressure and reduce the strain on your heart. They may also reduce
your risk for a future heart attack or heart failure.
Aspirin and other antiplatelets help prevent blood
clots in your coronary arteries. This can decrease your risk of heart attack
and stroke.
Beta-blockers slow your heart rate and lower your
blood pressure to reduce the amount of work your heart has to do. They also
reduce angina.
Calcium channel blockers slow your heart rate and
lower your blood pressure to reduce your heart's workload. They also help widen
(dilate) your coronary arteries and reduce angina.
Nitrates (nitroglycerin and long-acting nitrates)
relieve chest pain and other symptoms of angina.
Statins lower your cholesterol and may reduce your
risk of a future heart attack.
What to think about
Medicines for angina
Stable angina can often be controlled
with medicine such as:
If angina symptoms become worse, your doctor may need to adjust your
medicines. But if angina symptoms still get worse and medicines don't help, you
may need angioplasty or bypass surgery. For angina that gets worse quickly or
occurs at rest (unstable angina), you may need hospitalization and
urgent angioplasty,
stenting, or bypass surgery. For more information, see
the topic
Heart Attack and Unstable Angina.
Do not use erection-enhancing medicines such as sildenafil
(Viagra), tadalafil (Cialis), or vardenafil (Levitra) if you take nitroglycerin
or other nitrates for angina. Combined, these two drugs can cause a serious
drop in blood pressure.
If you are taking an erection-enhancing
medicine and seek treatment for angina, tell the doctor about your use of this
medicine so you don't get nitroglycerin or another type of nitrate. There are
other medicines that may work instead to ease your chest pain.
Aspirin
Aspirin, ibuprofen, and naproxen
are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and
inflammation. But only aspirin will reduce your risk for heart attack or
stroke. Don't substitute ibuprofen or naproxen for
low-dose aspirin therapy. If you need to take an NSAID
for a long time, talk with your doctor to see if it is safe for you.
The goals of surgery for
coronary artery disease are to:
Improve blood flow to the heart.
Relieve chest pain or discomfort (angina).
Improve your chances of living a longer life.
Many people with heart disease can be treated by lifestyle
changes and medicine or
angioplasty. But sometimes
coronary artery bypass graft surgery is needed. It uses healthy blood vessels to create detours around
narrowed or blocked arteries. Most of the time, bypass surgery is an open-chest
procedure.
Coronary artery bypass graft surgery improves blood flow to the heart. During this surgery, a
doctor connects (grafts) a healthy artery or vein from another part of your
body to the blocked coronary artery. The grafted artery goes around (bypasses)
the blocked part of the artery. The bypass provides a new pathway for blood to
your heart.
What to think about
Your treatment will depend in part
on:
How many arteries are blocked.
How badly the arteries are blocked, and where.
Other heart problems you may have.
Your feelings about treatment.
Surgery isn't right for everyone. Making lifestyle changes and taking
medicine or having angioplasty can work just as well for some people. And these
carry fewer risks than surgery.
No matter what treatment you
receive, you'll still need to make changes in the way you eat and how much you
exercise. These changes, along with not smoking, will give you the best chance
of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.
If you're thinking about surgery, ask your doctor how many
heart surgeries your surgeon and the hospital perform each year. Find out how
that number compares with heart surgeries done at other hospitals. People who
have bypass surgery at hospitals that do many heart surgeries tend to have
better results.
Angioplasty and Other Treatment
The goal of
angioplasty is to open blood vessels and increase
blood flow to the heart. It is done when arteries are narrowed or blocked from
coronary artery disease. Angioplasty can be done with
or without a small, expandable tube called a
stent.
Angioplasty is not surgery. It is done using a thin,
soft tube called a catheter that's inserted in your artery. It doesn't use
large cuts (incisions) or require anesthesia to make you sleep.
Most of the time, stents are placed during
angioplasty. The stent keeps the artery open. When stents are used, there is a
smaller chance that the artery will become narrow again.
Your doctor may use a bare metal stent or a drug-eluting stent. Drug-eluting stents are coated with medicine that helps keep the artery open after angioplasty.
Atherectomy might be done during angioplasty. But it is only done in certain
cases. Atherectomy is done to shave away and maybe remove plaque in a narrowed artery.
What to think about
Your treatment will depend in part on:
How many arteries are blocked.
How badly the arteries are blocked, and where.
Other heart problems you may have.
Your feelings about treatment.
No matter what treatment you receive, you'll still need
to make changes in the way you eat and how much you exercise. These changes,
along with not smoking, will give you the best chance of living a longer,
healthier life. A cardiac rehabilitation program can help you make these healthy changes.
Although treatment for
coronary artery disease is increasingly successful at
prolonging life and reducing complications and hospitalization, the disease can
lead to a
heart attack, a
stroke, and other fatal conditions. It's a good idea
to think about end-of-life decisions before these events happen, while you are
still active and able to talk about your wishes.
