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OVERVIEW

What is coronary artery disease?

Coronary artery disease is also called CAD. It occurs when the coronary arteries (blood vessels) that carry blood to your heart get blocked with plaque. That plaque collection is called atherosclerosis. Plaque is made of elements including fat and cholesterol. Over time, plaque can harden inside the walls of your arteries. When it does, it blocks the flow of blood to your heart. That blockage can cause angina (squeezing pain or pressure in your chest), a heart attack, or death. Coronary artery disease can lead to other problems, too, including heart failure and arrhythmias.

SYMPTOMS

What are the symptoms of CAD?

As your arteries become blocked you may experience:

• Angina
• Tightness in your arms, back, the back of your neck, or jaw.
• Shortness of breath
• Heart attack

Coronary artery disease may take years to develop. You may not notice symptoms until the disease has progressed far.

CAUSES & RISK FACTORS

What causes CAD?

Coronary artery disease affects both men and women. Several factors can increase your risk of developing the disease, including:

• Age
• Family history
• High blood pressure
• High cholesterol
• Smoking
• Poor diet
• Obesity or being very overweight
• Not exercising (sedentary lifestyle)
• Other health problems (such as diabetes)

DIAGNOSIS

How is coronary artery disease diagnosed?

Your healthcare provider may perform a physical exam and listen to your heart. They may also discuss your symptoms, family history, diet, activity level, and other medical conditions. There is no single test that can diagnose coronary artery disease. If your healthcare provider suspects you have it, they may order one or more of the following tests.

• EKG (electrocardiogram). This is a painless, simple test that monitors your heart’s beat and rhythm. Also, it tests the strength and timing of your heart’s electrical signals. It involves putting electrodes (tiny pads attached to wires) on your chest. The pads are held in place by a sticky substance.
• Stress test. During this test, you will be asked to exercise to give your heart a workout. You will be connected to heart, blood pressure, and oxygen monitors during the test. These monitors can detect changes to your heart rate, rhythm, electrical activity, or blood pressure during the test. The staff will also monitor you for shortness of breath or chest pain. If you are unable to exercise for medical reasons, the staff will administer medicine to raise your heart rate. Your heart’s response to the workout may suggest to the healthcare provider that you have possible blockages and need further testing. This test is painless. It’s a test that uses sound waves to see a picture of your heart while it’s beating. The picture will give healthcare providers a look at the size and shape of your heart. Also, it shows your heart chambers and valves.
• Chest X-ray. This is an X-ray focused in the area of your heart. The X-ray can detect signs of heart failure.
• Blood tests. The lab can test for certain conditions that raise your risk of coronary artery disease. These include testing certain fats, cholesterol, sugar, and proteins.
• Cardiac catheterization and coronary angiogram. This procedure is normally done if other tests show you have coronary artery disease. It’s performed in a hospital. You will get medicine before the test to make you sleepy. However, you may remain awake. During the test, a thin, flexible tube is inserted into a blood vessel in your arm, groin (upper thigh), or neck. The doctor will carefully move the tube to your coronary arteries, then inject a dye. An X-ray is used to monitor the dye as it travels through your coronary arteries. This helps the healthcare provider see your blood flow through your heart and blood vessels. This test is generally painless.

PREVENTION

Can coronary artery disease be prevented or avoided?

Coronary artery disease can’t be completely prevented or avoided. However, you can reduce your risks for getting the disease by:

• Stop smoking.  Nicotine raises your blood pressure, which contributes to coronary artery disease.
• Control your blood pressure.
• Eat healthy. Choose fruits, vegetables, meats, fish, and whole grains. Try to avoid processed foods, white flour, sugars, and high fructose corn syrup. If you have questions, contact your healthcare provider about how to make heart-healthy changes to your diet.
• Exercise. Regular exercise can make your heart stronger and reduce your risk of heart disease.
• Ask your healthcare provider about taking a low dose of aspirin each day. Aspirin helps prevent CAD, but taking it also has some risks.
• Ask your healthcare provider about taking vitamin supplements. While foods that are rich in vitamin E are very healthy and help reduce cardiovascular risk, the Canadian Task Force on Preventative Health Care has concluded that there is insufficient evidence for or against taking vitamin E supplements for the prevention of cardiovascular disease. Even though a diet rich in healthy foods reduces cardiovascular risk, there is no clear evidence that taking multivitamins does the same thing.

Talk to your healthcare provider about how to improve your diet. Diet and lifestyle changes will lower your risk of coronary artery disease. Your body will need time to respond to the changes you make. Your healthcare provider will watch your progress. For example, if your cholesterol level hasn’t improved after you’ve made changes for a few months, your healthcare provider may prescribe medicine to lower your cholesterol. You need to keep up the healthy lifestyle changes you started to help the medicine work.

TREATMENT

How is CAD treated?

Most people who have CAD take medicine to help control their condition. Medicines called beta-blockers, calcium channel blockers and nitrates can help relieve angina. Taking low‑dose aspirin every day can reduce the chance of a second heart attack in people who have already had one. ACE (angiotensin-converting enzyme) inhibitors help lower blood pressure and reduce the workload on the heart. Statins reduce the LDL (“bad”) cholesterol level in your blood. Your healthcare provider will tell you whether you should take any of these medicines.

Medicines may have side effects. Aspirin may cause upset stomach. Nitrates may cause a flush (redness in the face) and headaches. Beta-blockers cause tiredness and sexual problems in some patients. Calcium channel blockers may cause constipation and leg swelling. Most patients don’t have side effects. If you have side effects after taking a medicine, tell your healthcare provider.

Angioplasty is a surgical treatment for CAD.  This surgery is used to open blocked arteries around the heart. During this surgery, your doctor inserts a small tube, called a catheter, into an artery in your arm or leg. A small balloon and a metal stent are on the tip of the catheter. With a special instrument, the doctor threads the catheter from your arm or leg to the area around your heart. They then inflate the balloon, which also moves the stent into place. The balloon moves the plaque out of the way. The stent keeps your artery open so the blood can flow properly to your heart.

Another surgical treatment for CAD is bypass surgery. Pieces of veins or arteries are taken from the legs and sewn into the arteries of the heart to bring blood past a blockage and increase the blood flow to the heart. Bypass surgery is usually done when angioplasty isn’t possible or when your healthcare provider feels it’s a better choice for you.

Surgery, such as angioplasty or bypass surgery also has potential risks. The major risks can include heart attack, stroke or even death. These are rare and most patients do well. After angioplasty, you can usually expect to return to your previous activity level, or even a better activity level, within a few days. It takes longer (a few weeks or months) to recover from bypass surgery.

Living with coronary artery disease

Living with coronary artery disease means being aware of your risks and reducing the ones you can control. This includes diet, exercise, and stopping smoking. It is important to take your prescription medicine for high blood pressure, high cholesterol, diabetes, and any other health conditions.

FOR MORE INFORMATION

Heart and Stroke Foundation of Canada
Nova Scotia Toll free 1-800-423-4432
Prince Edward Island: (902) 892-7441

Canadian Heart and Stroke Foundation Website at:
http://www.heartandstroke.ca/

Public Health Services of Canada Website
https://www.canada.ca/en/public-health/services/diseases/heart-health/heart-diseases-conditions.html