Coronary Artery Disease (CAD): Symptoms, Causes, And Treatment

Coronary Artery Disease (CAD), also known as Coronary Heart Disease (CHD) or ischemic heart disease, is one of the most common types of heart disease worldwide. It occurs when the coronary arteries, which supply blood and oxygen to your heart, become narrowed or blocked. This limits the flow of blood and can cause chest pain, shortness of breath, heart attacks and other severe complications.

CAD happens because plaque, a mix of cholesterol, fats, and calcium, builds up inside the coronary arteries over many years. This process is known as atherosclerosis. The symptoms usually include chest pain, shortness of breath, tiredness and pain in the arm, jaw or back. It is usually treated using a change in lifestyle, medications and in severe cases, surgery, such as angioplasty or bypass.

In an exclusive interaction with us, Dr Utagi suggests that understanding CAD early can help reduce risk and prevent long-term complications. Read ahead to know everything he shared with us.

What Is Coronary Artery Disease?

Coronary artery disease occurs when plaque builds up in the inner part of the coronary arteries, making them hard and constricted. Over time, this reduces the heart’s oxygen supply and can cause symptoms during physical activity, emotional stress, or even at rest. Some of the major involved mechanisms include:

• Atherosclerosis: A gradual deposition of plaque on the artery wall
• Endothelial dysfunction: Reduced ability of blood vessels to dilate
• Inflammation: Chronic inflammation increases plaque development

As per the Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA), CAD is one of the top causes of morbidity and mortality in all parts of the world. The National Center for Health Statistics, Mortality Data on CDC WONDER, highlights that one person dies every 34 seconds from cardiovascular disease, making heart disease one of the leading causes of death for men, women, and people of most racial and ethnic groups.

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Symptoms of Coronary Artery Disease

As per the Cleveland Clinic, CAD symptoms usually develop gradually over time. Some individuals may not even exhibit any symptoms till the artery is blocked. Common symptoms include: 

1. Chest Pain or Discomfort (Angina)

Angina is a feeling of pressure, squeezing, heaviness, burning, or tightness, caused by reduced blood flow to the heart muscle, frequently caused by physical work or emotional pressure. However, it usually goes away in a few minutes of rest.

2. Shortness of Breath

Slower blood circulation can cause inefficiency of the heart, causing difficulty breathing, especially during activity.

3. Fatigue

Another early indicator may be unexplained fatigue or decreased exercise capacity.

4. Pain Radiating to the Arm, Neck, Jaw, or Back

For females and the elderly, one other prime symptom of CAD is pain that radiates to the arm, neck, jaw, and/or back.

5. Heart Attack (Advanced Symptom)

Seek emergency medical help immediately if the following symptoms occur. A complete artery blockage can cause:

• Intense chest pain
• Sweating
• Nausea
• Light-headedness
• Shortness of breath

Silent Symptoms (Especially in Women and People with Diabetes)

“There are atypical symptoms to some individuals, including diabetic patients, those with high blood pressure, and women,” highlights Dr Utag. These silent symptoms may include:

• Mild indigestion-type pain
• Unusual fatigue
• Dizziness
• Sleep disturbances
• Shoulder or upper back pain

According to the guidelines published by the American Heart Association, premenopausal women often present with non-classic symptoms, which in turn lead to underrecognition.

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Causes of Coronary Artery Disease

CAD develops from a complex interaction between lifestyle factors, genetics, and underlying health conditions. These include:

1. Atherosclerosis

The primary cause, i.e. plaque buildup, is composed of:

• LDL (bad) cholesterol
• Triglycerides
• Calcium
• Inflammatory cells

2. High LDL Cholesterol

According to a 2021 review article published in Frontiers, elevated LDL increases plaque formation, a primary driver of atherosclerosis, by depositing cholesterol in artery walls, which can lead to inflammation and the formation of fatty plaques.

3. High Blood Pressure (Hypertension)

Long-term pressure damages artery walls, which in turn can lead to coronary artery disease.

4. Diabetes or Insulin Resistance

The American Heart Association cites that diabetes and insulin resistance raise inflammation and accelerate atherosclerosis.

5. Smoking

Long-term smoking damages the endothelium, a thin, active inner lining of your blood vessels that regulates blood pressure and keeps your blood flowing smoothly, which promotes plaque buildup over time.

