Coronary Artery Disease - Symptoms, Causes, Treatment

Medically Reviewed by
Dr. Saurabh Chopra
Coronary Artery Disease

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Coronary Artery Disease
Medically Reviewed by Dr. Saurabh Chopra Written by Sparshi Srivastava

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Research by Kumar and Sinha in 2020 shows that Indians are hospitalised for coronary artery disease symptoms 2-4 times more than other ethnicities. Alarmingly, the admission rates are 5-10 times higher for those under 40.

It affects 21.4% of diabetics and 11% of non-diabetics in India. Thus, consultation is required for symptoms, and awareness is needed to prevent complications. Let’s read about coronary artery disease causes, risks, treatments, and more. 

Disease Name

Coronary Artery Disease

Symptoms

Chest pain (angina), breathlessness, Fatigue

Risk Factors

Age, sex, family history, high blood pressure, cholesterol levels, diabetes

Diagnosis

Blood tests, Electrocardiogram (ECG or EKG), Echocardiogram, Heart CT Scan

Treated By

Cardiologist

Treatment

Lifestyle changes, medicines, heart surgery

About Coronary Artery Disease

Coronary artery disease (CAD) is a cardiac condition affecting the main blood vessels or coronary arteries supplying blood to the heart. CAD develops when the blood flow to the heart muscle is reduced due to fats and cholesterol buildup on the artery walls. It typically progresses over many years. 

Types of Coronary Artery Disease

Plaque buildup in the arteries is just one form of coronary heart disease. There are three main types of coronary artery disease that you need to know. These are:

  1. Obstructive Coronary Artery Disease: This common type develops when plaque gradually narrows the coronary arteries. It eventually blocks blood flow to the heart, thus leading to a heart attack.

  2. Nonobstructive Coronary Artery Disease: Unlike obstructive disease, nonobstructive coronary artery disease isn't caused by plaque buildup. It arises from other issues, such as:

  1. Endothelial dysfunction (damage to the artery lining)
  2. Coronary vasospasm (artery constrictions at inappropriate times)
  3. Microvascular dysfunction (malfunctions in smaller artery branches)
  4. Myocardial bridging (compression of the coronary arteries by the heart muscle)
  1. Spontaneous Coronary Artery Dissection (SCAD): It develops when a coronary artery wall tear unexpectedly blocks blood flow. This condition often presents as a heart attack. 

Coronary Artery Disease Grades

CAD-RADS Level

Symptom Severity

Description

CAD-RADS 0

Asymptomatic

No blockage in any coronary artery

CAD-RADS 1 

Mild

A tiny narrowing (1% to 24%) in one spot

CAD-RADS 2 

Moderate

25% to 49% blockage in one or more arteries

CAD-RADS 3 

Significant

50% to 69% blockage in one or more arteries

CAD-RADS 4 

Severe

Blockage of 70% to 99% in one or more arteries

CAD-RADS 5 

Complete blockage

At least one artery is completely blocked. This can be recent (acute) or old (chronic).

The table above includes the six CAD-RADS categories (ranging from CAD-RADS 0 to CAD-RADS 5). These show a score (0 to 5) to describe how blocked the arteries are.

Coronary Artery Disease Symptoms and Signs

Coronary artery disease (CAD) symptoms onset when the heart does not receive enough oxygen-rich blood. CAD symptoms might not be noticeable initially and can occur only when the heart works hard, such as during exercise. 

As the condition progresses, symptoms can become severe or frequent. Signs of coronary artery disease may include:

  1. Chest Pain (Angina): This may feel like squeezing, tightness, or pain in the chest. Angina typically affects the middle or left side of the chest. In some individuals, especially women, the pain may be brief or sharp and is felt in the neck, arm, or back.

  2. Shortness of Breath: This may feel like an inability to catch one's breath. It shows that the heart is not pumping enough blood throughout the body. 

  3. Fatigue: If the heart cannot pump sufficient blood to meet the body's needs, the patient may feel unusually tired.

Causes of Coronary Artery Disease 

CAD is primarily caused by the deposition of plaque that narrows and obstructs blood flow in the arteries. The causes of coronary artery disease are as follows:

  1. Diabetes or insulin resistance

  2. High blood pressure

  3. Physical inactivity

  4. Smoking or tobacco use


"I have observed that one of the major challenges in CAD treatment is the late presentation of patients, often due to limited awareness and access to healthcare. I once treated a young tech professional with CAD in Bengaluru. Surprisingly, the main cause of his problem was his high stress, sedentary lifestyle and dietary habits. Fortunately, after a successful angioplasty, he returned to his regular life.”

