Understanding Coronary Artery Disease

What is coronary artery disease?
Coronary artery disease is a narrowing or blockage of the coronary arteries, the arteries that provide the heart muscle with blood. When the blood flow is slowed the heart doesn't get enough oxygen and nutrients. This usually results in chest pain called angina. When one or more of the coronary arteries are completely blocked, the result is a heart attack (injury to the heart muscle).

What causes the coronary arteries to narrow?
Coronary arteries become narrowed or clogged by plaque build-up in the artery walls. Plaque is made of excessive cholesterol and other substances floating through your bloodstream, such as inflammatory cells, proteins and calcium. Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. The artery narrows further and, in turn, less room for blood to flow through the arteries. Plaque build-up in the arteries is called atherosclerosis (atha-row-skla-row-sis), also known as "hardening of the arteries."

What should you do if you have coronary heart disease?
When you have coronary artery disease, it is important to take care of your heart. This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart. Procedures do not cure coronary artery disease. It is up to you to take steps to stop the disease from progressing.

1. Know the symptoms for coronary artery disease

The symptoms for coronary artery disease include:

• Chest discomfort (described as numbness, heaviness, dull aching, or burning; may radiate to left shoulder, arms neck, back or jaw)
• Shortness of breath
• Palpitations (a fluttering feeling, skipped beats)
• Faster heart rate
• Dizziness
• Nausea
• Extreme weakness

Call your doctor if symptoms become more frequent or severe.

Call for emergency assistance if rest and/or medications do not relieve symptoms within 15 minutes. DO NOT WAIT TO GET HELP.

2. Reduce your risk factors

Medical research has helped identify certain conditions, called risk factors, which place people at increased risk for heart disease.

Non-modifiable risk factors (those that cannot be changed)

• Male
• Older age - Heart disease is more likely to occur, as you get older.
• Family history (including race)

Modifiable risk factors (those you can control)

• Cigarette smoking
• High blood cholesterol
• High blood pressure
• Uncontrolled diabetes
• Physical inactivity
• Obesity or overweight
• Uncontrolled stress or anger
• Diet high in saturated fat and cholesterol
• Drinking too much alcohol

If you have more than two of the risk factors listed, you should discuss your risk factors with your doctor. Your goal is to decrease your risk factors and lessen your risk for future heart disease events. This is true if you do not have heart or blood vessel disease, if you are being treated medically for heart or blood vessel disease, or you have undergone a procedure (angioplasty, stents, bypass surgery) for heart or blood vessel disease.

3. Take your medications

Medications are used to control your symptoms and help your heart work more efficiently. Follow your doctor's instructions when you take your medications.

It is important to know:

• The names of your medications
• What they are for
• How often and at what times to take your medications

Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.

4. Have procedures or surgery – if necessary

Invasive procedures (such as balloon angioplasty or stents) or coronary artery bypass surgery may be needed to treat your narrowed or blocked artery.  These procedures increase blood supply to your heart but they are not a cure for coronary artery disease.  You will still need to focus on reducing your risk factors to prevent future disease development or progression.  If these procedures are or have been necessary, your cardiologist or surgeon will discuss the specific procedure with you. 

5. See your cardiologist for regular visits

Schedule regular appointments with your cardiologist (even if you have no symptoms). Your appointments may be spaced once a year, or more often, if your doctor feels you need to be followed more closely. Your appointments should include a medical exam and diagnostic studies (such as an electrocardiogram).

Call your doctor sooner if your symptoms worsen or become more severe or frequent.

The Cleveland Clinic Heart Center cardiologists and surgeons specialize in the treatment of coronary artery disease.  The team approach at the Cleveland Clinic Heart Center insures that patients receive the best care before, during and after their procedure.

For more information about coronary artery disease, interventional procedures or surgery, please contact the Heart Center Information & Resource Nurse toll-free at 866-289-6911 or e-mail us using the Contact Us form. We would be happy to answer your questions.

Resources:

• Your Guide to Coronary Artery Disease, CCF Heart Center, 5/02
• Understanding Coronary Heart Disease, CCF Health Information Center, 2/02
• Risk factors and Coronary Heart Disease, American Heart Association, http://www.americanheart.org

©Cleveland Clinic Foundation Heart Center, 8/2002