Yasmine Ali, MD, is board-certified in cardiology. She is an assistant clinical professor of medicine at Vanderbilt University School of Medicine and an award-winning physician writer.
Coronary artery disease (CAD) develops when fatty deposits (called plaques) develop within the arteries that supply your heart muscle. As a result, these coronary arteries become narrowed and, sometimes, completely blocked off. Because the heart muscle requires a continuous supply of oxygen and nutrients to survive, blockage of a coronary artery rapidly leads to significant problems, such as heart attacks and strokes.
Coronary artery disease is caused by lifestyle factors, such as smoking and lack of exercise, as well as medical conditions, such as high blood pressure and diabetes mellitus. Treatment includes managing risk factors with lifestyle adjustments and prescription medications, and sometimes directly repairing or replacing the arteries with surgical or specialized procedures.
Coronary artery disease is primarily caused by a condition called atherosclerosis in which fatty deposits (called plaques) accumulate within the walls of the arteries that bring oxygenated blood to the heart. High blood pressure and high cholesterol, among other factors, contribute to the development of coronary artery disease.
Coronary artery disease is not curable, but it can be managed through various therapies, including lifestyle changes (e.g., exercise and smoking cessation) and certain prescription medications (e.g., a statin). Depending on the severity of the disease, surgery or a procedure to open up a blocked or narrowed artery (called an angioplasty or percutaneous intervention) may be warranted.
There are several tests that doctors utilize to either diagnose coronary artery disease or assess whether a patient has a high likelihood of developing the disease. These tests include various blood tests, an electrocardiogram (ECG), an echocardiogram, a stress test, and a coronary angiogram.
Angina refers to the symptoms that occur (e.g., chest pressure or squeezing) when the heart muscle does not receive enough oxygen-rich blood. There are two main types of angina—stable and unstable. Stable angina is the most common type. Unstable angina is considered a medical emergency.
An arrhythmia, also called a heart or cardiac arrhythmia, is caused by a disturbance in the heart's electrical system, making a person's heart beat too fast, too slow, or in an irregular rhythm.
Atherosclerosis is a chronic disease in which plaque (fatty deposits) builds up in the walls of arteries. As these fatty deposits accumulate, the arteries narrow or become blocked. Depending on the affected artery, this narrowing or blockage impedes blood flow to vital organs, like the heart, brain, or kidneys.
Cardiac catheterization, also called a cardiac cath, evaluates your coronary arteries for blockages. During this test, a long, thin tube is inserted in your groin or arm and guided up to your heart. A dye is then injected so that the blood vessels supplying your heart can be visualized with an imaging technique known as fluoroscopy.
An echocardiogram performed on the heart is called a cardiac ultrasound or more clinically speaking, a transthoracic echocardiogram (TTE). This test uses sound waves to visualize the movement and function of a person’s heart muscle and valves.
An electrocardiogram, also called an ECG or EKG, is a diagnostic tool that evaluates the heart's electrical system. By examining ECG wave patterns, a doctor can determine a person's heart rate and rhythm and possibly identify certain types of heart disease.
An exercise stress test is useful in evaluating how well your heart handles physical activity, considering that during exercise, your heart muscle has to work extra hard to pump oxygenated blood to the rest of your body. During the test, a person is hooked up to an electrocardiogram machine while running or walking on a treadmill.
A nuclear stress test evaluates the presence, location, and severity of any blockages in the arteries that supply your heart muscle. The test uses a radioactive tracer (which is taken up by your heart muscle) and a special camera to create pictures of your heart as you rest and exercise.
Plaques consist of cholesterol, fatty materials, calcium, and large inflammatory cells called macrophages. In a disease called atherosclerosis, plaques accumulate within the walls of arteries. Over time, the arteries harden and thicken and may become narrowed or blocked.
Centers for Disease Control and Prevention. Coronary artery disease (CAD). Updated December 9, 2019.
Lu H, Daugherty A. Atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35(3):485–491. doi:10.1161/ATVBAHA.115.305380