- Dr. Saurabh Chopra

Cardiologist


Risk Factors of Coronary Artery Disease

This disease is highly prevalent in both males and females. Risk factors for coronary artery disease are enlisted below in two major categories:

Uncontrollable Risk Factors for CAD

  1. Age: The risk of artery damage and narrowing increases with age.

  2. Sex: Men are generally more susceptible to CAD, although women's risk increases post-menopause.

  3. Family History: Coronary artery disease risks also increase if the close relatives of a person have had some heart disease.

Controllable Risk Factors for CAD

  1. Smoking and Alcohol: Quitting tobacco and liquor is crucial, as it subsequently increases the risk of heart disease.

  2. Cholesterol Levels: High LDL "bad" cholesterol and low HDL "good" cholesterol levels can lead to atherosclerosis.

  3. Diabetes: It increases the risk of CAD and shares common risk factors like obesity and high blood pressure.

  4. Chronic Kidney Disease: Long-term kidney disease raises the risk of CAD.

  5. Physical Inactivity: Regular exercise is vital for heart health, while a lack of exercise is linked to CAD. Sleep patterns, stress, and an unhealthy diet are risk factors.

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Prevention of Coronary Artery Disease

Early identification of risks reduces the morbidity and mortality linked to CAD. Coronary artery disease prevention strategies are as follows:

  1. Modifying Daily Habits: Lifestyle changes can prevent CAD. Per week, it is recommended to perform at least 150 minutes of moderate-intensity activities (brisk walking) or over 75 minutes of vigorous-intensity activities (like biking, running, swimming).

  2. Quit Smoking: It is one of the significant risk factors for CAD. It is important to assess tobacco use in all adults during every primary care visit.

  3. Hypertension Management: Preventing hypertension is important to control CAD. Hypertension results from systolic blood pressure (BP) and diastolic BP of 130 mm Hg and 80 mm Hg or higher.

  4. Prevent Diabetes: Patients with Type 2 diabetes have a higher risk of developing CAD. These conditions are closely linked to sedentary living, dietary choices, physical activity levels, and body weight. It is important to manage diabetes to prevent any cardiac issues.

How is Coronary Artery Disease diagnosed?

For diagnosis, a cardiologist will examine, ask about the patient's medical history, evaluate their symptoms, and conduct various tests. The assessments include:

  1. Blood Tests: Measures blood sugar and cholesterol levels. A high-sensitivity C-reactive protein (CRP) test can detect a protein associated with artery inflammation.

  2. Electrocardiogram (ECG or EKG): It evaluates the electrical activity of the heart. ECG patterns, a type of heart rate, can be detected by placing electrodes on the chest and connecting them to a computer.

  3. Echocardiogram: Visualises blood flow through the heart using sound waves. Areas of the heart that move weakly may indicate a lack of oxygen or a previous heart attack. 

  4. Exercise Stress Test: The patient's heart is monitored while exercising either on a treadmill or a stationary bike. It can reveal heart issues that might not be apparent during rest.

  5. Nuclear Stress Test: The test measures blood flow to the heart at rest using a tracer injected and captured by an imaging machine. It identifies areas with poor blood flow or damage.

  6. Heart CT Scan: This detects calcium deposits and blockages in the, which can narrow the arteries.

  7. Cardiac Catheterisation and Angiogram: Identifies blockages in the heart arteries. The doctor inserts a catheter through the wrist or groyne and guides it to the heart.

Preparing for a Doctor's Appointment

To make the most of a cardiologist's visit, patients should take several preparatory steps before the consultation. These include:

  1. Gather all previous medical records and relevant test results.

  2. List all current medications, including prescriptions, over-the-counter drugs, and supplements.

  3. Document symptoms, their frequency, and how they affect daily life.

  4. Prepare a list of all queries to ask the doctor.

Questions to Ask the Cardiologist

When discussing a coronary artery disease diagnosis, one should come prepared with a list of questions. Some queries to consider asking include the following: 

  1. Considering my family and personal history, am I at a higher risk for coronary heart disease?

  2. Could my symptoms be related to CAD?

  3. Is my blood pressure within the normal range? If not, can the doctor help me manage my BP?

  4. What dietary choices should I make for better cardiovascular health?

  5. How much exercise is safe for me and beneficial for my heart?

Treatment for Coronary Artery Disease

Disease management depends on the symptoms and stage of the disease. Coronary artery disease treatment may often include lifestyle changes, medications or heart surgery.

