Coronary Artery Disease

Definition

Coronary artery disease is a narrowing or blockage of your coronary arteries (the blood vessels that supply oxygen-rich blood to your heart muscle to keep it pumping) usually caused by the buildup of fatty material called plaque. Coronary artery disease is also called coronary heart disease, ischemic heart disease and heart disease.

The coronary arteries are located directly on top of your heart muscle. You have four main coronary arteries:

The right coronary artery
The left coronary artery
The left anterior descending artery
The left circumflex artery

Blacks have the highest overall mortality rate from coronary heart disease (CHD) of any ethnic group in the United States, particularly out-of-hospital deaths, and especially at younger ages.

All of the reasons for the excess CHD mortality among Blacks aren’t clear. However, a high prevalence of certain coronary risk factors, delay in the recognition and treatment of high-risk individuals, and limited access to cardiovascular care play a major role.

Acute and chronic CHD in Blacks is similar to that in whites. However, Blacks have a higher risk of sudden cardiac death and present more often with unstable angina (not getting enough blood supply to your heart muscle, which leads to chest discomfort or chest pain) and non-Q-wave myocardial infarction than whites.

Blacks also have less obstructive coronary artery disease on angiography, but may have a similar or greater total burden of coronary atherosclerosis, according to the National Center for Biotechnology Information. The disproportionately high prevalence and severity of hypertension and type 2 diabetes in the Black community also plays a major role in the disparity they face with CHD.

Risk Factors

You have an increased risk of coronary artery disease if you:

Have a high cholesterol level (especially a high LDL “bad” cholesterol level and a low HDL “good” cholesterol level).
Have high blood pressure.
Have a family history of heart disease.
Have diabetes.
Are a smoker.
Are a man over 45 years of age or a post-menopausal woman.
Are overweight.
Are physically inactive.
Are Black, Mexican American, Native American, Native Hawaiian or an Asian American. The increased risks are caused by higher rates of high blood pressure, obesity and diabetes in these populations.

Symptoms

Symptoms of coronary artery disease aren’t always present. Sometimes you won’t know you have coronary artery disease until you have a heart attack. Symptoms of a heart attack include:

Chest discomfort (angina) described as heaviness, tightness, pressure, aching, burning, numbness, fullness, squeezing or a dull ache. The discomfort can also spread to or only be felt in your left shoulder, arms, neck, back or jaw.
Feeling tired.
Dizziness, lightheadedness.
Nausea.
Weakness.

Symptoms of a heart attack in women can be slightly different and include:

Discomfort or pain in the shoulders, neck, abdomen (belly) and/or back.
Feeling of indigestion or heartburn.
Unexplained anxiety.
Cold sweat.

Diagnosis

Unless your condition is an emergency (you’re having a heart attack or stroke), your cardiologist (heart doctor) will ask you about your symptoms, take your medical history, review your risk factors and perform a physical exam.

Diagnostic tests may include:

Electrocardiograph tests (EKG): This test records the electrical activity of the heart. Can detect heart attack, ischemia and heart rhythm issues.
Exercise stress tests: This is a treadmill test to determine how well your heart functions when it’s working the hardest. Can detect angina and coronary blockages.
Pharmacologic stress test: Instead of using exercise to test your heart when it is working its hardest, medication is given to increase your heart rate and mimic exercise. This test can detect angina and coronary blockages.
Coronary calcium scan: This test measures the amount of calcium in the walls of your coronary arteries, which can be a sign of atherosclerosis.
Echocardiogram: This test uses sound waves to see how well the structures of your heart are working and the overall function of your heart.
Blood tests: Many blood tests are ordered for factors that affect arteries, such as triglycerides, cholesterol, lipoprotein, C-reactive protein, glucose, HbA1c (a measure of diabetic control) and other tests.
Cardiac catheterization: This test involves inserting small tubes into the blood vessels of the heart to evaluate heart function including the presence of coronary artery disease.

Other diagnostic imaging tests may include:

Nuclear imaging: This test produces images of the heart after administering a radioactive tracer.
Computed tomography angiogram: Uses CT and contrast dye to view 3D pictures of the moving heart and detect blockages in the coronary arteries.

Treatments

Reducing your risk factors and making the necessary lifestyle changes is the first step to treating coronary artery disease. This includes:

Not smoking. If you smoke or use tobacco products, quit. Ask your healthcare providers about ways to quit, including programs and medications.
Managing health problems like high cholesterol, high blood pressure and diabetes.
Eat a heart-healthy diet. You can talk to your healthcare provider or a registered dietitian about ways to change your diet to reduce your risk of heart disease. Good dietary choices include the Mediterranean and DASH diets.
Limiting your alcohol use. You should limit daily drinks to no more than one drink per day for women and two drinks per day for men.
Increasing your activity level. Exercise helps you lose weight, improve your physical condition and relieve stress. Most people can reduce their risk of heart attack by doing 30 minutes of walking five times per week or walking 10,000 steps per day. Talk to your healthcare provider before you start any exercise program.
Taking your medications as prescribed by your doctor.

Coronary artery disease can lead to the following other heart conditions:

Angina.
Heart attack.
Heart rhythm problems.
Heart failure.
Cardiogenic shock.
Sudden cardiac arrest.

You can reduce your chance of developing any of these heart conditions if you follow your cardiologist’s treatment plan.

When to see a doctor

You should call 911 if you think you are having symptoms of a heart attack.

If a blood clot in a coronary artery has broken loose and moved into your brain, it can cause a stroke, although this is rare. Symptoms of a stroke include:

Drooping on one side of your face. Look at your smile in a mirror or ask someone to check your smile.
Arm weakness or numbness.
Difficulty speaking/slurred speech.

It is important that you act fast and call 911 immediately if you experience any of these symptoms because every minute you spend without treatment increases your risk of long-term damage.