Diagnosis
Coronary artery disease FAQs
Mayo Clinic cardiologist Stephen Kopecky, M.D., answers the most frequently asked questions about coronary artery disease (CAD).
Hi, I'm Dr. Steve Kopecky, a cardiologist at Mayo Clinic. And I'm here to answer some of the important questions you may have about coronary artery disease.
Many small changes can lead to great benefit over time. Remember that nothing you do to improve your health is ever too little. And nothing you do to improve your health is ever too late.
Cholesterol is always involved in the initiation of the narrowing of the arteries to the heart. And every plaque or narrowing of your arteries contains cholesterol. It is essential to control the cholesterol in order to optimally lower your chance of a heart attack.
Yes. All the studies that have shown regression of arterial narrowing have done three things. First, take care of the obvious factors like high blood pressure, smoking and high cholesterol. Second, address diet and physical activity. And third, help patients manage stress.
No. Half of the time, the first symptom a person has of coronary artery disease is actually a heart attack. And half of these heart attacks are fatal. So overall, for one out of four people, the first symptom is what we term sudden cardiac death.
No. Studies have shown that even if your cholesterol is well control with medicines, if you do not eat a healthy diet, your heart attack, stroke, and death rate is not significantly reduced.
Yes. Since your heart beats one hundred thousand times a day, even mild elevations of blood pressure above 130 over 80 can cause significant health problems, including heart attacks, strokes and heart failure.
I tell people they have a new part-time job called Your Health. In part of this is knowing what medicines you're on, what doses you're taking and why you're taking these medicines. Also very helpful, check your blood pressure regularly. Check your weight regularly at home. If any questions arise about your health, put them in your smartphone, so you'll have them the next time you have your visit with your doctor. Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time and we wish you well.
To diagnose coronary artery disease, a health care provider will examine you. You'll likely be asked questions about your medical history and any symptoms. Blood tests are usually done to check your overall health.
Tests
Test to help diagnose or monitor coronary artery disease include:
- Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. It can show how fast or slow the heart is beating. Your provider can look at signal patterns to determine if you're having or had a heart attack.
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Echocardiogram. This test uses sound waves to create pictures of the beating heart. An echocardiogram can show how blood moves through the heart and heart valves.
Parts of the heart that move weakly may be caused by a lack of oxygen or a heart attack. This may be a sign of coronary artery disease or other conditions.
- Exercise stress test. If signs and symptoms occur most often during exercise, your provider may ask you to walk on a treadmill or ride a stationary bike during an ECG. If an echocardiogram is done while you do these exercises, the test is called a stress echo. If you can't exercise, you might be given medications that stimulate the heart like exercise does.
- Nuclear stress test. This test is similar to an exercise stress test but adds images to the ECG recordings. A nuclear stress test shows how blood moves to the heart muscle at rest and during stress. A radioactive tracer is given by IV. The tracer helps the heart arteries show up more clearly on images.
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Heart (cardiac) CT scan. A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries.
Sometimes dye is given by IV during this test. The dye helps create detailed pictures of the heart arteries. If dye is used, the test is called a CT coronary angiogram.
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Cardiac catheterization and angiogram. During cardiac catheterization, a heart doctor (cardiologist) gently inserts a flexible tube (catheter) into a blood vessel, usually in the wrist or groin. The catheter is gently guided to the heart. X-rays help guide it. Dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages.
If you have an artery blockage that needs treatment, a balloon on the tip of the catheter can be inflated to open the artery. A mesh tube (stent) is typically used to keep the artery open.
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Treatment
Treatment for coronary artery disease usually involves lifestyle changes such as not smoking, eating healthy and exercising more. Sometimes, medications and procedures are needed.
Medications
There are many drugs available to treat coronary artery disease, including:
- Cholesterol drugs. Medications can help lower bad cholesterol and reduce plaque buildup in the arteries. Such drugs include statins, niacin, fibrates and bile acid sequestrants.
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Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in some people.
Daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Don't start taking a daily aspirin without talking to your health care provider.
- Beta blockers. These drugs slow the heart rate. They also lower blood pressure. If you've had a heart attack, beta blockers may reduce the risk of future attacks.
- Calcium channel blockers. One of these drugs may be recommended if you can't take beta blockers or beta blockers don't work. Calcium channel blockers can help improve symptoms of chest pain.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These medicines lower blood pressure. They may help keep coronary artery disease from getting worse.
- Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain. Nitroglycerin is available as a pill, spray or patch.
- Ranolazine. This medication may help people with chest pain (angina). It may be prescribed with or instead of a beta blocker.
Surgeries or other procedures
Coronary artery stent
Coronary artery stent
To place a coronary artery stent, a balloon on the tip of the catheter is inflated to widen the blocked artery (A). Then a metal mesh stent is placed (B). The stent helps hold the artery open so blood can flow through it (C).
Coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery creates a new path for blood to flow to the heart. A healthy blood vessel from another part of the body is used to redirect blood around a blocked area of an artery. Usually the blood vessel is taken from an artery in the chest, called the internal mammary artery. Sometimes it's taken from a leg vein, called the saphenus vein.
Sometimes, surgery is needed to fix a blocked artery. Some options are:
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Coronary angioplasty and stent placement. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). The heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow.
A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents slowly release medication to help keep the arteries open.
- Coronary artery bypass graft surgery (CABG). A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. CABG is an open-heart surgery. It's usually done only in those with many narrowed heart arteries.