Medications

Coronary artery disease medications are available to help patients manage their symptoms. Some of these include:

  1. Cholesterol Medicine: Recommend to lower "bad" LDL cholesterol and reduce plaque buildup. 

  2. Aspirin: This helps thin the blood and prevent blood clots. 

  3. Beta-blockers:  These medicines slow the heartbeat, thus lowering blood pressure.

  4. Angiotensin-converting Enzyme (ACE) Inhibitors and Angiotensin 2 Receptor Blockers (ARBs): They lower blood pressure and may help prevent CAD from getting worse.

  5. Calcium Channel Blockers: If one can't take beta blockers, these medicines may be suggested to help reduce chest pain.

Ayurvedic Treatment 

Ayurveda suggests an alternative list of treatments for coronary artery disease. They are free from chemicals, additives, and preservatives. The dosage is as follows:

  1. Arjuna Capsules and Tea: Effective in treating coronary artery disease, the capsules help manage symptoms like high blood pressure, high triglycerides, and high cholesterol. The tea aids in treating fatigue, circulatory ailments, and congestive heart failure. 

  2. Gotu Kola Capsules: Made from Centella Asiatica, it helps improve overall cardiac health due to their antioxidant properties. 

Homoeopathy 

Patients with coronary heart disease may respond well to homoeopathic treatments, which have a high success rate. Below are the top 5 homoeopathic medicines suggested by heart doctor for CAD.

  1. Crataegus Oxyacantha: It is considered a "heart tonic" in homoeopathy. It treats coronary insufficiency, increases the supply of blood and oxygen to the heart, and lowers cholesterol, angina attacks, and blood pressure.

  2. Spigelia Anthelmia: Used for left-sided symptoms like chest and arm pain. It treats conditions such as pericarditis, anaemia, heart issues and cardiac valve dysfunctions.

  3. Cactus Grandiflorus: It has antiarrhythmic and antihypertensive properties. It normalises cardiac rhythm and is often used to treat heart blocks.

  4. Glonoinum: Derived from nitroglycerin, it is used for chest pain radiating to the back or shoulders and palpitations. 

  5. Aurum Metallicum: Made from gold metal, it treats high blood pressure, heart hypertrophy, and chest pain. 

Surgeries or Other Procedures

Other CAD treatment options may include surgery that treats a blocked artery and improves blood flow. These may include:

  1. Coronary Angioplasty and Stent Placement: This is a common surgery for coronary artery disease and involves using a catheter with a tiny balloon. It widens a clogged heart artery, improving blood flow. A stent, often medicated to prevent re-narrowing, is placed to keep the artery open.

  2. CABG Surgery: The surgeon uses a vein or artery from another part of the body to bypass a blocked heart artery. This creates a new path through which the blood flows to the heart, improving circulation.

Estimated Cost of Coronary Angiography

The overall coronary angiography cost ranges from ₹1,35,000- ₹4,10,000. This cost may vary depending on the expertise of the doctor and the hospital facilities.

Treatment Option (Surgery)

Estimated Cost Range

Coronary Angioplasty

₹1,35,000- ₹4,10,000

Please Note: Patients must talk to HexaHealth experts about the latest price for the procedure.

Risk of Delay in Coronary Artery Disease

If a patient has CAD, it's crucial to seek treatment promptly to prevent complications and improve long-term health. Here are some risks of delaying CAD treatment:

  1. Increased Risk of Heart Attack: CAD narrows the arteries that supply blood to the heart. Delayed treatment restricts blood flow and increases the possibility of a heart attack. 

  2. Heart Failure: The cardiac muscle weakens when it doesn't receive enough oxygen-rich blood. Over time, this can lead to heart failure.

  3. Arrhythmias: Delayed treatment can also raise the risk of irregular heartbeats (arrhythmias).

  4. Worse Prognosis: Studies have shown that delaying treatment for CAD is associated with a higher chance of complications, disability, and even death.

When to call a doctor?

