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Coronary Artery Disease
(CAD; Coronary Atherosclerosis; Silent MI; Coronary Heart Disease; Ischemic Heart Disease; Atherosclerosis of the Coronary Arteries)
by Rosalyn Carson-DeWitt, MD
Coronary arteries bring oxygen rich blood to the heart muscle. Coronary artery disease (CAD) is narrowing of these arteries. If the blockage is complete, areas of the heart muscle may be damaged. In a severe case, the heart muscle dies. This can lead to a heart attack, also known as a myocardial infarction (MI).
Risk Factors TOP
Men, especially those who are over 45 years of age, are at increased risk. Women who are over 55 years of age are also at increased risk.
Factors that may increase your risk of CAD include:
Other risk factors may 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:
Chest pain may indicate more serious unstable angina or a heart attack if it includes the following:
Accompanying symptoms may include:
Immediate medical attention is needed for unstable angina. CAD in women may not cause typical symptoms. 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.
You will be asked about your symptoms and medical history. A physical exam will be done.
You may need to have your bodily fluids tested. This can be done with blood tests.
You may need to have pictures taken of your heart. This can be done with:
You may need to have your heart function tested. This can be done with:
Treatment may include:
This medication 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.
Other blood-thinning medications may be prescribed.
Beta-Blockers, Calcium-Channel Blockers, and ACE-Inhibitors TOP
These may help prevent angina. In some cases, they may lower the risk of heart attack.
Medications to Lower Cholesterol TOP
Medications, like statins, are often prescribed to people who have CAD. Statins lower cholesterol levels, which can help to prevent CAD events.
Patients with severe blockages in their coronary arteries may benefit from procedures to immediately improve blood flow to the heart muscle:
Options for Refractory Angina TOP
For patients who are not candidates for revascularization procedures, but have continued angina despite medication, options include:
To reduce your risk of CAD:
American Heart Association
National Heart, Lung, and Blood Institute
Heart and Stroke Foundation of Canada
Public Health Agency of Canada
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.
Coronary artery disease–Coronary heart disease. American Heart Association website. Available at:
...(Click grey area to select URL)
Updated April 26, 2017. Accessed September 13, 2017.
Coronary artery disease (CAD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 7, 2017. Accessed September 13, 2017.
Explore coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/cad. Updated June 22, 2016. Accessed September 13, 2017.
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Last reviewed September 2017 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 9/15/2014
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