Overview

Really anyone with risk factors for heart disease can develop CAD. But it's more likely as you get older and if you:

• Have high blood pressure, high cholesterol or diabetes
• Smoke
• Are overweight or obese
• Don't lead a very active lifestyle
• Eat a high-fat, poor diet
• Have a family history of early (premature) heart disease (meaning any first-degree female relative who has heart disease before the age of 65 or any first-degree male relative with heart disease before the age of 55)

"Although you can't pick your parents to change your genetic risk for heart disease—and your age is what it is—there are many risk factors for heart disease that you can change to help protect yourself. Talk with your health care team about what's right for you."

— Dr. Martha Gulati, CardioSmart.org editor in chief

The signs of CAD can vary. Some people have no symptoms at all, which is fairly typical during the early stages of the disease. For others, chest pain or chest pressure—or even a heart attack—might be the first sign of blockages in the heart's arteries.

Chest pain or discomfort is the most common symptom of reduced blood flow to the heart (also known as angina). It occurs when the heart isn't getting enough oxygen or blood. People describe it as pain, pressure, squeezing or fullness in their chest. But this feeling can also be very subtle. Chest pain or discomfort can be brought on by activity or extreme emotion, but it usually subsides with rest. You may also feel short of breath, generally weak or unusually tired. Women more often than men may not have chest pain; their symptoms may be limited to pain in their neck, jaw or back.

Severe narrowing or blockage of an artery can also lead to heart attack, which can happen when plaque ruptures into the artery and a clot forms to heal the injury.

When to call for help

A heart attack can feel different for men and women. If you think you are having a heart attack, don't question it. Act fast and dial 911 if you or a loved one has any of these symptoms.

Differences in Symptoms of Heart Attack/Angina Based on Sex
Men–usually more classic signs	Women–may be more subtle
Chest pain or discomfort Pain or discomfort in one or both arms or that radiates to the neck, jaw or back Shortness of breath	Chest pain or discomfort Pain or discomfort in one or both arms or that radiates to the neck, jaw or back Shortness of breath Difficulty breathing with usual activities (often in the weeks leading up to a heart attack) Nausea/vomiting Feeling lightheaded or faint

Your doctor will take a medical history, ask about your symptoms and listen to your heart with a stethoscope. He/she may order tests to determine whether you have CAD and to what extent (for example, doing an angiography can tell your provider exactly how much of the inner part of the vessel is blocked). The results of these tests can also help guide treatment decisions.

Tests may include:

• Routine blood tests to check the level of fats, cholesterol, sugar and proteins in your blood. These are risk factors for heart disease that can be modified with lifestyle changes and, if needed, medication.
• Electrocardiogram (EKG), which records your heart's electrical activity and shows how fast or evenly the heart is beating. It can also show whether there is enough blood supply to the heart or if it is already damaged.
• Echocardiogram to look at the structure and overall function of your heart.
• Stress testing, which involves exercising, usually on a treadmill or stationary bike (or taking medicine to simulate exercise if you are unable to be active), to non-invasively evaluate blocked arteries in the heart.
• Chest X-ray to look at the heart and lungs and to see if there are abnormalities that might explain your symptoms.
• Computed tomography (CT) scan of the heart that shows pictures of the heart's arteries and whether there is a buildup of plaque, even in the early stages before the plaque hardens.
• Coronary angiography is done in the cardiac catheterization laboratory, and involves threading a thin tube or catheter into an artery, usually in the wrist or leg, and up to the heart. The test goes into the body to directly evaluate the arteries of the heart. It usually is recommended when a non-invasive test is abnormal or a patient's symptoms strongly suggest CAD.

What do the results mean?

Your doctor might tell you that you have "less than 70% blockage in an artery." That means that you have non-obstructive CAD. In other words, blood flow to the heart muscle is not reduced at rest, but may be limited during intense exercise or exertion. In this case, risk reduction through lifestyle and medication is the best treatment.

