Coronary artery disease program (CAD)
Find a vascular specialistCoronary artery disease (CAD) is the most common type of heart disease. It affects the blood vessels that supply your heart, making it harder for your heart to get the blood and oxygen it needs. This can cause symptoms such as chest discomfort, shortness of breath and fatigue.
Coronary artery disease can develop slowly over many years, but there are steps you can take to lower your risk. At Advocate Health Care, our cardiologists offer comprehensive care to help prevent, diagnose and treat CAD.
What is coronary artery disease?
Coronary artery disease occurs when your coronary arteries can’t deliver enough blood to your heart muscle. The arteries may become narrowed or blocked, which can reduce the flow of oxygen-rich blood to your heart.
This reduced blood flow is known as ischemic heart disease.
Over time, plaque can build up along the walls of an artery, causing it to narrow, reducing blood flow and potentially blocking it completely.
How coronary arteries work
Your coronary arteries are blood vessels that surround your heart. They deliver the oxygen and nutrients your heart muscle needs to keep pumping blood throughout your body.
When your coronary arteries are healthy, blood can flow freely through them. If an artery becomes narrowed or blocked, less blood and oxygen can reach your heart muscle.
How plaque buildup (atherosclerosis) causes CAD
Atherosclerosis is the buildup of plaque inside your arteries. Plaque is made up of cholesterol, fat, calcium and other substances found in your blood. Over time, plaque can cause an artery to become stiff and narrow.
The rate at which plaque builds up varies from person to person. Several factors affect how quickly atherosclerosis develops, including high cholesterol, high blood pressure, smoking, diabetes, being overweight or having obesity, physical inactivity and a family history of heart disease. Your age also can increase your risk.
A piece of plaque can also break open, causing a blood clot to form. If the clot blocks blood flow to your heart, it can cause a heart attack. If you think you are experiencing a heart attack, call 911 immediately.
Types of coronary artery disease
There are three main types of coronary heart disease that can affect your heart in different ways. Not all types are caused by plaque buildup.
Obstructive coronary artery disease is the most common type of CAD. It occurs when your coronary arteries gradually narrow due to plaque buildup (atherosclerosis).
As the artery narrowing worsens, it can eventually cut off blood flow to your heart. A sudden blockage is known as a heart attack, which requires immediate medical attention to minimize heart damage.
Nonobstructive coronary artery disease occurs because of other problems with your coronary arteries. It’s not caused by plaque buildup. Instead, your coronary arteries may have problems such as:
- Compression or squeezing from the heart muscle (myocardial bridging)
- Constrictions at improper times (coronary vasospasm)
- Damage to the artery lining (endothelial dysfunction)
- Malfunctions in smaller artery branches (microvascular dysfunction)
Nonobstructive coronary artery disease can still cause many of the traditional symptoms of coronary artery disease, such as chest pain or shortness of breath. Many people with nonobstructive coronary artery disease experience angina, or chest pain, related to CAD. While nonobstructive heart disease can develop in anyone, it’s most common in females.
Spontaneous coronary artery dissection (SCAD) occurs when a tear in the coronary artery wall partially or completely blocks blood flow. This tear happens suddenly and often causes a heart attack.
SCAD and heart attack symptoms can vary from person to person but may include:
- Chest pain, especially on the left side or center of your chest that doesn’t go away with rest
- Jaw, neck or back pain
- Lightheadedness or weakness
- Pain radiating from your chest through your shoulders or arms
- Sensations of fullness, pressure or squeezing in your chest
- Shortness of breath, even at rest
How common is coronary artery disease?
Though coronary artery disease is the most common cause of death in the U.S., it’s largely preventable through lifestyle changes and medication. Early detection is also important. A heart scan can help you discover your risk of CAD.
What are the symptoms of coronary artery disease?
Signs and symptoms of coronary artery disease can vary greatly from one person to another. In the early stages, you may not notice any coronary artery disease symptoms. “It’s not unusual for people to say that they’ve been having heart disease symptoms, but they thought it was indigestion,” says Dr. Paul Silverman, cardiologist with Advocate Health Care. “There are people who have something called silent ischemia, where the heart’s not getting enough blood flow, but they don’t experience any symptoms.”
