Overview
Coronary artery disease (CAD) is a common cardiovascular condition caused by the buildup of plaque (fatty deposits) in the coronary arteries, leading to reduced blood flow to the heart muscle. It is a leading cause of heart attacks and remains a major contributor to morbidity and mortality worldwide.
Causes & Risk Factors
1. Modifiable Risk Factors
- Hyperlipidemia (high LDL, low HDL)
- Hypertension
- Diabetes Mellitus
- Smoking and tobacco use
- Obesity (BMI ≥ 30)
- Sedentary lifestyle (physical inactivity)
- Unhealthy diet (high saturated fats, trans fats, processed foods)
- Excessive alcohol consumption
- Chronic stress
2. Non-Modifiable Risk Factors
- Increasing age
- Male gender (risk increases in women after menopause)
- Family history of premature heart disease
3. Associated Medical Conditions
- Metabolic syndrome
- Chronic kidney disease
- Obstructive sleep apnea
- Chronic inflammatory conditions (e.g., rheumatoid arthritis, lupus)
Most cases of CAD are preventable. Managing modifiable risk factors—especially cholesterol, blood pressure, diabetes, and lifestyle habits—plays a crucial role in reducing the risk of heart attack and other complications.
Symptoms
Common Symptoms
- Chest pain or discomfort (angina)
- Shortness of breath
- Fatigue (especially with exertion)
Atypical Symptoms
- Neck, jaw, shoulder or back pain
- Nausea or indigestion-like discomfort
- Dizziness or lightheadedness
- Unexplained weakness
Symptoms of Complications (Urgent)
- Severe or prolonged chest pain (heart attack)
- Pain radiating to arm, jaw, or back
- Sweating
- Nausea or vomiting
- Sudden shortness of breath
Silent CAD
Some individuals, especially those with diabetes, may have no symptoms until a serious event such as a heart attack occurs.
Diagnosis
1. Clinical Assessment
- History of chest pain, shortness of breath
- Evaluation of risk factors (HTN, DM, hyperlipidemia)
- Physical examination
2. Initial Tests
- Electrocardiogram (ECG)
- Blood tests (lipid profile, blood sugar, cardiac biomarkers)
3. Non-Invasive Imaging & Functional Tests
- Stress testing (exercise or pharmacologic)
- Echocardiography
- CT Coronary Angiography (CTCA)
4. Invasive Testing (Gold Standard)
Coronary angiography directly visualizes blockages in coronary arteries and helps guide treatment such as stenting or surgery.
Early diagnosis allows timely intervention and improves long-term outcomes.
Treatment
1. Lifestyle Modifications
- Heart-healthy diet (low fats and cholesterol)
- Regular physical activity
- Weight reduction
- Smoking cessation
- Stress management
- Control of hypertension, diabetes, and cholesterol
2. Medications
- Antiplatelets (Aspirin, Clopidogrel)
- Statins
- Beta-blockers
- ACE inhibitors / ARBs
- Nitrates for angina
- Calcium channel blockers
3. Interventional Procedures
- Percutaneous Coronary Intervention (PCI)
- Coronary Artery Bypass Grafting (CABG)
4. Cardiac Rehabilitation
- Supervised exercise programs
- Education on heart-healthy living
- Risk factor modification
5. Long-Term Management
- Regular follow-up
- Monitoring cholesterol, BP, blood sugar
- Medication adherence
A combination of lifestyle changes, medications, and procedures can significantly improve survival and quality of life in CAD.
When to Seek Medical Advice
Warning Symptoms
- Chest pressure, tightness, heaviness or burning
- Pain during exertion or emotional stress
- Chest discomfort improving with rest but recurring
- Shortness of breath on exertion
- Fatigue or reduced exercise tolerance
- Dizziness during activity
Emergency Signs
- Severe chest pain lasting >10–15 minutes
- Pain radiating to arm, jaw, neck, or back
- Sweating
- Nausea or vomiting
- Sudden shortness of breath
- Feeling of impending doom or collapse