Or your doctor might say you have "over 70% blockage in one artery." This means that you have severe blockages in both coronary arteries. Blood flow to the heart muscle is significantly reduced and would likely explain any chest pain or shortness of breath you may have been feeling. In this case, your doctor might recommend more aggressive medical treatment, and possibly recommend a procedure or surgery.

Degree of CAD	How much the artery is blocked
Mild	Less than 49%
Moderate	50%-70%
Severe	More than 70%

There are a number of treatment options for CAD, including lifestyle changes, medications, surgery and/or medical procedures.

Lifestyle changes include:

• Adopting a heart-healthy eating plan
• Exercising regularly
• Getting to a healthy body weight
• Not smoking
• Managing stress

Medications may be recommended to treat high cholesterol, high blood pressure, and high blood sugar. Sometimes medications for chest pain that comes on with activity are recommended. Aspirin or other blood thinners may also be recommended.

Procedures or surgeries may be recommended if you have a severely narrowed coronary artery to reduce the risk of a heart attack. For example:

• Percutaneous interventions use a stent to help prop open the artery or a balloon procedure to dilate, or open, the artery (also called transcatheter interventions). This is also known as a PTCA or stent.
• Coronary artery bypass surgery (CABG), or open-heart surgery, to insert segments of arteries or veins around the obstruction and bypass the blockage.

Your treatment will depend on:

• How much narrowing there is and where it is located (if it's near the heart muscle or if the branches are involved)
• How many arteries are affected
• Your symptoms
• Your age and overall health
• Other risk factors
• Your preferences

Cardiac rehab is beneficial to all patients with angina (chest pain) or after a heart attack, coronary procedure, valve surgery or heart failure. Cardiac rehab is a 12-week program that includes a mix of supervised exercise, nutrition counseling, stress management, smoking cessation assistance and education about the disease process, including how you can better take control of your health and improve outcomes.

Finding out that you or a loved one has CAD can be upsetting. But you're not alone and there is good news: More people are living with CAD than ever before thanks to earlier diagnosis and better treatments. There are also steps you can take to help prevent problems and feel better.

1. Learn all you can about your condition. It will help you to ask the right questions, and know how to best to manage it.
2. Make heart-healthy choices every day. Simple changes can make a big difference.
3. Ongoing care is a priority. Your heart team will want you to come in for periodic visits and imaging tests to help track your condition. It's important to keep these appointments. Be prepared to talk about any changes in your health or how you are feeling.
4. Find an exercise program that's right for you. Talk with your doctor about what type of physical activity is best, and how often you should be active.
5. Ask your family and friends to help you adopt—and keep up with—healthy habits. Think about ways to make it fun. For example, cooking a new, healthy meal together or centering get-togethers around activities such as taking a nature hike, riding bikes or trying a new exercise class.
6. Take your medications exactly as prescribed. Medications don't work the way they should if you don't take the right dose at the right time. Talk with your cardiologist and pharmacist if you don't know how to take your medications or what their role is.
7. Ask whether consulting a nutritionist or dietitian might be helpful. He/she can look at your eating patterns and map out a plan for making heart healthier choices, and also give tips on how to control portions d prepare foods.
8. Seek counseling and/or join a support group, especially if you feel depressed or anxious. Untreated depression or high stress is linked to worsening heart disease, including heart attacks.
9. Find positive ways to cope with stress. Too much stress can be bad for the heart—and your general health.

To learn more about CAD, visit CardioSmart's condition center. In addition to the resources on CardioSmart.org, you can find out more about CAD at:

• American Heart Association
  www.heart.org
• Mended Hearts
  www.mendedhearts.org
• National Lung, Blood and Heart Institute
  www.nhlbi.nih.gov
• U.S. National Library of Medicine
  www.medlineplus.com search 'coronary artery or heart disease'
• WomenHeart
  www.womenheart.org