Coronary artery disease
Coronary artery disease (CAD) develops when atherosclerotic plaque builds up in the arteries that supply the heart muscle. It can reduce blood flow, cause angina and increase the risk of heart attack, heart failure and sudden cardiac events.
At a glance
Quick facts
- Category
- Atherosclerotic cardiovascular disease
- Main mechanism
- Plaque narrows coronary arteries
- Common symptom
- Chest pain or pressure
- Can be silent
- Yes
- Major complication
- Heart attack
- Treatment
- Risk reduction, medicines, procedures when needed
Dr. Augustine Chinemerem Anadu
Consultant Family Physician · University of Calabar Teaching Hospital
Reviewed for clinical accuracy, practical wording and general-medicine context.
Names & terminology
How this entity may be named or searched
- Coronary artery disease (CAD)
- Common term for atherosclerotic disease affecting the coronary arteries.
- Coronary heart disease (CHD)
- Often used interchangeably with CAD in public and clinical sources.
- Ischemic heart disease
- A broader term describing heart disease caused by reduced blood supply to the myocardium.
- Angina
- Chest discomfort caused by myocardial ischemia; it is a symptom syndrome, not a synonym for CAD.
Structured entity profile
Clinical profile
Overview
Coronary artery disease is caused mainly by atherosclerosis, a process in which plaque builds up within the coronary arteries. As the arteries narrow, the heart muscle may receive too little oxygen during exertion or stress, producing ischemia and angina. [1]
Plaque can also rupture and trigger a blood clot that suddenly blocks a coronary artery, causing an acute coronary syndrome or heart attack. Some people have no symptoms before the first serious event, which is why prevention and risk-factor control are central to care. [1] [2]
Symptoms and warning signs
SYMPTOM MATRIX
Coronary disease ranges from silent atherosclerosis to acute coronary syndrome
New, severe or persistent chest symptoms require urgent assessment rather than self-triage.
- Chest pressure, tightness or heaviness
- Symptoms triggered by exertion or stress
- Shortness of breath
- Reduced exercise tolerance
- Fatigue
- Arm, shoulder, jaw, neck or back discomfort
- Nausea or sweating
- Dizziness or lightheadedness
- Atypical or minimal symptoms
- No symptoms before a complication
- Chest pain or pressure at rest or lasting several minutes
- Severe or worsening breathlessness
- Cold sweat, nausea or collapse
- New symptoms with marked weakness or fainting
Possible acute coronary syndrome is an emergency. Seek immediate medical help according to local emergency guidance.
Diagnosis
Diagnosis depends on whether the person is stable or may be having an acute coronary syndrome. Clinicians assess symptoms, cardiovascular risk factors, physical findings and a resting ECG; suspected acute presentations also require cardiac biomarkers such as troponin. [1] [3]
A single normal resting ECG does not rule out coronary artery disease. Further or repeat testing depends on the clinical setting and level of suspicion.
For stable symptoms, further testing may include CT coronary angiography, stress testing or invasive coronary angiography depending on the pre-test likelihood, symptoms, prior disease and local guideline pathways. The goal is to identify clinically important coronary disease and guide risk-reducing treatment. [1] [3]
Diagnostic pathway
Separate emergency presentations from stable coronary symptoms
Testing is selected according to symptoms, risk and whether acute myocardial injury is suspected.
No single test is appropriate for every person with chest symptoms; suspected acute coronary syndrome and stable symptoms follow different pathways. Source [1]
Risk factors and prevention
Risk increases with high LDL cholesterol, high blood pressure, diabetes, smoking, older age, family history, chronic kidney disease and physical inactivity. Prevention therefore focuses on smoking cessation, healthy eating, physical activity, weight management where appropriate and control of blood pressure, lipids and diabetes. [2] [4]
Treatment and management
Long-term treatment aims to reduce the risk of heart attack and stroke and to control angina. It typically combines lifestyle changes with evidence-based medicines such as lipid-lowering treatment, antiplatelet therapy when indicated and antianginal medicines selected for the individual clinical context. [3] [4]
Coronary revascularization with percutaneous coronary intervention or bypass surgery is used in selected patients with acute coronary syndromes, persistent symptoms despite medical therapy or coronary anatomy where revascularization is expected to improve outcomes. [3]
Treatment & care hub
Treat symptoms and the underlying atherosclerotic risk
CAD care is broader than relieving chest pain alone.
Lower future cardiovascular risk
Control lipids, blood pressure, diabetes and tobacco exposure alongside healthy lifestyle measures.
Reduce ischemic symptoms
Antianginal medicines are selected according to heart rate, blood pressure, comorbidities and response.
Prevent coronary thrombosis
Antiplatelet treatment is used in defined coronary disease settings; choice and duration depend on the clinical scenario.
Restore coronary blood flow
PCI or bypass surgery may be appropriate for acute events, uncontrolled symptoms or specific coronary anatomy.
Living with coronary artery disease
Ongoing care includes adherence to preventive medicines, physical activity or cardiac rehabilitation when appropriate, monitoring of blood pressure and lipids, and prompt reassessment if symptoms change. New or worsening chest pain should not be assumed to be “usual angina” without clinical assessment. [3] [4]
United States estimate
Coronary heart disease affects about 1 in 20 U.S. adults
CDC reports coronary heart disease as the most common type of heart disease in the United States.
Common questions
Frequently asked questions
The terms are commonly used interchangeably. Both usually refer to atherosclerotic disease affecting the coronary arteries.
Yes. Some people have silent disease and are first diagnosed after a heart attack or another complication.
No. Chest pain has many causes, but new, severe or persistent chest pressure must be assessed urgently because it can represent an acute coronary syndrome.
Assessment may include ECG, blood tests, CT coronary angiography, stress testing or invasive angiography depending on whether symptoms are acute or stable.
Yes. Many people are managed with lifestyle measures and medicines; revascularization is used when it is expected to improve symptoms or outcomes.
Sources
- NHLBI, NIH — Coronary Heart Disease
- CDC — About Coronary Artery Disease (CAD)
- NHLBI, NIH — Coronary Heart Disease — Treatment
- CDC — Heart Disease Facts
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
Older adults and people with diabetes may have atypical or silent coronary disease, so the absence of classic angina does not end the assessment when clinical suspicion remains high.