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Overview

Coronary artery disease is a narrowing of the arteries that supply blood to the heart a process that is known as atherosclerosis. Coronary artery disease is also called:

• CAD
• Coronary heart disease (CHD)
• Heart disease
• Ischemic heart disease.

By any name it is the leading cause of death in both men and women in Canada and much of the developed world. While some risk factors for this disease are beyond your control leading a healthy lifestyle may reduce your risk significantly.

Causes

While some people may have a genetic condition that increases their risk of heart disease lifestyle is far and away the most common cause.

All muscles require oxygen for energy. The heart is no different. It relies on a steady supply of oxygen which it gets from blood that is delivered through the coronary arteries.

Over many years a sticky fatty material called plaque builds up in the blood vessels. The arteries then become clogged and as the arteries narrow and harden the blood and oxygen flow is reduced.

This can result in:

• Angina. Chest pain or discomfort that occurs when your heart is not getting enough blood.
• Heart attack. A heart attack happens when a blood clot suddenly cuts off most or all blood supply to part of the heart. Cells in the heart muscle that do not receive enough oxygen-carrying blood begin to die. This can cause permanent damage to the heart muscle.

Coronary artery disease can also weaken your heart muscle and contribute to:

• Heart failure. In heart failure the heart is not able to pump blood to the rest of the body effectively. Heart failure does not mean that your heart has stopped or is about to stop working. But it does mean that your heart is failing to pump blood the way that it should.
• Arrhythmias. Changes in the normal rhythm of the heartbeats. Some can be quite serious.

Symptoms

When it comes to coronary artery disease the most common symptoms should be taken as a potentially life-threatening condition. They include:

Chest pain

A lack of oxygen causes a chest pain called angina. This feels like a crushing pressure or tightness and is usually brought on by physical or emotional stress. The pain typically goes away within minutes after you stop the activity. But such pain indicates a condition that must be diagnosed quickly.

Shortness of breath

When your heart isn't getting an adequate supply of blood you may extreme fatigue shortness of breath and swelling of feet and ankles. These are also symptoms of congestive heart failure a condition in which the heart is weak and overloaded as it tries to pump blood.

Heart attack

Symptoms of a heart attack include sweating chest or arm pain that does not go away and fainting.

It is important to know that you may have coronary heart disease without even knowing it. Sometimes there are no symptoms at all although you could develop them in the future. When there are symptoms they can be mild or very serious.

Treatment

There is no cure for CAD but there are various treatment options. In an emergency situation you may be given nitroglycerin to help open a clogged artery and lessen chest pain. If doctors suspect a heart attack they can give you a clot-busting drug which if taken early enough can stop its progression. After administering an electrocardiogram angiogram and other tests your medical team might recommend surgery to open up or bypass damaged arteries.

Prevention

The risk of it developing coronary artery disease increases dramatically if you smoke don't exercise don't eat a well-balanced diet are overweight or have high blood or cholesterol levels. If your doctor suspects that you are at risk of coronary artery disease appropriate lifestyle changes can help slow its progress. To reduce your risk the Heart and Stroke Foundation of Canada recommends the following:

• Keep blood pressure at healthy levels. Adults should have their blood pressure checked regularly especially if high blood pressure runs in the family. People with high blood pressure should ask their doctors how to reduce it. Blood pressure can often be brought into normal ranges by lifestyle changes such as: losing excess weight; exercising; reducing salt intake; increasing consumption of potassium-rich foods and managing stress levels. Sometimes medication may also be required. Blood pressure lowering medication must be taken exactly as directed.
  
• Keep cholesterol at healthy levels. Adults should have their blood cholesterol levels checked regularly especially if there's a family history of high cholesterol. People with high cholesterol levels should ask their doctors how to reduce them. Blood cholesterol levels can sometimes be lowered by reducing the amount of fat in the diet. Sometimes cholesterol lowering medications may also be needed.
  
• Stop smoking. A smoker's risk of coronary heart disease is far higher than that of a non-smoker. Smokers should ask their doctors for advice on how to quit smoking. There are many smoking cessation programs and cessation aids to help smokers quit.
  
• Exercise regularly. Regular exercise can reduce your risk of developing coronary artery disease. Exercise increases levels of "good" (High Density Lipoprotein or HDL) cholesterol helps you manage stress and improves the efficiency of the heart lungs and muscles. Even modest levels of low-intensity exercise are beneficial if done regularly.
  
• Control diabetes. Patients with diabetes should take steps to manage it well. Diabetes (especially poorly controlled diabetes) increases the risk of developing coronary heart disease.
  
• Maintain a healthy body weight. Adults should keep their body weight as close as possible to the ideal body weight for their age and build. (If you are not sure of your ideal body weights you should consult your doctor.) Exercise and proper diet are two key factors in maintaining a healthy weight. People who are more than 30% over their ideal weight are more likely to develop coronary heart disease and stroke even if they have no other risk factors. Added weight increases the strain on the heart and contributes to high blood pressure and high blood cholesterol. It can also lead to type-2 (adult-onset) diabetes.
  
• Learn to control stress. Stress is often associated with unhealthy activities such as smoking overeating excessive drinking worrying or outbursts of anger. People under severe stress should consult their doctors for advice on how to manage stress. Stress management programs focus on learning to identify prioritize and discuss problems eating well getting enough sleep and exercising.

Additional Resources

Heart and Stroke Foundation of Canada

The Healthy Heart Kit