Coronary Artery Disease (CAD)

The heart is a bulk of coordinated muscle.  Each beat, it pumps blood throughout the body from its hollow chambers, then relaxes so the chambers can fill again for the next beat.  But the heart muscle itself requires oxygen, delivered to it via the Coronary Arteries.  See Diagram — Heart Anatomy.

Coronary Artery Disease is when these small arteries get clogged with “plaque” (mixture of clots, fats, white blood cells, and more), which builds up gradually over the years.ย  Its main risk factors are:

Major Risk Factors:

  • Age: Men >35-40; Women after menopause
  • High Blood Pressure (Hypertension)
  • Smoking (or less than 3 years since quitting)
  • Diabetes
  • High Cholesterol (Hyperlipidemia)
  • Family History of Heart Attack (at near the same age as patient)

Other risk factors include:

  • Obesity
  • Sedentary lifestyle
  • Stimulant Use (cocaine, meth, etc.)
  • Any disease which involves ongoing activation of our immune system, including chronic untreated infections (HIV, etc.), chronic inflammatory diseases (e.g. rheumatoid arthritis, inflammatory bowel disease, etc. etc.), and active cancer.

Coronary Artery Disease has no symptoms, until itโ€™s severe enough to cause one of two conditions:

  • A full-blown Heart Attack (Myocardial Infarction; M.I.).  Heart muscle dies if its circulation (the coronary arteries) is cut off for too long (“myocardium” = heart muscle; “infarction” = muscle death, in medical-speak).  If a lot of muscle dies, so do you.  Death can also occur in a small heart attack with electrical short circuit (“ventricular fibrillation”), which stops the heart from pumping (cardiac arrest); in this case, defibrillation (shocking) saves lives without a doubt.
  • Angina Pectoris.  This is chest pain from insufficient blood circulation; the medical term is โ€œischemia.โ€  Here heart muscle remains alive, but feels pain.  Ischemia can eventually lead to Infarction (muscle death).  But prevention is available, by medical treatment, by angioplasty (keeping the clogged artery open with stents), or a coronary by-pass (open heart surgery).

Thereโ€™s also a newer third term used in ERs and hospitals: โ€œAcute Cardiac Syndromeโ€ (ACS).  Thatโ€™s when a patient arrives with chest pain or shortness of breath, and clinicians canโ€™t tell yet if itโ€™s a complete M.I. or not.  See our topic Diagnosing Coronary Artery Disease.

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