Coronary artery disease

Coronary artery disease occurs when the coronary arteries — the blood vessels supplying blood to the heart — narrow. This narrowing can restrict blood flow to the heart, causing symptoms such as chest pain or shortness of breath.

Without treatment, coronary arteries can become completely or nearly completely blocked, a condition called a chronic total occlusion. Other names for coronary artery disease include coronary heart disease and ischemic heart disease.

There are three types of coronary artery disease:

• Obstructive coronary artery disease: This type occurs when a fatty substance called plaque builds up the coronary arteries, leading to artery narrowing. Its the most common type of coronary heart disease.
• Nonobstructive coronary artery disease: There’s no plaque buildup in the coronary arteries. Instead, narrowing in the coronary artery is caused by other conditions, including irregular constrictions (coronary vasospasm), heart tissue that compresses the coronary arteries (myocardial bridging) or damage to the artery lining (endothelial dysfunction).
• Spontaneous coronary artery dissection (SCAD): A sudden tear in the coronary artery wall blocks blood flow to the heart. SCAD causes sudden symptoms that often present as a heart attack.

Coronary artery disease often doesn’t cause noticeable symptoms in early stages. As the coronary arteries continue to narrow, the condition can cause more frequent and intense symptoms, including:

• Chest pain (angina), fullness or pressure
• Fatigue
• Heart palpitations, or sensations of a racing heartbeat
• Shortness of breath (dyspnea)
• Swelling in the hands or feet

Sometimes, the first symptom of coronary artery disease is a heart attack. Heart attacks may cause crushing chest pain, arm pain, shoulder pain, and shortness of breath. A heart attack is a medical emergency and requires timely care to minimize heart damage.

Coronary artery disease most often occurs when plaque builds up in the coronary arteries. Several conditions or lifestyle habits can lead to this plaque buildup, including:

• Diabetes
• A diet high in sodium or sugar
• High blood pressure (hypertension)
• High cholesterol
• Sedentary lifestyle
• Smoking

People are also more likely to develop coronary artery disease if they have risk factors such as:

• Being male
• Being 65 or older
• Chronic lack of sleep
• Family history of coronary artery disease
• Long-term stress
• Obstructive sleep apnea

Coronary artery disease progression tends to be slow in most people, but it does vary from person to person. Many people have coronary artery disease for several years before they ever experience symptoms. The condition tends to progress more quickly in people who have multiple risk factors.

Lifestyle changes can slow the progression of coronary artery disease. Your doctor may suggest adopting habits such as:

• Eating a diet low in saturated fats, trans fats and sugar
• Exercising several times a week
• Managing your blood pressure and cholesterol with the help of your healthcare provider

Your doctor performs a physical exam and asks about your symptoms. Most people need one or more tests to diagnose coronary artery disease, including:

• Coronary angiography, using X-rays and contrast dye to view how blood flows through the coronary arteries
• Coronary artery calcium scan, using a CT scan to assess the coronary arteries for calcium or plaque buildup
• Echocardiogram to view the heart’s structures
• Electrocardiogram (EKG) to measure the electrical activity in the heart
• Electron-beam computed tomography (EBCT), using an electron gun to scan the chest and check for calcium buildup in the linings of the coronary arteries
• Exercise stress test to evaluate how the heart functions during exercise or while taking medications that mimic the effects of exercise
• Heart CT scan, using X-rays and specialized computers to create pictures of the heart
• Intravascular ultrasound to see inside the coronary artery walls, pinpoint plaque and plan treatment
• Nuclear stress test, injecting a small, safe amount of radioactive material into the bloodstream to see how well blood flows through the heart at rest and during exercise

Coronary artery disease treatment focuses on improving blood flow to your heart. The experts in Penn’s Coronary Artery Disease Program use their vast clinical knowledge and judgment to determine the best treatment plan for you. We offer a full range of coronary artery disease treatments, including minimally invasive and clinical trial treatments.

Diagnosis and choice of treatment for coronary artery disease are not as straightforward as might be imagined. That’s where the vast experience of Penn physicians makes a difference. Their expert clinical judgment and knowledge of the latest technology and techniques are why the toughest cases in the region are routinely referred to Penn Medicine.

Treatment plans may include:

• Lifestyle changes, including cardiac rehabilitation
• Medications to improve blood flow, prevent blood clots or reduce cholesterol
• Interventional procedures, such as percutaneous coronary interventions (PCI)
• Hybrid revascularization, a procedure that combines PCI and CABG techniques to restore blood flow
• Coronary artery bypass grafting (CABG)

Some risk factors for coronary artery disease, such as age and family history, aren’t controllable. But there are some lifestyle changes that can lower your risk of developing coronary artery disease, including:

• Achieving and maintaining a healthy weight for your age, body type, and sex
• Controlling chronic conditions such as diabetes or high blood pressure
• Eating a nutritious diet high in lean protein, whole grains, healthy fat, fruits and vegetables
• Exercising at a moderate intensity for at least 150 minutes per week
• Managing stress with healthy coping techniques, such as meditating or talking with trusted loved ones
• Lowering your alcohol intake and avoiding binge drinking
• Quitting smoking