What is coronary artery disease?

The coronary arteries are the arteries that provide blood flow and oxygen to the heart muscle itself. Coronary artery disease is a narrowing of these small blood vessels.

The coronary arteries can become blocked or narrowed by:

• A build-up of fat (cholesterol) in the lining of the arteries
• Blood clots in the arteries
• Spasm of the arteries

If coronary arteries become blocked or narrowed enough, areas of heart muscle may not receive enough blood and oxygen. This can result in symptoms of angina (heart discomfort), heart attack (heart muscle damage) or even sudden cardiac arrest (heart stops beating effectively).

What is vulnerable plaque?

Doctors have, for many years, thought that the main cause of a heart attack or stroke is the buildup of plaque in an artery. With time, the plaque buildup would narrow the artery so much that the artery would either close off or become clogged by a blood clot. However, it is now believed that these types of blockages cause only about 3 out of 10 heart attacks.

Many people who have heart attacks do not have arteries which are badly narrowed by plaque, but have another type of plaque (most often called vulnerable plaque) which is buried within the lining of the artery.

Often these vulnerable plaque areas show up in heart catheterizations as smaller blockages (such as 30-50%), or are sometimes undetected. At this stage, they may only slightly slow the flow of blood, if at all. In these instances, as the plaque builds in the lining of the artery, the inside lining can become thin and inflamed. Inflammation (swelling) is the body's natural reaction to injury. Inflammation is thought to be a main contributor to many diseases, including coronary artery disease.

When this inflammation is combined with other stressors, like high blood pressure, it can cause the thin covering over the plaque to crack, spilling the contents of the vulnerable plaque into the bloodstream. When this happens, the body tends to quickly form a clot in that area of the artery. This clot can suddenly block off blood flow through that artery which could cause a sudden heart attack.

Can vulnerable plaque be prevented?

You can decrease inflammation in the same ways that you can cut your heart attack risk:

• Take aspirin and/or fish oil supplements (if recommended by your doctor)
• Eat a healthy, balanced diet
• Follow a regular exercise program
• If you smoke--quit

Researchers also think that obesity and diabetes may be tied to inflammation. Most doctors agree that following a heart healthy lifestyle still plays the most important role in reducing your risk of having a heart attack. Modifying your risk factors is important in preventing inflammation and heart disease. See the article titled "Improving Your Heart Health."

What are the warning signs and symptoms of coronary artery disease?

Angina (heart discomfort) is a warning sign of coronary artery disease. Do not ignore this symptom, as it is often a sign of an impending heart attack. If you or someone you know is experiencing angina, call 9-1-1 at once to get to an emergency room immediately. Symptoms of angina:

• Pressure, tightness, squeezing, fullness, pain or burning in the chest
• Indigestion, abdominal fullness, "gas," heartburn, nausea and vomiting
• Numbness, tingling or aching in any part of the arm
• Discomfort in the shoulder, neck or jaw area
• Full feeling or pain in the throat
• Shortness of breath and dizziness
• Upper back pain
• Fatigue, weakness
• Sweating

It is important to understand that men and women experience angina differently. These differences are described below:

Men typically experience the following common warning signs of a heart attack:

• Severe to moderate chest pain (or discomfort)
• Dizziness
• Shortness of breath
• Nausea
• Radiating pain (or discomfort) in the arms and chest
• Feeling of impending doom

Women may have symptoms that differ greatly from men. While chest pain (or discomfort) is often a key warning sign of a heart attack, some women who have a heart attack do not experience chest pain. A woman's pain (or discomfort) may be in the back, arm, neck, shoulder, and/or throat. Also, women will typically have more "non-pain" symptoms than men. These include vomiting, nausea, fatigue and shortness of breath.

It is also surprisingly common for people to experience no symptoms at all. This is especially true of diabetics and those over the age of 75. We recommend that these individuals visit their family physician and/or cardiologist on a regular basis to continually monitor their health.

How is coronary artery disease detected?

Usually doctors suspect that you may have cardiovascular disease based on your cardiovascular risk factors. During a physical exam, your doctor will evaluate many of these risks, which include diabetes, high blood pressure, high blood cholesterol, previous family history, history of smoking, etc.

We invite you to take our free online heart risk assessment at any time to evaluate your cardiovascular health - simply click the graphic in the upper left. It only takes about ten minutes, and your results are generated immediately. Please print and bring these results to your next physician visit.

In addition to evaluating your risk factors, there are also noninvasive imaging techniques available to detect coronary artery disease at its earliest stage. Young or old, it is extremely important to be aware of coronary artery disease. It is a progressive disease that can lead to death or heart failure. There are many treatment options and risk factor reduction strategies that can slow the progression or in some cases reverse the effects of the disease.

The non-invasive and catheterization techniques available to detect coronary artery disease are listed below (catheterization technique is noted with an *):