Coronary artery disease: what it is, what the symptoms are and how it is treated

By Cristiano Antonino Last updated Apr 4, 2023

The term coronary artery disease refers to diseases of the coronary arteries, the vessels that carry blood to the heart muscle

In fact, the heart muscle needs a constant supply of oxygen-rich blood, which is supplied by the coronary arteries, which branch off from the aorta as it exits the heart.

In case of coronary artery disease, one or more of these arteries narrows, obstructing blood flow and resulting in chest pain (called ‘angina’) or heart attack (also called ‘myocardial infarction’).

Nothing is more important than timely intervention in the event of a suspected heart attack, as a few minutes can make the difference between a rescue and death.

Symptoms of coronary artery disease

The problem with coronary artery disease is that the symptoms do not occur when the problem arises but when the arterial obstruction is already advanced.

For this reason, timeliness is everything.

One of the first symptoms experienced by sufferers (and one of the most common) may be the feeling that the heart is under greater strain than usual, both during exercise and at rest.

Generally, the symptoms of coronary artery disease vary from person to person, but include:

discomfort or pain in the chest (angina)
breathlessness
feeling of extreme tiredness following physical activity
swelling of the feet
shoulder or arm pain
atypical chest pain in women, which may be momentary or acute and localised in the abdomen, back or arm

Compared to men, women may also present with nausea and pain in the back or jaw.

In the case of obstructed or closed coronary arteries, extremely serious complications can occur, such as

arrhythmia (changes in heartbeat)
infarction (interruption of blood flow to the heart and death of heart tissue)
heart failure (heart becomes too weak to adequately pump blood)

Causes

Heart-related diseases that fall under coronary artery disease are usually caused by a build-up of fat on the inner walls of the arteries.

These deposits consist of cholesterol, calcium and other substances that travel in the blood and the result of their accumulation is called ‘plaque’.

Plaque can clog the coronary arteries and make them stiff and irregular, leading to atherosclerosis.

This process can affect many arteries, not just coronary arteries.

The obstructions may be single or multiple and present different stages of severity and different locations.

Gradually, deposits reduce the blood and oxygen supply to the heart muscle causing chest pain (angina), difficulty breathing (dyspnoea) and other symptoms, while complete obstruction can induce a heart attack.

However, there are also other causes related to the abnormal reduction of blood flow to the heart.

In some cases, coronary artery disease may be caused by a spasm of a coronary artery, which may occur spontaneously or be the consequence of taking substances such as cocaine and nicotine.

Or it may be that during physical activity a coronary artery does not expand sufficiently in response to the need for increased blood supply.

This can cause a blood supply that is less than what the heart needs.

There can therefore be insufficient blood supply under conditions of exertion, when the heart muscle requires more blood.

Basically, if the heart does not receive enough blood, it can no longer contract and pump blood normally.

If coronary artery disease is suspected, the doctor may prescribe a specialist cardiological examination.

Coronary artery CT is the test used to assess the coronary arteries in patients with risk factors but without heart attack symptoms.

Thanks to this modality, it is possible to identify the state of the coronary arteries in a simple and painless way for the patient, and then set up a more appropriate therapeutic approach, reducing the risks for the patient.

In fact, in just a few minutes, this advanced diagnostic test makes it possible to detect or exclude the presence of coronary artery disease, precisely highlighting the ‘diseased’ vessel and its level of obstruction.

The test takes about 20 minutes and the report is available within 24 hours at the latest.

Other specific tests, which allow a proper assessment of the health of the coronary arteries, are

blood tests (with particular reference to the evaluation of blood lipid levels, blood glucose and possible markers of cardiac damage)
electrocardiogram (ECG)
exercise tests

Coronary artery disease, risk factors

On average, men are affected 10 years earlier than women, because until the menopause the latter are protected by high oestrogen levels.

After the menopause, coronary artery disease becomes more likely and common among women, especially after the age of 75 (because they live longer).

There are certain factors that influence the development of coronary artery disease, in addition to advancing age:

presence of coronary artery disease in a first-degree relative, developed before the age of 55 in the case of men or 65 in the case of women;
high blood levels of low-density lipoprotein (LDL) cholesterol;
high blood levels of lipoprotein a;
low blood levels of cholesterol carried by high-density lipoprotein (HDL);
diabetes mellitus;
smoking (more than doubles the risk of coronary artery disease and heart attack);
high blood pressure;
obesity and dietary factors (a diet low in fibre, vitamins C, D and E, phytochemicals and omega-3 polyunsaturated fatty acids increases the risk of coronary artery disease);
physical inactivity;
high blood levels of C-reactive protein (CRP).

Limiting alcohol intake to one or two drinks a day appears to slightly reduce the risk of coronary artery disease (but increases the risk of stroke).

Certain metabolic disorders such as hypothyroidism, hyperhomocysteinemia and an elevated apolipoprotein B level are also risk factors.

Interventions and therapies

If coronary artery disease is detected at an early stage, the doctor may prescribe antiplatelet, hypolipidemic and beta-blocking drugs, which are intended to reduce the extent of the disorders, improve cardiac output and prevent heart attacks.

More frequently, in cases of coronary artery disease, two treatments are usually employed: stent implantation and bypass surgery.

Stents are expandable tubes with a mesh-like structure used to keep arteries pervious while by-pass surgery consists of re-routing blood flow at an obstruction using a section of healthy artery taken from another part of the cardio-circulatory system.

In the case of stent implantation, a device is used to restore blood flow in the coronary artery.

It is nothing more than an expandable tube with a wire mesh structure made of steel or cobalt alloy that is mounted on a balloon and expanded inside the artery to compress the plaque and restore blood flow.

Coronary artery bypass grafting or ‘CABG’ is a common cardiac procedure.

The surgeon removes a section of a healthy blood vessel from the leg, chest or arm and then connects it to the coronary artery just downstream of the site of the obstruction.

In this way, the new vessel creates an alternative pathway through which blood can flow by avoiding (in fact, by-passing) the blocked section of the artery and thus reach the heart.

This operation is performed under general anaesthesia and the patient remains unconscious during the procedure.

Preventing coronary artery disease

Preventing coronary artery disease is possible by intervening on those risk factors over which we can have control.

Some of these factors are related, so by changing a certain lifestyle, automatically another aspect is improved.

Take the case of smoking: those who stop smoking halve their risk of coronary artery disease compared to those who continue to do so.

Or diet: several lifestyle changes are associated with a lower likelihood of coronary artery disease, such as eating less saturated fat by eliminating trans fats, introducing more fruit and vegetables into one’s diet, or consuming more fibre.

The daily diet is in fact very important: one should reduce alcohol to a couple of glasses a day, avoid complex carbohydrates such as sugar, white bread and white flour, and therefore stay on a 25-35% fat percentage of daily calories.

This is because fats produce total cholesterol and LDL (bad) cholesterol.

So, no fats? No: green light to oily fish, such as salmon, high in omega-3 fats (good fats).

So, a person should maintain an ideal weight and follow a varied diet: the Mediterranean diet, consisting of large quantities of fruit, vegetables, nuts of various kinds and olive oil, seems to reduce the risk of coronary heart disease more than other diets.

Finally, let’s not forget physical activity: those who practice it consistently are less prone to developing coronary artery disease and hypertension.

In particular, physical activities that promote endurance (such as brisk walking, cycling and jogging) or muscular strength (weight training) are recommended.

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