Coronary artery disease — also known as CAD — occurs when the arteries and blood vessels that provide oxygen and nutrients to the heart become narrow or blocked. CAD is the result of atherosclerosis, which is simply a build-up of fatty substances on the inside of the walls of the artery. When the blockage gets too large, blood flow to the heart is restricted or, in the case of a heart attack, completely cut off. CAD is the leading cause of death among both men and women in the United States.

Symptoms of CAD may include — but are not necessarily limited to — the following:

• Chest pain, also known as angina (see next question)
• Shortness of breath
• Heavy feeling in the chest
• Tightness in the chest
• A burning sensation in the chest
• Pressure behind the breastbone or in the arms, neck and/or jaw

Some people experience no symptoms at all of coronary artery disease; a heart attack may be the first sign of the disease.

If you are experiencing any of the symptoms listed above, it is very important that you call 911 IMMEDIATELY. Do not ever attempt to drive yourself to the hospital, and do not ask a family member or friend to drive you. Paramedics who respond to your 911 call have special training and equipment that can save your life in a cardiac emergency.

Typically, atherosclerosis (a thickening of the inside walls of the coronary arteries) is the culprit in CAD. Cholesterol and other forms of fat accumulate inside the artery. Other things that pass through the artery — such as calcium and some components of blood — attach to this fat and harden into what is called plaque. Sometimes these plaques break away into blood clots and block the flow of blood through the artery (which is called coronary thrombosis).

Other causes of CAD may include:

• Congenital defects (abnormalities in the structure of the arteries)
• Muscle spasms
• Infection from chlamydia bacteria and other related organisms

There are a number of risk factors for CAD; some cannot be changed, while others are a lifestyle choice and can be changed. Risk factors that cannot be changed include:

• Heredity—People whose parents have coronary artery disease are more likely to develop it. African-Americans are also at increased risk because they experience a higher rate of severe hypertension than whites do.
  
  
• Sex—Men are more likely to have heart attacks than women are and are more likely to have heart attacks at a younger age. After age 60, however, women have coronary artery disease at a rate equal to that of men.
  
  
• Age—Men who are 45 years old and above and women who are 55 years old and above are more likely to have coronary artery disease. Occasionally, coronary disease may strike a person in their 30s. People over age 65 are more likely to die of a heart attack than younger people. Older women are twice as likely as older men to die within a few weeks of a heart attack.

Risk factors that CAN be controlled through changes in lifestyle include:

• Smoking—Smoking increases both the chance of developing coronary artery disease and the chance of dying from it. Smokers are two to four times more likely than are non-smokers to die of a sudden heart attack. They are more than twice as likely as non-smokers to have a heart attack. They are also more likely to die within an hour of a heart attack. Second-hand smoke may also increase risk.
  
  
• High cholesterol—Risk of developing coronary artery disease increases steadily as blood cholesterol levels go above 160 mg/dL. Total blood cholesterol is considered high at levels above 240 mg/dL, and borderline at 200-239 mg/dL. High-risk levels of low-density lipoprotein (LDL cholesterol) begin at 130-159 mg/dL, depending on other risk factors.
  
  
• High blood pressure—High blood pressure makes the heart work harder, which weakens the muscle over time. As a result, a number of diseases can gain a foothold, including heart attack, stroke, kidney failure and congestive heart failure. A blood pressure of 140 over 90 (140/90) or above is considered high. In combination with obesity, smoking, high cholesterol and/or diabetes, high blood pressure raises the risk of heart attack or stroke several times over.
  
  
• Lack of physical activity—Even modest physical activity such as walking is beneficial if done regularly.Click here for information about senior exercise classes at Glendale Adventist
  
  
• Diabetes—The risk of developing coronary artery disease is seriously increased for diabetics. More than 80 percent of diabetics die of some type of heart or blood vessel disease.
  
  
• Obesity—Excess weight causes unnecessary strain on the heart and heightens your risk of developing coronary artery disease, even if you have no other risk factors. Obesity increases blood pressure and blood cholesterol and can lead to diabetes.

Your doctor will start with a basic exam. He or she will ask you about your medical history, discuss your symptoms with you, listen to your heart and perform a few basic screening tests to measure such factors as weight, blood pressure, blood lipid (fat) levels and levels of fasting blood glucose (a form of sugar).