Some of the most common coronary artery disease symptoms include:
- Chest pain
- Heart palpitations
- Indigestion
- Irregular heart rhythms, called arrhythmias
- Severe fatigue
- Shortness of breath
- Swelling of the hands and feet
Early signs of CAD
As your coronary arteries narrow, you may experience:
- Chest pain
- Racing, fluttering or pounding heartbeats (heart palpitations)
- Shortness of breath, especially during activity
For some people, the first sign of coronary artery disease is a heart attack. In fact, coronary artery disease is one of the most common causes of heart attacks.
Heart attack symptoms
A heart attack occurs when the blood supply to your heart is suddenly blocked. It requires emergency treatment to restore blood flow to your heart.
Although heart attack symptoms can vary from person to person, the most common symptoms include:
- Chest pain in the center or left side of your chest
- Discomfort in your back, neck or jaw
- Lightheadedness or weakness
- Pain that radiates through one or both shoulders or arms
- Sensations of squeezing, pressure or fullness in your chest
- Shortness of breath, even without activity
CAD symptoms in women
Like heart attacks, the symptoms of coronary artery disease may also vary between men and women. “For women, oftentimes it may just be pain in the middle of the back, unexplained shortness of breath, jaw discomfort or burning in the chest,” says Dr. Silverman. “Women tend to experience heart disease in a different way than men.”
Heart attack symptoms are also slightly different in women than in men. Women may experience chest pain, but they also report:
- Anxiety
- Back pain
- Difficulty sleeping
- Extreme fatigue
- Indigestion
- Nausea
Because women’s symptoms may be less obvious and specific, they’re more likely to delay seeking medical treatment. But the sooner you receive treatment, the lower your risk of severe damage to your heart muscle.
When to seek emergency care for CAD symptoms
You should always call 911 or seek emergency treatment for:
- Chest pain: Chest pain can occur for many reasons. But because it's often one of the main symptoms of a heart attack, you should always seek emergency treatment for chest pain. Call 911 if you experience generalized pain or pain on the left side of the chest, especially along with other heart attack symptoms.
- Heart palpitations: Heart palpitations may feel like your heart is pounding, racing or skipping beats. Often, heart palpitations aren’t a cause for concern, especially if they happen infrequently and only last a few seconds. But if you have other heart disease symptoms, see your health care provider for evaluation and diagnosis. Call 911 if you experience heart palpitations along with other heart attack symptoms, including chest pain or shortness of breath.
When to speak with your provider about CAD symptoms
Some heart disease symptoms can be serious but may not require emergency treatment. You should call your provider if you experience:
- Abnormal heart rhythms: An irregular heart rhythm (arrhythmia) may feel like a fluttering or racing heartbeat. Irregular heartbeats may be no cause for concern, or they may point to an underlying condition like coronary artery disease. If you experience symptoms of persistent arrhythmias, see your provider for diagnosis and treatment.
- Fatigue: Many conditions can cause severe fatigue, including heart disease. If you feel constantly tired or have difficulty performing daily tasks, call your provider. You may need a heart screening to diagnose or rule out coronary artery disease.
- Swelling of the hands and feet: Swollen hands or feet are among the most common heart disease symptoms. Swelling doesn’t always mean you have heart disease, but you should call your provider for a checkup. You may need tests to diagnose or rule out coronary artery disease.
Coronary artery disease risk factors
Several factors can increase your risk of developing CAD. Some are within your control, while others are not.
CAD risk factors you can control
Managing these factors can help lower your risk of CAD and its complications.
Certain foods can increase your risk of plaque buildup. In particular, limit your intake of foods that are high in:
- Saturated fats, a type of dietary fat often solid at room temperature
- Trans fats, solid dietary fats made from liquid oils, such as margarine or shortening
- Sodium, including table salt, prepackaged or processed foods
- Sugar, including desserts, ready-to-eat cereals, sodas, energy drinks and juices
Obesity is defined as excess body fat. When you carry too much body weight, it can place extra stress on your blood vessels, making your heart work harder to pump blood through your body. Obesity is also linked to high cholesterol, high blood pressure and diabetes, which are all significant risk factors for coronary artery disease.
Staying physically active is one of the best ways to maintain a healthy weight. It can help lower your blood pressure and strengthen your heart. Ideally, aim for at least 150 minutes of moderate-intensity exercise, such as walking, biking or swimming, every week.
Smoking is the number one cause of preventable death in the U.S. And it’s a major risk factor for cardiovascular disease. It constricts your blood vessels, causing your heart to work even harder.
