Coronary artery disease

Call local emergency services now for chest pressure, squeezing or pain that is new, severe, persistent or keeps returning—especially with breathlessness, cold sweat, nausea, light-headedness, or discomfort in an arm, shoulder, back, neck, jaw or upper stomach. Heart-attack symptoms can be subtle and may differ between people. Do not drive yourself. If you already have a prescribed emergency plan, follow it while help is on the way; do not delay the call to try a home remedy.

What is coronary artery disease?

Coronary artery disease (CAD), also called coronary heart disease, affects the arteries that supply oxygen-rich blood to the heart muscle. The usual process is atherosclerosis: cholesterol-containing plaque builds within an artery wall and can narrow the channel or impair how the vessel works. A plaque may rupture or erode, allowing a blood clot to form at that site and suddenly reduce blood flow. That local process can cause an acute coronary syndrome, including a heart attack.

Not all coronary disease is a fixed major blockage. Some people have angina or reduced blood flow with non-obstructive arteries because of small-vessel dysfunction or coronary spasm. Others have plaque without symptoms. Diagnosis and treatment therefore depend on the whole clinical picture, not one symptom or test alone.

Symptoms: stable patterns and urgent change

Angina is usually described as pressure, tightness, heaviness or discomfort rather than a sharp pinpoint pain. It may spread to the arm, shoulder, neck, jaw, back or upper abdomen. Exertion, cold weather or emotional stress may bring on a predictable pattern that settles with rest or prescribed medicine. Breathlessness, fatigue, nausea or unusual weakness may be prominent, and some people have no warning symptoms.

A new symptom, discomfort at rest, a pattern occurring with less effort, lasting longer or not responding as usual may signal an acute coronary syndrome. Treat that change as urgent. Symptoms alone cannot reliably distinguish indigestion, stable angina and a heart attack.

Risk is personal, not predetermined

Risk increases with smoking, high blood pressure, high LDL cholesterol, diabetes, kidney disease, older age, family history and established vascular disease. Inactivity, an eating pattern high in salt or highly processed food, harmful alcohol use, poor sleep and some inflammatory conditions can contribute. Pregnancy complications and menopause may inform assessment, but sex or age alone does not determine an individual's outcome. Social conditions, medicine access and exposure to air pollution also matter.

Several risks can be changed or treated. A person can develop CAD without every typical factor, and a fit-looking person is not automatically protected. A clinician can estimate overall cardiovascular risk and agree priorities without blame.

How CAD is assessed

Assessment begins with the symptom pattern, timing, examination, medical and family history, medicines and risk factors. If an acute coronary syndrome is possible, an electrocardiogram and serial blood tests for cardiac troponin are central; normal early findings do not always end the assessment. Other tests may include blood pressure, cholesterol, glucose, kidney function and echocardiography.

For suspected chronic disease, the next test depends on clinical likelihood and local guidance. Coronary CT angiography can show plaque and anatomy; stress imaging can assess reduced blood flow; invasive angiography is selected when risk is high, symptoms are severe or a procedure may be needed. Some very-low-risk people need no further cardiac test. Normal large arteries do not dismiss persistent symptoms, because small-vessel angina or spasm may require focused evaluation.

Treatment reduces symptoms and future risk

Care is individualized and usually combines daily habits, medicines and sometimes a procedure. A sustainable heart-healthy pattern emphasizes vegetables, fruit, whole grains, pulses, nuts and appropriate unsaturated fats while limiting tobacco, excess salt and highly processed foods. Activity should match ability and symptoms. Cardiac rehabilitation provides supervised exercise, education and support after a heart event or procedure and for selected people with chronic disease.

Statins are first-line medicines for lowering atherosclerotic risk; additional cholesterol-lowering treatment may be needed. Antiplatelet therapy, blood-pressure or diabetes treatment, and anti-anginal medicines such as beta blockers, calcium-channel blockers or nitrates are chosen for the person's diagnosis and other conditions. A beta blocker is not automatically required indefinitely for everyone with CAD. Aspirin can cause serious bleeding: do not start, stop or share it without clinical advice.

If you have prescribed glyceryl trinitrate or another short-acting nitrate, learn exactly how to use it and when your plan says to call emergency services. Never combine nitrates with medicines for erectile dysfunction such as sildenafil or tadalafil because blood pressure can fall dangerously. Supplements, garlic products and other “natural blood thinners” cannot replace proven treatment and may interact with prescribed medicines.

Stents, bypass surgery and shared decisions

Percutaneous coronary intervention opens an artery, usually with a stent. Coronary artery bypass grafting routes blood around narrowed segments. These are not simply last resorts after every medicine has failed. The choice depends on whether the situation is acute or chronic, the location and complexity of disease, heart function, diabetes and other health conditions, symptom burden, expected benefits, procedural risks and personal preferences.

In chronic disease, a procedure may relieve limiting angina and is recommended in some anatomical patterns to improve outcomes. It does not remove the underlying tendency to atherosclerosis, so risk-reducing medicines and follow-up continue. After a stent, stopping prescribed antiplatelet medicine early can be dangerous; contact the treating team before any interruption, including before dental work or surgery.

Living with CAD

Keep an up-to-date medicine list and ask what to do if doses are missed or side effects occur. Report worsening symptoms, fainting, reduced exercise tolerance or signs of bleeding. Do not abandon treatment because a reading or symptom improves. Routine repeat scans or stress tests are not generally needed when symptoms and function are unchanged; follow-up should be driven by the agreed plan and new clinical findings.

CAD can lead to heart attack, rhythm problems, heart failure or sudden death, but its course varies. Smoking cessation, cholesterol and blood-pressure control, appropriate activity, rehabilitation, medicine adherence and timely reassessment can substantially lower risk. Anxiety after a cardiac diagnosis is common and deserves support alongside physical care.