If someone experiences any potential symptoms of CAD, they must immediately consult a doctor. These include:

  1. Chest pain (angina) and pain radiating to the shoulder, back, arm, neck, jaw, teeth, or upper belly

  2. Shortness of breath, especially with exertion and cold sweats.

  3. Feeling faint, lightheaded, or dizzy

  4. Fatigue

  5. Nausea

Diet for Coronary Artery Disease 

It is crucial in lowering the risk of coronary artery disease. The ACC/AHA 2019 guidelines have recommended a diet for CAD which includes:

  1. Plant-based Diet: Rich in fruits, legumes, vegetables, nuts, whole grains, and fish. This diet is highly recommended for reducing cardiovascular risks. 

  2. Monounsaturated/Polyunsaturated Fats: Includes foods such as avocados, nuts, seeds, olives, corn, and soybeans. One must also consume olive oil, flaxseed oils, fish, and walnuts, as it lowers CAD.

  3. Reducing Dietary Sodium: This has been linked to lower blood pressure and enhanced heart health.

  4. Avoiding Sugary Foods: These lead to a decreased likelihood of diabetes, thus also reducing the risk of CAD.

Takeaway

Coronary artery disease symptoms often include chest pain, fatigue, heart palpitations, shortness of breath or swelling in the hands or feet. Early detection and medical intervention are key to managing this disease effectively.

At HexaHealth, we specialise in assisting patients by informing them about the coronary artery disease causes and ensuring proper treatment. We help with prompt diagnoses and provide customised treatment strategies. Our team guarantees that everyone receives the necessary support and care during treatment.

Related Reads

FAQs for Coronary Artery Disease

Coronary artery disease (CAD) is caused by the narrowing or blockage of coronary arteries. This is mainly due to plaque buildup that reduces the blood flow to the heart. One may also experience chest pain, shortness of breath, and heart attacks.

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Some common symptoms of CAD include chest pain and discomfort. Other symptoms are shortness of breath, fatigue, and pain in the arms or shoulders.

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The accumulation of fats, cholesterol or plaque in the coronary arteries is the major cause of coronary artery disease (CAD). Atherosclerosis is a buildup that can cause arteries to narrow down, thus reducing blood flow to the heart muscle.

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Major risk factors include high cholesterol, high blood pressure, smoking, diabetes, obesity, lack of exercise, and family history. Certain conditions like autoimmune diseases and sleep disorders can also increase risk.

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Several procedures can be used to diagnose coronary artery disease. These include:

  1. Coronary angiography: It creates images of the coronary arteries and visualises blood flow using contrast dye and X-rays. 

  2. CT scan: This test produces cross-sectional body images using X-rays. Plaque accumulation and blockages can also be detected with a CT coronary angiography.

  3. Electrocardiogram: It gauges the electrical activity of the heart.

  4. Stress test: To assess the performance of the heart during physical exertion.

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Treatments for CAD include lifestyle changes for coronary artery disease like diet and exercise and medications to manage risk factors. In some cases of severe blockages, procedures like angioplasty or bypass surgery may be necessary. 

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Yes, lifestyle changes like quitting smoking, eating a healthy diet, and exercising can prevent or slow down the progression of CAD. Controlling risk factors through medication is also essential.

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Managing coronary artery disease involves making some lifestyle modifications. Some such changes include: 

  1. Diet: Consume a heart-healthy diet low in sodium, alcohol, saturated fats, and added sugars. Consume more fruits, vegetables, and whole grains.

  2. Physical activity: Engage in 75-150 minutes of physical activity each week. 

  3. Weight: If the waist measurement is above 35 inches in females or above 40 inches in males, there is a higher possibility of developing heart disease.

  4. Smoking: Give up tobacco since it can narrow and harm blood vessels.

  5. Sleep: Make sure to get enough rest.

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Many medications can be used to treat coronary artery disease (CAD). These include:

  1. Antiplatelets: Medications for long-term treatment are also called platelet aggregation or function inhibitors.

  2. Statins: These medications reduce cholesterol levels by inhibiting the liver enzyme responsible for lowering the risk of CAD and heart attacks.

  3. Beta-blockers: They lower blood pressure and slow the heart rate, which lessens the strain on the heart.

  4. Nitroglycerin: Used to treat CAD patients' angina or chest pain.

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Surgical treatments for CAD include angioplasty with stent placement to open blocked arteries. Doctors may also recommend coronary artery bypass grafting (CABG) to bypass blocked arteries using grafts from other parts of the body.

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When plaque builds up on the walls of the blood vessels, it damages the cells that line the arteries, leading to coronary heart disease (CAD). Atherosclerosis is a disorder caused by plaque accumulation that narrows and hardens the arteries, limits blood flow and puts more strain on the heart. A heart attack could be the outcome.