E-cigarettes can be just as harmful – recent research has found that vaping raises your risk of a heart attack, coronary artery disease and depression. A smoking cessation program can help you successfully quit smoking and immediately improve your overall health.
Alcohol and drugs can also be major sources of heart damage. Both can weaken and thin your heart muscle and may lead to heart rhythm problems. Quitting isn’t easy, but your health care provider can help you create a plan to stop smoking or using drugs or alcohol.
Nearly half of all Americans have one of the three major risk factors for coronary artery disease: smoking, high blood pressure and high cholesterol.
High blood pressure is often called “the silent killer” because you may have it without experiencing any symptoms. But, over time, high blood pressure weakens your arteries, which further decreases blood flow to your heart.
Cholesterol is the main component in plaque. Your liver naturally produces all the cholesterol you need, but you may consume extra cholesterol in the food you eat. As cholesterol increases in your blood, it can form fatty deposits (plaque) in your arteries. This plaque buildup is the primary cause of coronary artery disease.
Diabetes is also a major risk factor for coronary heart disease. In diabetes, your body either doesn’t make enough insulin or doesn’t use it correctly. Insulin is the hormone that helps convert sugar into energy. When you have diabetes, sugar builds up in your bloodstream. Over time, high blood sugar can damage your blood vessels and stiffen your heart muscle.
Sleep apnea is often associated with high blood pressure, heart arrhythmias and heart failure. Although many people think of sleep apnea as a snoring condition, it’s much more than that.
The most common type of sleep apnea is obstructive sleep apnea, in which your upper airway has trouble staying open when you’re asleep. This leads to temporary pauses in breathing. Each time your airflow stops, your body sends out stress hormones. This pattern can eventually lead to high blood pressure, diabetes and heart disease.
While stress alone isn’t considered a root cause of coronary artery disease, chronic stress can increase your overall risk.
Dr. Ajay Baddi, a cardiologist with Advocate Heart Institute, explains it this way: “Usually, stress is the trigger – it doesn’t cause a heart attack or heart disease by itself. Stress raises your adrenaline, which, combined with coronary artery disease, can damage your heart.”
Finding healthy ways to manage ongoing stress may help protect your heart health.
CAD risk factors you can’t control
Some risk factors can’t be changed, but it doesn’t mean you will develop CAD. Your provider can help you understand your individual risk and identify steps you can take to protect your heart.
- Family history: If a family member has or had heart disease or another heart condition, it increases your risk for coronary artery disease. Your risk is especially higher if one of your parents or siblings had a heart attack before age 50.
- Age and gender: As you get older, your risk of heart disease increases. Adults over 65 are more likely to develop coronary artery disease, especially if they also have other risk factors. Males also have an overall higher risk of coronary artery disease. For females, the risk significantly increases after menopause.
What are the complications of coronary artery disease?
Without treatment, coronary heart disease can lead to serious complications. These may include:
- Arrhythmias (irregular heartbeat)
- Cardiogenic shock
- Cardiac arrest
- Heart attack
- Heart failure
Your risk of complications depends on factors such as the extent of your coronary artery disease, your overall health and whether you receive treatment.
How is coronary artery disease diagnosed?
Your provider will ask about your symptoms, health history and risk factors. They may also perform a physical exam and recommend tests to check your heart and blood vessel.
A common test used to look for narrow or blocked coronary arteries is a coronary angiogram. During the test, your doctor guides a thin tube called a catheter through a blood vessel to your heart and injects contrast dye. X-ray images show how blood flows through your coronary arteries. The procedure is called cardiac catheterization.
During the angiogram, your provider may insert a wire through the catheter to measure the pressure difference across the blockage. This technique, called instantaneous wave-free ratio (IFR), helps assess the severity of the blockage and determine the best course of treatment.
Other tests our cardiologists use to diagnose coronary artery disease include:
- Electrocardiogram (ECG): Measures the electrical activity of your heart.
- Stress test: Uses an electrocardiogram (ECG) while you exercise to evaluate how your heart functions when it’s working harder.
- Echocardiogram: Uses sound waves to produce images of your heart and nearby blood vessels.
- CT angiogram: Uses contrast dye and a computer tomography (CT) scan to create detailed images of your heart and coronary arteries.