6. Sedentary Lifestyle

Sedentary living, such as a desk-bound workday, high screen time, or avoiding physical hobbies, may lead to obesity, inflammation and a lack of balance in cholesterol, which may cause heart problems.

7. Unhealthy Diet

Excessive consumption of saturated fat, trans fat, sugar, and sodium poses added danger.

Risk Factors for Coronary Artery Disease

According to the Centres for Disease Control and Prevention, CAD risk increases with:

• Age (men above 45 years, women above 55)
• Family history of heart disease
• High cholesterol
• High blood pressure
• Smoking
• Diabetes
• Sedentary lifestyle
• Obesity
• Chronic stress
• Hormonal changes of post-menopause

How is Coronary Artery Disease Diagnosed

The diagnosis of CAD involves evaluating symptoms, medical history, and conducting several tests, including:

1. Blood Tests: Monitors cholesterol levels, blood sugar and inflammatory (CRP) markers.

2. Electrocardiogram (ECG/EKG): Identifies abnormal heartbeats or past silent cardiac attacks.

3. Echocardiogram: Images the heart using ultrasound to determine blood flow and heart performance.

4. Stress Test: Examines the cardiac responsiveness to physical exercise or the effects of stressful stimuli when using medications.

5. Coronary CT Angiography: Non-invasive imaging to detect blockages.

6. Cardiac Catheterisation and Coronary Angiogram: The gold standard for identifying artery blockages, where a dye is injected to visualise narrowing.

7. Coronary Calcium Score: Measures calcium deposits and predicts risk with a CT scan.

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Treatment for Coronary Artery Disease

The treatment for CAD is typically based on the extent of artery blockage and symptoms. Most cases require a combination of lifestyle changes, medications, and sometimes procedures. These may include:

1. Lifestyle Modifications

Doctors usually recommend certain lifestyle changes as the first line of treatment. “These can significantly slow or reverse plaque growth,” Dr Utagi notes. Here’s what he suggests:

- Heart-Healthy Diet

• Fruits, whole grains, and more vegetables.
• Lean proteins
• Fats that are healthy (olive oil, nuts, seeds)
• Restrict saturated fats, trans fats and sodium.
• Mediterranean and DASH diets are highly recommended.

- Regular Physical Activity

The American Heart Association recommends at least 150 minutes of moderate exercise per week to prevent heart disease.

- Quit Smoking

Quitting smoking helps to stimulate blood flow and prevent heart attacks.

- Maintain Healthy Weight

Maintaining a normal BMI helps lower chronic systemic inflammation, commonly measured by C-reactive protein (CRP), which reduces cardiovascular risk, suggests the American Heart Association.

- Stress management

Dr Utagi notes that cardiovascular health gets significantly improved by meditation, yoga, therapy, and proper sleep.

2. Medications

Doctors may prescribe:

• Statins: Reduce LDL cholesterol and stabilise the plaques.
• Antiplatelet Medications: Reduce the risk of clotting.
• Beta-blockers: Lower blood pressure and heart rate.
• ACE Inhibitors / ARBs: Assist in better heart function and blood pressure management.
• Nitroglycerin: Relieves angina symptoms.
• PCSK9 inhibitors: For people who cannot reduce LDL with statins alone.

However, note that all medications must always be taken under a doctor’s supervision.

3. Surgical / Interventional Procedures.

- Coronary Angioplasty and Stent Placement

In these procedures, a balloon is used to open the artery, and a stent keeps it open.

- Coronary Artery Bypass Grafting (CABG)

A surgeon creates a new pathway around the blocked artery. CABF is often recommended to people with multiple blockages or severe disease.

When to See a Doctor

Consult a doctor once every year if you have risk factors such as diabetes, high blood pressure, or a family history of heart disease. However, seek immediate medical attention if you notice:

• Chest pain lasting more than a few minutes
• Chest pain with sweating, nausea, or breathlessness
• Sudden dizziness or fainting
• Pain that spreads to the arm, jaw, or back

Bottomline

Coronary artery disease is a long-term condition that progresses silently and can lead to serious complications if ignored. Understanding its symptoms, causes, and treatment options is key to early diagnosis and prevention. With the right lifestyle changes, evidence-based medications, and timely medical intervention, CAD can be managed effectively, and quality of life can be significantly improved.