From there, your doctor may recommend other diagnostic tests, which may include one or more of the following:

Electrocardiogram
This test shows the heart's activity; it may also show that your heart is not receiving enough oxygen (a condition called ischemia). An electrocardiogram will most likely be performed in your physician's office and takes only about 10 minutes. A nurse or technician will place electrodes on your chest, arms and legs, and your heart activity will be recorded on a paper strip that the doctor can read.

Exercise stress test
Since nearly half of patients with significant coronary artery disease have normal electrocardiograms, your doctor may recommend this test, which is performed either in the physician's office or in an exercise laboratory. It is another type of electrocardiogram that measures how your heart and blood vessels respond to physical stress and exercise.

During this test, you will be asked to exercise on a treadmill or a stationery bicycle while the same electrodes as in the electrocardiogram again record your heart's activity. This test normally takes 15 to 30 minutes to complete.

Exercise echocardiography
Your physician may use this test to help confirm the findings of your exercise stress test. During the test, an ultrasound image is made of your heart. This is a similar process to the ultrasounds used to see a baby in the womb, but instead uses sound waves to make a video of your heart in motion. With these images, a cardiologist can often spot abnormalities in the motion of the walls of the heart that may indicate coronary artery disease.

During this test, a technician will press a hand-held device against your chest in order to make the image. The test is performed in a cardiology outpatient diagnostic laboratory and takes about 30-60 minutes.

Radionuclide angiography
This is another test that further clarifies findings from an exercise stress test. It allows physicians to see the blood flow to the coronary arteries. The procedure starts with an injection into your bloodstream of a small amount of a mildly radioactive substance such as thallium. This will pose no danger whatsoever to you. Then a technician uses a gamma camera to record a picture of your heart revealed by the thallium. Radionuclide angiography is usually performed in the nuclear medicine department of a hospital and takes about 30-60 minutes.

Coronary angiography
This test explores the coronary arteries in detail. In the hospital's cardiac catheterization laboratory, a cardiologist inserts a thin tube called a catheter into an artery in your arm or leg and directs it toward your heart. Inside your heart, a camera attached to the tube records images (an angiogram) of your beating heart, as well as any blockages that may be present. This procedure may be followed by an angioplasty, which removes plaque build-up in your arteries, or by other procedures.

There are three main ways to combat CAD: lifestyle changes, medication and surgery.

Lifestyle changes
This approach involves changing habits that contribute to CAD, including:

• Quitting smoking
• Losing weight
• Increasing exercise
• Restricting your consumption of fat, sodium and other known dietary contributors to CAD

Your doctor may provide you with guidelines for changing lifestyle choices that contribute to CAD. You may also be referred to a smoking cessation group, a dietary counselor or other health professionals.

Medication
Any medication your doctor prescribes will be tailored to the specific nature of your coronary artery disease, but may include one or more of the following:

• Beta-blockers, which control angina by decreasing the workload on your heart. These drugs can also decrease your risk of additional heart attacks.
  
  
• Nitroglycerin or other "nitrates," which control angina.
  
  
• Calcium-channel blockers, which relax the arteries and help to control angina.
  
  
• Aspirin and other similar drugs, which reduce the formation of clots.
  
  
• Cholesterol-lowering drugs, which helps people whose elevated level of cholesterol cannot be controlled by changes in diet.
  
  
• Digitalis drugs and ACE inhibitors, which address problems with the pumping action of the heart.

Catheterization and Surgery
People with frequent or disabling angina, along with those who have severe blockages, may require special cardiac procedures or surgery, such as:

• Angioplasty—Also known as the "balloon procedure," a cardiologist threads a thin tube called a catheter through a leg or arm artery into the heart. Once inside the blocked artery, the doctor expands the balloon in the tip of the catheter, which compacts the built-up plaque against the walls of the artery. This procedure is performed while the patient is awake and may take one to two hours.
  
  
• Coronary artery bypass surgery—In this surgery, a blood vessel-usually from the leg or chest--is grafted onto a blocked artery to bypass the obstruction. If more than one artery is blocked, a bypass can be done on each. This allows the blood to flow freely once again to the heart. Following surgery, you will likely need to take certain heart medications and follow particular dietary and exercise guidelines.