- Coronary artery calcium (CAC) scan: Uses a CT scan to measure calcium buildup in your coronary arteries.
- CT fractional flow reserve: Uses data from a CT scan to create a 3D model of your coronary arteries. Specialized computer technology then estimates how much a blockage may affect blood flow to your heart.
How is coronary artery disease treated?
Our experienced cardiologists and heart surgeons offer advanced treatments for coronary artery disease. We work as a team to understand your condition and create a care plan tailored to your needs.
Your care team considers several factors when recommending treatment. These may include how much your arteries are narrowed, where the blockages are located, your symptoms and how well your heart is working.
Treatment may include lifestyle changes, medications or procedures to improve blood flow. You may need more than one type of treatment.
Healthy habits can help slow the progression of coronary artery disease and lower your risk of complications. Your provider may recommend that you:
- Eat a heart-healthy diet
- Increase activity levels
- Lose weight
- Quit smoking
- Decrease alcohol consumption
- Reduce stress
- Treat sleep apnea
If the blockage is less severe, your care team may recommend medication along with lifestyle changes to manage symptoms and slow the progression of coronary artery disease.
Your doctor may prescribe medications to:
- Lower cholesterol and blood pressure
- Manage diabetes
- Reduce chest pain
- Improve blood flow
- Reduce the risk of blood clots
Take your medications as prescribed and talk with your provider before stopping a medicine or changing your dose.
Angioplasty is a procedure that opens a narrowed or blocked coronary artery. During the procedure, your cardiologist guides a thin tube called a catheter through a blood vessel to the affected artery.
A small balloon may be inflated to widen the artery. Your provider may also place a stent, which is a small mesh tube that helps keep the artery open.
Coronary artery bypass grafting (CABG) is a type of open-heart surgery that creates a new route for blood to flow around a blocked or narrowed coronary artery.
During CABG, a surgeon uses a healthy blood vessel from another part of your body to create the bypass. This allows blood to flow around the blockage and reach the heart muscle.
Not everyone with coronary heart disease needs surgery or a stent. Some people can manage their condition with medications and lifestyle changes.
Coronary artery bypass surgery (CABG) or angioplasty may be recommended when you have significant blockages, ongoing symptoms despite medication or certain patterns of coronary artery disease that are better treated with a procedure.
Your care team will recommend the approach that best fits your condition and overall health.
How to prevent coronary artery disease
Knowing your risk factors is the first step in preventing coronary artery disease. Speak with your provider about developing a plan to:
- Improve your health habits
- Manage your blood pressure and cholesterol
- Treat any underlying conditions, such as diabetes or sleep apnea
Frequently asked questions about CAD
Five common symptoms of coronary artery disease include:
- Chest pain or pressure
- Shortness of breath
- Fatigue
- Pain or discomfort in the arms, shoulders, neck, jaw or back
- Dizziness or lightheadedness
Some people don’t have symptoms until coronary artery disease becomes more advanced or causes a heart attack.
There isn’t one life expectancy for everyone with coronary artery disease. Your outlook depends on factors such as the severity of your disease, your age, other health conditions and how well your risk factors are managed.
Treatment can help reduce your risk of heart attack and other complications. Work with your provider to manage coronary artery disease and make changes that support your long-term heart health.
Yes. Coronary artery disease can become serious because reduced blood flow to the heart can lead to a heart attack, heart failure or other life-threatening complications. However, coronary artery disease is treatable, and managing your risk factors and following your treatment plan can help protect your heart.
You can take several steps to manage coronary artery disease and protect your heart. Your treatment may include lifestyle changes, medications, cardiac rehabilitation or procedures such as angioplasty and stenting or coronary artery bypass grafting (CABG).
Start by talking with your provider about your symptoms and risk factors. Together, you can create a treatment plan that’s right for you.
When to schedule a heart scan
If you have several risk factors for heart disease, you may need a heart scan to check your coronary arteries. Heart scans look for plaque buildup and other signs of coronary artery disease.
We offer quick and inexpensive heart scans to find out if you are at risk of developing coronary artery disease – or if you already have it. This simple test just might save your life. Learn more about our $49 heart scans.
Are you at risk for heart disease?
Knowing your risk factors of heart disease – the leading cause of death in the U.S. – can help you lower your chances of developing it. Our heart health quiz estimates your risk, determines which of your risk factors are controllable and gives you an idea of what do to next based on your results.