Coronary artery disease

Atherosclerosis

Angina

Myocardial infarction

Microvascular disease

 

Coronary artery disease

Coronary artery disease (CAD) is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis.

 

Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina or a heart attack.

 

CAD is the most common type of heart disease. It's the leading cause of death in the United States for both men and women.

 

Signs & Symptoms

A common symptom of coronary artery disease (CAD) include:

 

• Angina - chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.
• Emotional stress also can trigger the pain.
• Shortness of breath.

 

However, some people have no signs or symptoms. This is called silent CAD. It may not be diagnosed until a person shows signs and symptoms of a heart attack, heart failure, or an arrhythmia. The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary arteries.

 

Major risk factors

 

• High blood cholesterol levels
• High blood pressure
• Smoking
• Insulin resistance, diabetes, and metabolic syndrome
• Overweight or obesity
• Lack of physical activity
• Age 
• Family history of early heart disease

 

Outlook

Treatment for CAD may include lifestyle changes, medicines, and medical procedures. Lifestyle changes include following a heart healthy eating plan, increasing physical activity, maintaining a healthy weight, quitting smoking, and reducing stress.

Taking action to control your risk factors can help prevent or delay CAD. You can take action by making lifestyle changes and/or taking medicines as prescribed by your doctor.

 

Atherosclerosis

Atherosclerosis is a disease in which plaque builds up on the insides of your arteries, the blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.  Over time, plaque hardens and narrows your arteries reducing the flow of oxygen-rich blood to your organs and other body parts.  This can lead to serious problems, including heart attack, stroke, or even death.

 

Atherosclerosis can affect any artery in the body.

 

• Coronary artery disease (CAD) occurs when plaque builds up in the coronary (heart) arteries.
• Carotid artery disease occurs when plaque builds up in the carotid arteries (the arteries that supply blood and oxygen to your brain).
• Peripheral arterial disease (PAD) occurs when plaque builds up in the major arteries of the legs, arms, and pelvis.

 

Major risk factors

 

• High blood cholesterol levels
• High blood pressure
• Smoking
• Insulin resistance, diabetes, and metabolic syndrome
• Overweight or obesity
• Lack of physical activity
• Age 
• Family history of early heart disease

 

Signs & Symptoms

Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as a heart attack or stroke. Other signs and symptoms depend on which arteries are narrowed or blocked.

 

Outlook

Your doctor will diagnose atherosclerosis based on your medical and family histories, your risk factors, and the results of a physical exam and diagnostic tests. Treatments for atherosclerosis may include lifestyle changes, medicines, and medical procedures and surgery. Lifestyle changes include following a healthy eating plan, increasing physical activity, maintaining a healthy weight, quitting smoking, and reducing stress.

 

Taking steps to control your risk factors can help prevent or delay atherosclerosis and its related diseases. These steps include making lifestyle changes and/or taking medicines as prescribed by your doctor.

 

Angina

Angina is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina itself isn't a disease. Rather, it's a symptom of an underlying heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most common type of heart disease.

 

There are three types of angina - stable, unstable, and variant (Prinzmetal's). Knowing how the types are different is important. This is because they have different symptoms and require different treatment.

 

• Stable angina. The most common type. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. If you know you have stable angina, you can learn to recognize the pattern and predict when the pain will occur. Pain usually goes away in a few minutes after you rest or take your angina medicine. Stable angina isn't a heart attack, but it makes a heart attack more likely in the future.
• Unstable angina. Does not follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine. Unstable angina is very dangerous and needs emergency treatment. It's a sign that a heart attack may happen soon.
• Variant (Prinzmetal's) angina. Is rare. It usually occurs while you're at rest. The pain can be severe. It usually happens between midnight and early morning. This type of angina is relieved by medicine.

 

Signs & Symptoms

Angina may feel like pressure or squeezing in your chest. It may feel like indigestion. Other signs and symptoms include:

 

• Pain in the shoulders, arms, neck, jaw, or back.
• Nausea
• Fatigue
• Shortness of breath
• Sweating, light-headedness, or weakness also may occur

 

Outlook

Treatments for angina include lifestyle changes, medicines, medical procedures, and cardiac rehabilitation. Lifestyle changes include following a healthy eating plan, quitting smoking, being physically active, losing weight, and learning how to handle stress and relax.