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The prognosis for CAD varies based on the severity and management of the disease. With timely treatment and lifestyle changes, many individuals can control their symptoms and reduce the risk of complications.

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Reducing risk involves adopting a heart-healthy lifestyle, including exercise, a balanced diet and healthy body weight. It also involves not smoking and managing conditions like hypertension and diabetes.

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A heart-healthy diet for CAD includes plenty of fruits, whole grains, vegetables, lean proteins and healthy fats. One must also reduce saturated fats, trans fats, sodium, and added sugars in the diet.

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Frequent exercise can help manage coronary artery disease (CAD) if it already exists. It also lowers the risk of developing CAD in the following ways:

  1. Enhances blood and cardiac circulation

  2. Reduces blood pressure by pumping more blood through the arteries.

  3. Exercise raises "good" cholesterol, or high-density lipoproteins, which can help lower cholesterol levels.

  4. It can support weight loss over time and help one keep the excess weight off.

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Plaque accumulation in the coronary arteries narrows them and lowers heart blood flow, thus resulting in coronary artery disease (CAD). Untreated CAD can result in several potentially fatal consequences, such as:

  1. Heart attack

  2. Cardiac failure

  3. Heart arrhythmia

  4. Cardiogenic shock

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According to research by Dr Drobni et al. in 2022, 40–60% of CAD cases are hereditary. New technologies like genome-wide association studies have helped researchers better understand how genetics play a role in CAD. This study has improved our knowledge beyond what earlier family and twin studies could reveal.

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Recent advancements in CAD treatment include drug-eluting stents and new medications. This also involves PCSK9 inhibitors and minimally invasive surgical techniques, which improve outcomes and recovery times.

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Yes, coronary artery disease can be brought on by stress. Heart disease can be caused by stress in several ways, including:

  1. Prolonged stress can make the body more inflammatory, causing plaque to accumulate in the arteries.

  2. Stress can also cause hypertension or elevated blood pressure, which may lead to CAD.

  3. Emotional stress can raise cortisol levels, impacting platelets and autonomic tone, which regulate blood pressure and heart rate.

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Knowing the risk will assist one in deciding about medication and healthy lifestyle modifications to help prevent heart disease. When it comes to adults aged 20 to 79 who do not have heart disease, risk assessments should be conducted every 4 to 6 years.

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Early signs of CAD include chest discomfort, shortness of breath, fatigue, and sometimes silent symptoms that only become apparent during physical exertion. Early detection is key for effective management.

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References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Mayo Clinic. Coronary artery disease [Internet]. Mayo Clinic. 2022. link
  2. Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360 degree overview. Medical Journal, Armed Forces India [Internet]. 2020 Jan 1;76(1):1–3. link
  3. Kumar P, Bhatia M. Coronary Artery Disease Reporting and Data System: A Comprehensive Review. Journal of Cardiovascular Imaging. 2022;30(1):1.link
  4. Regmi M, Siccardi MA. Coronary Artery Disease Prevention [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022. link
  5. Coronary artery disease - Diagnosis and treatment - Mayo Clinic [Internet]. Mayoclinic.org. 2024. link
  6. Coronary Heart Disease - Diagnosis | NHLBI, NIH [Internet]. www.nhlbi.nih.gov. 2023 [cited 2024 Jul 13]. link
  7. Drobni ZD, Kolossvary M, Karady J, Jermendy AL, Tarnoki AD, Tarnoki DL, et al. Heritability of Coronary Artery Disease: Insights From a Classical Twin Study. Circulation: Cardiovascular Imaging. 2022 Mar;15(3).link
Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

Reviewer

Dr. Saurabh Chopra

Dr. Saurabh Chopra

MBBS , MD General Medicine , DM Cardiology

13 Years Experience

Dr Saurabh Chopra is a Cardiologist currently associated with Narayana Superspeciality Hospital, Sector 24 in Gurugram. He has 13 years of experience in Cardiology and worked as an expert Cardiologist in different cities of Ind...View More

Author

Sparshi Srivastava

Sparshi Srivastava

B.Tech Biotechnology (Bansal Institute of Engineering and Technology, Lucknow)

2 Years Experience

An ardent reader, graduated in B.Tech Biotechnology. She was previously associated with medical sciences secondary research and writing. With a keen interest and curiosity-driven approach, she has been able to cont...View More

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