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Coronary Artery Disease: When the Heart Doesn’t Get Enough Blood

The information below will help you understand what it means when the coronary arteries cannot supply the heart with enough blood. The described symptoms do not necessarily mean that you have coronary artery disease (or short CAD), but if the symptoms persist and you feel concerned, please contact your physician.

Man getting a consultations with a physician

What Is Coronary Artery Disease?

The narrowing or blockage of coronary arteries usually happens due to plaque buildup, which can cause Coronary Artery Disease (CAD). In some cases, coronary artery disease can entirely block the supply of oxygen-rich blood to the heart muscle, causing a heart attack. 

What Causes Coronary Artery Disease?

Arteries narrow when blockages, made up of blood fats, cholesterol and other substances, start to build up in the artery walls. This hardens the arteries and they cannot react to cardiac stress like exercising. When this happens, the heart does not get the oxygen-rich blood it needs. As plaque grows, it can completely block the artery, preventing a part of the heart muscle from receiving oxygen and causing a heart attack. Vessels are often blocked or narrowed in multiple spots. If an artery in the brain is blocked, it can lead to a stroke.

Coronary artery disease is more likely: 1) with increasing age, 2) in men than in women before menopause, 3) if close relatives have suffered CAD early in life.

Some of the following risk factors can be influenced, but some cannot:

  • Age (over 45 for men, over 55 for women)
  • Family history of heart and vascular disease
  • Diabetes
  • Smoking
  • Hypertension (high blood pressure)
  • High levels of blood cholesterol (LDL, sometimes called “bad” cholesterol) and triglyceride  (a type of fat found in the blood)
  • Low level of "good" cholesterol (HDL)
  • Excess weight or obesity
  • Excessive alcohol consumption
  • Excessive stress
  • Lack of exercise

What Are the Symptoms of Coronary Artery Disease?

Since arteries narrow and harden gradually over the years, it can take decades before patients experience discomfort. The first symptoms usually appear when the heart is under stress, for example during exercise. Symptoms vary and may also occur at rest or during sleep. If you suspect you are having a heart attack or are experiencing chest discomfort, especially with the following symptoms, seek medical help immediately:

  • Shortness of breath
  • Heart palpitations
  • Discomfort, pressure or pain in the center of the chest (angina pectoris) or radiating to one or both arms or jaw
  • Pain in the neck, jaw, throat, abdomen, or back
  • Quick exhaustion during physical activity which did not use to be symptoms
  • Dizziness
  • A fast heartbeat
  • Nausea or vomiting
  • Sweating


If you have these symptoms, even rarely or temporarily, consult your physician. Men over 45 and women over 55 should have regular check-ups.

Man clutching his chest with both hands

How Is Coronary Artery Disease Diagnosed?

These tests may be used to confirm coronary artery disease:

  • Electrocardiography (ECG): records the electrical activity of the heart.
  • Echocardiogram (ECHO): uses ultrasound to detect how the heart is working.
  • Stress test: it is important to repeat tests while the heart is under physical or pharmacological stress.
  • Catheterization of the heart (also called Coronary Angiography): a test done in a catheterization laboratory (“cath lab”) in which a physician injects contrast medium into the vascular system. X-ray images of the heart then show where the coronary vessels may be narrowed.
  • Intravascular ultrasound (IVUS): performed in the cath lab using high-frequency ultrasound waves to show the inside of a vessel.
  • Magnetic resonance imaging (MRI): a non-invasive method to see lesions in the arteries.
  • Computer tomography (CT): An X-ray scan showing the arteries at different angles.
  • Blood tests: to check blood fat levels in the blood. Certain parameters can indicate damaged heart muscle cells.

How Is Coronary Artery Disease Treated?

In the early stages, medication combined with changes in lifestyle and a healthy diet may be able to mitigate the symptoms and slow the progress of coronary artery disease (CAD). If the disease is already advanced, the affected coronaries have to be widened mechanically. The cardiologist will most likely recommend a combination of different treatment options based on the symptoms, the findings, and the future risks for the patient.

Felame physician talking to an elderly female patient

These options include:

  • Medication and lifestyle changes:

Drugs to lower blood pressure, aspirin or other antiplatelet agents to prevent blood clotting, nitrates to relieve chest pain, statins to lower cholesterol, etc. Each patient is different so your physician will work on an individual therapy that suits you best.

For lifestyle changes please check out our “Fit for a Healthy Heart” and “Heart-Healthy Diet” sections.

  • Minimally invasive treatment: percutaneous coronary intervention (PCI)

Percutaneous coronary intervention (PCI) is executed through a thin, flexible tube, called a catheter, in a catheterization laboratory (“cath lab”). The physician accesses the vascular system most often via the femoral artery in the groin or other arteries in the arm. Only a tiny cut in the skin is needed to access the vessel.

  • Balloon angioplasty and/or stenting

Balloon angioplasty is an intervention that is performed with a balloon catheter. Stenting means the same procedure as the angioplasty in the beginning, but placing a metallic stent into the vessel to restore the blood flow. Find out more about balloon angioplasty and stenting here.

Resorbable scaffolds are innovative stents made of materials like magnesium alloys that widen the artery and then dissolve slowly over a period of time

  • Bypass surgery: coronary artery bypass graft

If a minimally invasive PCI is not possible, the patient will need to undergo open-heart surgery under general anesthetic. This procedure is called bypass surgery or coronary artery bypass graft (CABG). In this method, the obstructed part of the coronary artery is bypassed with a segment of a healthy vessel secured from another part of the patient’s body. Blood can now flow around the blockage. This surgery can be done while the heart is beating (beating heart surgery) or while the heart is stopped and a heart-lung machine controls circulation (arrested heart surgery).

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