 

You can prevent or lower your risk for angina and CAD by making lifestyle changes and treating related conditions.

If you have angina, it's important to know the pattern of your angina, what medicines you take (keep a list) and how often you should take then, how to control your angina, and the limits on your physical activity. You should know how and when to seek medical help.

 

Myocardial infarction (heart attack)

Heart attacks occur most often as a result of coronary artery disease (CAD). In CAD, a fatty material called plaque builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.

 

During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats).

Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.

 

Signs & Symptoms

The most common heart attack signs and symptoms are:

 

• Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
• Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath may occur with or before chest discomfort.
• Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

 

Outlook

Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.

 

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms. Many more people could recover from heart attacks if they got help faster.

 

If you think you or someone you know may be having a heart attack:

 

• Call 9–1–1 as soon as possible after the start of symptoms. If your symptoms stop completely in less than 5 minutes, still call your doctor.
• Only take an ambulance to the hospital. Going in a private car can delay treatment.
• Take a nitroglycerin pill if your doctor has prescribed this type of medicine.

 

Microvascular disease

Coronary microvascular disease (MVD) affects the heart's smallest coronary arteries. Coronary MVD is a new concept. It's different from traditional coronary artery disease (CAD). In CAD, plaque builds up in the heart's large arteries. This buildup can lead to blockages that limit or prevent oxygen-rich blood from reaching the heart muscle. Coronary MVD occurs in the heart's tiny arteries when:

 

• Plaque forms in the arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. It narrows the coronary arteries and reduces blood flow to the heart muscle. As a result, the heart doesn't get the oxygen it needs. This is known as ischemic heart disease, or heart disease. In coronary MVD, plaque can scatter, spread out evenly, or build up into blockages in the tiny coronary arteries.
• Arteries spasm (tighten). Spasms of the small coronary arteries also can prevent enough oxygen-rich blood from moving through the arteries. This too can cause ischemic heart disease.
• Walls of the arteries are damaged or diseased. Changes in the arteries' cells and the surrounding muscle tissues may, over time, damage the arteries' walls.

 

Signs & Symptoms

Typical signs and symptoms of CAD include:

 

• Angina
• Pressure or squeezing in the chest
• Shortness of breath
• Heavy sweating
• Arm or shoulder pain
• Sleep problems
• Fatigue (tiredness) and lack of energy

 

Outlook

Death rates from heart disease have dropped quite a bit in the last 30 years. This is due to improved treatments for conditions such as blocked coronary arteries, heart attack, and heart failure. However, death rates haven't improved as much in women as they have in men. Diagnosing coronary MVD has been a challenge for doctors. Most of the research on heart disease has been done on men. Standard tests used to diagnose heart disease have been useful in finding blockages in the coronary arteries. However, these same tests used in women with symptoms of heart disease—such as chest pain—often show that they have "clear" arteries. Standard tests look for blockages that affect blood flow in the large coronary arteries. However, these tests can't detect plaque that forms, scatters, or builds up in the smallest coronary arteries.

The standard tests also can't detect when the arteries spasm (tighten) or when the walls of the arteries are damaged or diseased. As a result, women are often thought to be at low risk for heart disease.

 

Coronary MVD is thought to affect up to 3 million women with heart disease in the United States. Most of the information known about coronary MVD comes from the National Heart, Lung, and Blood Institute's WISE study (Women's Ischemia Syndrome Evaluation). The WISE study began in 1996. Its goal was to learn more about how heart disease develops in women. The role of hormones in heart disease has been studied, as well as how to improve the diagnosis of coronary MVD. Further studies are under way to learn more about the disease, how to treat it, and its outcomes.

 

 

Source: "Heart and Vascular Diseases." Diseases and Conditions Index. The National Heart, Lung, and Blood Institute. The National Institutes of Health.