When you are
diagnosed with coronary artery disease, your doctor will discuss treatment
options with you. If your heart disease is advanced and your life will most
likely be shortened by the illness, your doctor may talk to you about whether
you want to be revived (resuscitated) when your illness progresses and your
breathing stops. You may want to learn more about aggressive life-sustaining
medical treatment and whether it is right for you.
Many other decisions about end-of-life issues, such as
writing a living will and estate planning, can be made in advance, leaving
valuable time for spending with loved ones and on other important matters.
The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies.
Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.
Society of Thoracic Surgeons
633 North Saint Claire Street
Floor 23
Chicago, IL 60611
Phone:
(312) 202-5800
Fax:
(312) 202-5801
Web Address:
www.sts.org
The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.heart.org
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
HeartHub for Patients
Web Address:
www.hearthub.org
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
Email:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
WomenHeart: The National Coalition for Women With Heart
Disease
818 18th Street NW
Suite 1000
Washington, DC 20006
Phone:
1-877-771-0030 toll-free
Fax:
(202) 728-7238
Web Address:
www.womenheart.org
WomenHeart: The National Coalition for Women with Heart Disease is
a nonprofit organization dedicated to reducing heart disease, death, and
disability among women. The coalition also sponsors a network of support
groups, a bulletin board, a newsletter, and other services.
Roger VL, et al. (2011). Heart disease and stroke statistics—2012 Update: A report from the American Heart Association. Circulation, 125(1) e2–e220.
U.S. Department of Health and Human Services (2010). A Report of the Surgeon
General: How tobacco smoke causes disease: The biology and
behavioral basis for smoking-attributable disease. Available online: http://www.surgeongeneral.gov/library/tobaccosmoke/report/full_report.pdf.
Other Works Consulted
Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.
Budoff M, et al. (2006). Assessment of coronary artery
disease by cardiac computed tomography: A scientific statement from the
American Heart Association Committee on Cardiovascular Imaging and
Intervention, Council on Cardiovascular Radiology and Intervention, and
Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16): 1761–1791.
Chou R, et al. (2011). Screening asymptomatic adults with resting or exercise electrocardiography: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(6): 375–385.
Drozda J Jr, et al. (2011). ACCF/AHA/AMA PCPI 2011 Performance measures for adults with coronary artery disease and hypertension: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association Physician Consortium for Performance Improvement. Journal of the American College of Cardiology, 58(3): 316–336.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
Fraker TD, et al. (2007). 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. Circulation, 116(23): 2762–2772.
Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238).
Greenland P, et al. (2007). ACCF/AHA 2007 clinical
expert consensus document on coronary artery calcium scoring by computed
tomography in global cardiovascular risk assessment and in evaluation of
patients with chest pain. Circulation, 115(3):
402–426.
Greenland P, et al. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 56(25): e50–e103.
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.
Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227–239.
[Erratum in Circulation, 110(6): 763.]
Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.
Hillis LD, et al. 2011 ACCF/AHA Guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652–e735.
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express
(NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and
Human Services.
Kushner KG, et al. (2009). 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevated myocardial infarction (Updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (Updating the 2005 guideline and 2007 focused update). A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 120(22): 2271–2306.
Levine GN, et al. (2011). 2011 ACC/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
Pearson TA, et al. (2003). Markers of inflammation and
cardiovascular disease: American Heart Association and the Centers for Disease
Control and Prevention scientific statement. Circulation, 107(3): 499–511.
Redberg RF, et al. (2009). ACCF/AHA 2009 Performance measures for primary prevention of cardiovascular disease in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures. Circulation, 120(13): 1296–1336.
Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473.
Taylor AJ, et al. (2010). ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 – Appropriate use criteria for cardiac computed tomography: A Report of the American
College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Journal of the American College of Cardiology, 56(22): 1864–1894.
U.S. Preventive Services Task Force (2008). Screening for lipid disorders in adults. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm.
U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
U.S. Preventive Services Task Force (2012). Screening for coronary heart disease with electrocardiography: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm.
Credits
By
Healthwise Staff
Primary Medical Reviewer
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Roger VL, et al. (2011). Heart disease and stroke statistics—2012 Update: A report from the American Heart Association. Circulation, 125(1) e2–e220.
U.S. Department of Health and Human Services (2010). A Report of the Surgeon
General: How tobacco smoke causes disease: The biology and
behavioral basis for smoking-attributable disease. Available online: http://www.surgeongeneral.gov/library/tobaccosmoke/report/full_report.pdf.
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.
Heart Disease: Should I Have Angioplasty for Stable Angina?
Heart Disease: Eating a Heart-Healthy Diet
Atherosclerosis
How a Heart Attack Happens
Coronary Angioplasty
Coronary Artery Bypass Surgery for Coronary Artery Disease
The Heart and the Coronary Arteries: Front View
Angina Symptoms
Cardiovascular System
Coronary Stent
Preventing Heart Disease
Heart Disease and Depression
Bypass Surgery for Heart Disease
Heart Disease: Aspirin and Heart Attack Risk
