Coronary Artery Disease

The term "heart disease," also known as cardiovascular disease, covers a lot of ground. It's used for a variety of problems with the circulatory system, from high blood pressure to abnormal heart rhythms. Most of the time, though, when people speak of heart disease what they really mean is coronary artery disease—a narrowing of the coronary arteries. No wider than a strand of spaghetti, each coronary artery deliver bloods to hard-working heart muscle cells.

The cause of coronary artery disease is almost always atherosclerotic plaque—gooey cholesterol-filled deposits that form inside artery walls. Plaque is usually the result of an unhealthy diet, too little exercise, high cholesterol, high blood pressure, smoking, and other "insults" that damage the lining of artery walls.

When a coronary artery becomes clogged with plaque, it can't always deliver enough blood to the heart muscle cells it is supposed to supply. Sometimes this doesn't cause any noticeable symptoms. Sometimes it causes angina — chest pain that occurs with physical exertion or stress. Coronary artery disease can also be the root cause of a heart attack, or lead to the chronic condition known as heart failure.

Coronary artery disease affects millions of Americans. Once limited almost entirely to older people, it is now beginning to appear in younger folks, a change driven by the rising tides of obesity and type 2 diabetes.

Coronary artery disease isn't an inevitable part of growing older. A healthy lifestyle that includes exercise, a healthy diet, and not smoking goes a long way to preventing it, especially when started at a young age. Lifestyle changes and medications can also reverse coronary artery disease, or at least prevent it from getting worse.

Coronary Artery Disease Articles

Artery disease below the belt

In peripheral artery disease (PAD), the arteries below the heart become clogged with fatty deposits. The main symptom (pain in the calf, thigh, or buttocks with walking that goes away with rest) doesn’t always occur or is mistaken for something else, so PAD often goes unrecognized. But people with PAD likely have narrowed heart and brain arteries as well, putting them at risk for a heart attack or stroke. Treatments include regular walking, medications, and for severe cases, a procedure to open a blocked artery in the leg. (Locked) More »

High-tech heart scans: Who might need one?

Computed tomography angiography (CTA) is one of several techniques used to evaluate people with chest pain that’s thought to result from coronary artery disease. It provides detailed views of the heart’s arteries. Compared with other tests, such as exercise stress tests with nuclear imaging, CTA takes less time and is easier to endure. But it requires radiation exposure and provides no clear long-term advantages in terms of preventing heart attacks or similar problems. (Locked) More »

For "bad" cholesterol, lower is better; dual drug therapy may help

High cholesterol, in particular high low-density lipoprotein (LDL), the so-called bad cholesterol, is a key cause of heart disease. A large clinical trial called IMPROVE-IT set out in 2005 to answer two key questions about LDL: The results of IMPROVE-IT were recently published in The New England Journal of Medicine. Dr. Deepak L. Bhatt, Editor in Chief of the Harvard Heart Letter, talked about the significance of the IMPROVE-IT findings with Dr. Christopher P. Cannon, the trial's lead investigator, and Dr. John A. Jarcho, an editor of The New England Journal of Medicine. More »

Battling breathlessness

Shortness of breath is one of the most common problems people bring to their doctors. The most obvious causes such as asthma, chronic obstructive pulmonary disease, and coronary artery disease are relatively easy to uncover with a battery of standard tests. For some people, however, the source of the problem remains frustratingly elusive. Advanced cardiopulmonary testing that measures heart and lung function during exercise can often provide answers. (Locked) More »

Realizing the promise of Life's Simple 7

Minute specks of calcium in the walls of the heart’s arteries signal a higher risk of future heart attack or stroke. Doctors can detect these deposits using an imaging technique known as a coronary artery calcium scan. Making positive changes to reduce cardiovascular risk in seven key areas as outlined in the American Heart Association’s Life’s Simple 7 program may prevent the development of heart disease. (Locked) More »

The problem with plaque: Even lesser amounts are still risky

A normal stress test can often provide reassurance that there are no severely narrowed segments in the heart’s arteries. But many people with normal stress tests may still have plaque buildup in the coronary arteries that is too small to show up on a stress test. This is known as non-obstructive coronary artery disease, and it can lead to heart attack or death, especially if there are many areas of plaque or multiple coronary arteries are affected. Recognizing and treating this condition with medicines and lifestyle changes can reduce heart attack risk. (Locked) More »

Atrial fibrillation overview

Atrial fibrillation is a heart rhythm disorder in which the upper chambers of the heart (the atria) beat fast and irregularly. Normally, the muscular walls of the right and left atria contract at the same time, pumping blood into the lower two chambers (the ventricles). Then the walls of the ventricles contract at the same time, pumping blood to the rest of the body. How is this coordinated? A normal heartbeat starts with an electrical impulse that comes from the sinus node, a cluster of cells in the right atrium. That signal causes the atria to beat, pumping blood into the ventricles. Then it travels to another part of the heart called the atrioventricular node, located in the center of the heart between the atria and the ventricles. From there, the signal travels down to the ventricles, and causes them to beat, sending blood throughout the body. More »

Abnormal rhythms of the atria

Several kinds of abnormal heart rhythm (arrhythmia) occur in the heart's upper chambers (the atria). These include atrial fibrillation, atrial flutter, atrial tachycardia, and paroxysmal atrial tachycardia or paroxysmal supraventricular tachycardia. Atrial fibrillation is a common heart rhythm disturbance. More than 2.5 million Americans have it. Instead of forcefully contracting in a coordinated manner, the walls of the left and right atria quiver and do not effectively pump blood into the ventricles. Sometimes atrial fibrillation comes and goes, and sometimes it stays constant. As with many heart rhythm abnormalities, atrial fibrillation is often caused by coronary artery disease. More »

Atherosclerosis: symptoms and treatments

Every organ and tissue in the body needs a supply of fresh, oxygen-rich blood. That blood is delivered to all parts of the body through blood vessels called arteries. A healthy artery is like a clean pipe: It has a smooth lining and is free of blockages that interfere with blood flow. Atherosclerosis is the buildup of cholesterol-filled deposits called plaque on the inner walls of arteries. Plaque narrows the vessels and slows down blood flow. Atherosclerosis can occur in any artery in the body, from those nourishing the heart (coronary arteries) to those supplying the brain, intestines, kidneys, and legs. Atherosclerosis begins as microscopic damage to the inner lining of an artery wall. Many forces can cause this damage, including high blood pressure, cigarette smoke, diabetes, high cholesterol, conditions that cause blood to clot more easily, drugs such as cocaine and androgens, and possibly infections of the inner linings of the arteries. More »