Coronary Artery Disease (CAD)
What Is Coronary Artery Disease?
Coronary artery disease (CAD) is a cardiovascular condition caused primarily by the buildup of atherosclerotic plaques within the coronary arteries, which supply oxygen-rich blood to the heart muscle.
Atherosclerosis occurs when cholesterol and other substances accumulate in the arterial wall, forming plaques that may narrow the coronary arteries and reduce blood flow.
Coronary artery disease may cause chest pain, shortness of breath, and reduced exercise tolerance. However, some patients may have no noticeable symptoms.
One of its most serious complications is myocardial infarction (heart attack), which may occur when an atherosclerotic plaque ruptures or erodes, leading to blood clot formation.
What Are the Symptoms of Coronary Artery Disease?
The most common symptom is chest discomfort, particularly during physical activity.
Common symptoms include:
- Chest pressure, tightness, or burning
- Chest pain during walking or climbing stairs
- Pain radiating to the arm, shoulder, back, neck, or jaw
- Shortness of breath during exertion
- Fatigue
- Reduced exercise tolerance
- Cold sweating
- Nausea or upper abdominal discomfort
Some patients may develop coronary artery disease without typical chest pain.
In patients with diabetes, older adults, and women, symptoms such as shortness of breath, unusual fatigue, or reduced exercise capacity may be prominent.
What Causes Coronary Artery Disease?
The most common cause is atherosclerosis.
Major risk factors include:
- Elevated LDL cholesterol
- Hypertension
- Diabetes mellitus
- Smoking
- Family history of premature coronary artery disease
- Advanced age
- Obesity
- Physical inactivity
- Chronic kidney disease
- Elevated lipoprotein(a)
- Unhealthy dietary habits
Cardiovascular risk assessment should consider these factors together.
What Are the Types of Coronary Artery Disease?
1. Chronic Coronary Syndrome
Chronic coronary syndrome includes relatively stable clinical presentations of coronary artery disease.
Patients may experience chest discomfort or shortness of breath during walking, climbing stairs, or other physical activities.
Symptoms often improve with rest.
2. Acute Coronary Syndrome
Acute coronary syndrome may occur when an atherosclerotic plaque ruptures or erodes, leading to thrombus formation within a coronary artery.
It includes unstable angina and myocardial infarction and requires urgent medical evaluation.
3. Coronary Microvascular Disease
Coronary microvascular disease involves dysfunction of the small blood vessels supplying the heart muscle.
Patients may experience angina or myocardial ischemia even without significant narrowing of the major coronary arteries.
4. Coronary Vasospasm
Coronary vasospasm occurs when a coronary artery temporarily constricts, reducing blood flow.
It may cause chest pain, particularly at rest.
How Is Coronary Artery Disease Diagnosed?
Diagnosis is based on symptoms, cardiovascular risk factors, clinical examination, and appropriate diagnostic testing.
1. Electrocardiogram (ECG)
An ECG records the electrical activity of the heart.
It may reveal signs of myocardial ischemia or myocardial infarction. However, a normal ECG does not exclude coronary artery disease.
2. Echocardiography
Echocardiography evaluates cardiac function, regional wall motion, and possible underlying structural heart disease.
3. Exercise Stress Testing
Exercise testing may be used in selected patients to evaluate symptoms and possible evidence of myocardial ischemia during physical activity.
4. Stress Echocardiography and Other Functional Tests
Stress echocardiography, myocardial perfusion imaging, and other appropriate tests may be used to assess whether coronary artery disease causes insufficient blood flow to the heart muscle.
5. Coronary Computed Tomography Angiography (CCTA)
Coronary CT angiography is a noninvasive imaging technique used to visualize coronary artery anatomy and atherosclerotic plaques.
It is an important diagnostic option in appropriately selected patients.
6. Invasive Coronary Angiography
Coronary angiography is an invasive procedure used to visualize the coronary arteries through a catheter.
The catheter is usually introduced through an artery in the wrist or groin.
The procedure identifies the location and severity of coronary artery narrowing.