More Information
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and home remedies
Making certain lifestyle changes can help keep the arteries healthy and can prevent or slow coronary artery disease. Try these heart-healthy tips:
- Don't smoke. Smoking is a major risk factor for coronary artery disease. Nicotine tightens blood vessels and forces the heart to work harder. Not smoking is one of the best ways to lower the risk of a heart attack.
- Control blood pressure. Adults should get their blood pressure checked by a health care provider at least every two years. You may need more-frequent checks if you have a history of high blood pressure. Ask your health care provider what blood pressure goal is best for you.
- Manage cholesterol. Adults should get a cholesterol test when in their 20s and at least every five years after. Some people need more-frequent checks. The optimal LDL cholesterol level is lower than 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). But it depends on your overall health. If you have other risk factors for heart disease, your target LDL cholesterol may be below 100 mg/dL (2.6 mmol/L). Ask your provider what your cholesterol levels should be.
- Check your blood sugar. If you have diabetes, carefully managing your blood sugar can help reduce the risk of heart disease.
- Eat heart-healthy foods. Eat plenty of fruits, vegetables, whole grains, legumes and nuts. Avoid saturated fats and trans fats. Reduce salt and sugar. Eating one or two servings of fish a week also may help keep the heart healthy.
- Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
- Get moving. Exercise helps manage weight and control diabetes, high cholesterol and high blood pressure — all risk factors for coronary artery disease. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity.
- Maintain a healthy weight. Being overweight increases the risk of coronary artery disease. Losing even a small amount of weight can help reduce risk factors for coronary artery disease.
- Ask about cardiac rehabilitation. If you've had heart surgery, your doctor may suggest a program of education, counseling and exercise training that's designed to help improve your health.
- Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to tame stress.
- Get recommended vaccines. Get a flu (influenza) vaccine each year.
Regular medical checkups are important. Some of the main risk factors for coronary artery disease — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can help you maintain better heart health.
Alternative medicine
Omega-3 fatty acids are a type of unsaturated fatty acid. It's thought that they can lower inflammation throughout the body. Inflammation has been linked to coronary artery disease. However, the pros and cons of omega-3 fatty acids for heart disease continue to be studied.
Sources of omega-3 fatty acids include:
- Fish and fish oil. Fish and fish oil are the most effective sources of omega-3 fatty acids. Fatty fish — such as salmon, herring and light canned tuna — contain the most omega-3 fatty acids and, therefore, the most benefit. Fish oil supplements may offer benefit, but the evidence is strongest for eating fish.
- Flax and flaxseed oil. Flax and flaxseed oil contain a type of omega-3 fatty acid called alpha-linolenic acid (ALA). ALA contains smaller amounts of omega-3 fatty acids than do fish and fish oil. ALA may help lower cholesterol and improve heart health. But research is mixed. Some studies haven't found ALA to be as effective as fish. Flaxseed also contains a lot of fiber, which has various health benefits.
- Other oils. Alpha-linolenic acid (ALA) can also be found in canola oil, soybeans and soybean oil.
Other supplements may help lower blood pressure or cholesterol — two risk factors for coronary artery disease. Some that may be effective are:
- Barley
- Psyllium, a type of fiber
- Oats, a type of fiber that includes beta-glucans and is found in oatmeal and whole oats
- Garlic
- Plant sterols (found in supplements and some margarines, such as Promise, Smart Balance and Benecol)
Always talk to a health care provider before taking herbs, supplements or medications bought without a prescription. Some drugs and supplements can interfere with other drugs.
Preparing for your appointment
If you have symptoms of coronary artery disease or any risk factors, make an appointment with your health care provider. You may be referred to a heart specialist (cardiologist).
Here's some information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. You may need to avoid food or drinks for a short while before some tests.
- Write down any symptoms you're having, including any that may seem unrelated to coronary artery disease.
- Write down your medical information, including other conditions you have and any family history of heart disease.
- Bring a list of medications with you to your appointment. Include doses.
- Ask a family member or friend to go with you to the appointment, if possible. An extra person can help you remember what the provider says.
- Write down questions to ask your health care provider.
Questions to ask your health care provider at your first appointment include:
- What is causing my symptoms?
- What tests do I need?
- Should I see a specialist?
- Do I need to follow any restrictions while I wait for my next appointment?
- When should I call 911 or emergency medical help for my symptoms?
If you're referred to a heart doctor (cardiologist) for coronary artery disease, you may want to ask these questions:
- What is my risk of long-term complications from coronary artery disease?
- What treatment do you recommend?
- If I need medication, what are the possible side effects?
- Do I need surgery? Why or why not?
- What diet and lifestyle changes should I make?
- What restrictions do I need to follow, if any?
- How frequently will you see me for follow-up visits?
- I have other health problems. How can I best manage these conditions together?
Don't hesitate to ask additional questions about your condition.
What to expect from your doctor
A health care provider who sees you for coronary artery disease may ask:
- What are your symptoms?
- When did you begin having symptoms?
- Have the symptoms gotten worse over time?
- Do you have chest pain or difficulty breathing?
- Does exercise or activity make the symptoms worse?
- Do you have heart problems in your family?
- Have you been diagnosed with other health conditions?
- What medications do you take?
- Have you ever had radiation therapy?
- How much do you exercise in a typical week?
- What's your typical daily diet?
- Do you or did you smoke? How much? If you quit, when?
- Do you drink alcohol? How much?
What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. These habits protect against coronary artery disease and its complications, including heart attack and stroke.