Coronary Artery Disease
Coronary artery disease is the narrowing of the heart’s own arteries by cholesterol plaque. It causes chest pain on exertion, and when a plaque ruptures it triggers a heart attack — the leading cause of death worldwide, yet highly treatable and largely preventable.
Overview
The coronary arteries wrap the heart and feed its muscle. Atherosclerotic plaque grows silently within their walls for decades, driven by LDL cholesterol, smoking, hypertension, diabetes, and genetics. Stable plaque narrows the channel gradually, producing predictable exertional angina. Unstable plaque can rupture suddenly, forming a clot that blocks the artery — a myocardial infarction, where heart muscle dies by the minute. Care therefore has two goals: preventing plaque events with medication and lifestyle, and restoring blood flow when narrowing or occlusion limits the heart.
Signs & Symptoms
- Chest pressure or tightness on exertion, easing with rest (angina)
- Pain radiating to the arm, jaw, neck, or back
- Shortness of breath on effort
- Unusual fatigue, nausea, or cold sweat — sometimes the only signs, especially in women and people with diabetes
- Crushing chest pain at rest lasting more than a few minutes — call an ambulance
How It Is Diagnosed
ECG and cardiac troponin blood tests identify heart attacks. For stable symptoms, stress testing or CT coronary angiography visualizes narrowings non-invasively. Invasive coronary angiography remains the definitive map, often combined with pressure-wire measurement to judge whether a narrowing truly limits flow.
Treatment Options
Medication and risk-factor control
Statins, antiplatelet agents, blood-pressure treatment, diabetes management, smoking cessation, and cardiac rehabilitation form the backbone of care for every patient, with or without procedures.
Percutaneous coronary intervention (angioplasty and stenting)
A balloon opens the narrowed artery and a drug-eluting stent scaffolds it open, delivering medication that prevents re-narrowing. In heart attacks, emergency PCI is the standard of care.
Adjunctive techniques for complex disease
Rotational atherectomy drills through heavily calcified plaque and specialized guidewires and microcatheters reopen chronic total occlusions — extending PCI to anatomy once considered untreatable.
Coronary artery bypass surgery (CABG)
For extensive multi-vessel or left-main disease, surgeons graft arteries and veins around the blockages. Heart teams weigh PCI versus CABG for each anatomy and patient profile.
When to See a Doctor
New exertional chest discomfort deserves prompt cardiology review. Chest pain at rest lasting more than a few minutes, especially with sweating or breathlessness, is a medical emergency — every minute of delay costs heart muscle.
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Frequently Asked Questions
What is the difference between angina and a heart attack?+
Angina is temporary muscle starvation during exertion that resolves with rest — a warning sign. A heart attack is a complete blockage killing muscle, causing pain at rest that does not resolve. The second is an emergency.
How long does a coronary stent last?+
Modern drug-eluting stents become part of the artery wall permanently. The treated segment usually remains open long-term; protecting the rest of the arteries with medication is what determines the future.
Can coronary artery disease be reversed?+
Plaque rarely disappears, but intensive cholesterol lowering stabilizes and can modestly regress it, dramatically cutting heart-attack risk. Prevention is cumulative: the earlier risk factors are controlled, the better.
Is stenting or bypass surgery better?+
Neither is universally better — it depends on how many vessels are diseased, diabetes status, anatomy, and surgical risk. Heart teams combining cardiologists and surgeons recommend the strategy with the best evidence for your pattern.
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