When appropriate, balloon angioplasty and stent implantation may be performed during the same session.
Not every patient with suspected coronary artery disease requires invasive coronary angiography.
How Is Coronary Artery Disease Treated?
Treatment aims to reduce the risk of myocardial infarction and other cardiovascular events, relieve symptoms, and improve quality of life.
1. Lifestyle Modifications
Important measures include:
- Smoking cessation
- Regular physical activity
- A Mediterranean-style diet
- Weight management
- Blood pressure control
- Diabetes management
- Cholesterol reduction
2. Medication
Depending on the patient's clinical condition, treatment may include:
- Statins and other lipid-lowering medications
- Antiplatelet medications
- Beta blockers
- Calcium channel blockers
- Nitrates
- ACE inhibitors or angiotensin receptor blockers
Medication is individualized according to cardiovascular risk and associated medical conditions.
3. Coronary Balloon Angioplasty and Stent Implantation
Percutaneous coronary intervention (PCI) is a minimally invasive procedure used to treat selected coronary artery narrowings with balloon angioplasty and, when appropriate, stent implantation.
The procedure is usually performed through an artery in the wrist or groin.
A coronary stent is a small metallic mesh tube placed inside the narrowed artery to help maintain blood flow.
PCI can be lifesaving during an acute myocardial infarction.
In chronic coronary syndromes, it may be performed to relieve symptoms and, in selected anatomical and clinical situations, improve prognosis.
4. Coronary Artery Bypass Grafting (CABG)
Coronary artery bypass grafting is a surgical procedure that creates alternative pathways for blood to reach areas of the heart beyond narrowed or blocked coronary arteries.
CABG may be preferred in certain patients with left main coronary artery disease, complex multivessel disease, or diabetes.
The decision between PCI and CABG depends on coronary anatomy, clinical characteristics, and expected treatment benefits.
Is Coronary Artery Disease Dangerous?
Untreated or inadequately controlled coronary artery disease may lead to:
- Myocardial infarction
- Heart failure
- Serious cardiac arrhythmias
- Sudden cardiac death
- Reduced quality of life
Early diagnosis, appropriate medication, risk factor management, and revascularization when indicated can significantly reduce these risks.
Does Every Coronary Artery Narrowing Require a Stent?
No. Not every coronary artery narrowing requires stent implantation.
Treatment decisions depend on:
- Location and severity of the narrowing
- Presence of myocardial ischemia
- Symptoms
- Cardiac function
- Associated medical conditions
- Response to medical therapy
Some patients can be managed effectively with medication, while others may benefit from PCI or coronary bypass surgery.
Is Coronary Artery Disease Completely Cured After Stent Implantation?
A coronary stent treats a specific narrowed segment of an artery.
However, atherosclerosis is a chronic disease that may affect multiple areas of the vascular system.
Therefore, lipid-lowering therapy, appropriate antiplatelet medication, and cardiovascular risk factor management remain important after stent implantation.
Successful PCI does not mean that the underlying coronary artery disease has completely disappeared.
Can Coronary Artery Disease Be Prevented?
The risk of coronary artery disease can be significantly reduced.
Lowering LDL cholesterol, avoiding smoking, controlling blood pressure and diabetes, maintaining a healthy diet, and engaging in regular physical activity are essential preventive measures.
Patients with a strong family history or elevated lipoprotein(a) may benefit from a more detailed cardiovascular risk assessment.
When Should You Consult a Cardiologist?
Patients experiencing chest discomfort during walking or climbing stairs, exertional shortness of breath, unexplained fatigue, or those with significant cardiovascular risk factors should undergo a cardiology evaluation.
New, worsening, or persistent chest pain at rest, particularly when accompanied by sweating, nausea, shortness of breath, or fainting, may indicate a heart attack and requires immediate emergency medical attention.
Assoc. Prof. Sezen Bağlan Uzunget, MD
Cardiologist
This content is provided for general educational purposes. Diagnosis and treatment should be individualized according to the patient's clinical condition.
Türkçe: Koroner Arter Hastalığı