Diagnosis

The doctor will ask questions about your medical history, do a physical exam and order routine blood tests. He or she may suggest one or more diagnostic tests as well, including:

  • Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress.

    In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.

  • Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity.

    Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.

  • Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise.

    Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.

    Another stress test known as a nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It's similar to a routine exercise stress test but with images in addition to an ECG. A tracer is injected into your bloodstream, and special cameras can detect areas in your heart that receive less blood flow.

  • Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor may inject a special dye into your coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart.

    This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.

  • Heart scan. Computerized tomography (CT) technologies can help your doctor see calcium deposits in your arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely.

    A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries.

Treatment

Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures.

Lifestyle changes

Making a commitment to the following healthy lifestyle changes can go a long way toward promoting healthier arteries:

  • Quit smoking.
  • Eat healthy foods.
  • Exercise regularly.
  • Lose excess weight.
  • Reduce stress.

Drugs

Various drugs can be used to treat coronary artery disease, including:

  • Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants.
  • Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries.

    If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin.

  • Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks.
  • Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by temporarily dilating your coronary arteries and reducing your heart's demand for blood.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease.

Procedures to restore and improve blood flow

Sometimes more aggressive treatment is needed. Here are some options:

  • Angioplasty and stent placement (percutaneous coronary revascularization). Your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls.

    A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open.

  • Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.

Lifestyle and home remedies

Lifestyle changes can help you prevent or slow the progression of coronary artery disease.

  • Stop smoking. Smoking is a major risk factor for coronary artery disease. Nicotine constricts blood vessels and forces your heart to work harder, and carbon monoxide reduces oxygen in your blood and damages the lining of your blood vessels. If you smoke, quitting is one of the best ways to reduce your risk of a heart attack.
  • Control your blood pressure. Ask your doctor for a blood pressure measurement at least every two years starting at age 18. If you're age 40 or older, or you're age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. He or she may recommend more frequent measurements if your blood pressure is higher than normal or you have a history of heart disease. The ideal blood pressure is generally below 120 systolic and 80 diastolic, as measured in millimeters of mercury (mm Hg).
  • Check your cholesterol. Ask your doctor for a baseline cholesterol test when you're in your 20s and at least every five years after. If your test results aren't within desirable ranges, your doctor may recommend more-frequent measurements. Most people should aim for an LDL level below 130 milligrams per deciliter (mg/dL), or 3.4 millimoles per liter (mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L).
  • Keep diabetes under control. If you have diabetes, tight blood sugar management can help reduce the risk of heart disease.
  • Get moving. Exercise helps you achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure — all risk factors for coronary artery disease. With your doctor's OK, aim for about 30 to 60 minutes of moderate to physical activity most or all days of the week.
  • Eat healthy foods. A heart-healthy diet, such as the Mediterranean diet, that emphasizes plant-based foods, such as fruits, vegetables, whole grains, legumes and nuts — and is low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Eating one or two servings of fish a week also is beneficial.
  • Maintain a healthy weight. Being overweight increases your risk of coronary artery disease. Losing even just a few pounds can help lower your blood pressure and reduce your risk of coronary artery disease.
  • Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

In addition to healthy lifestyle changes, remember the importance of regular medical checkups. 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 set the stage for a lifetime of better heart health.

Alternative medicine

Omega-3 fatty acids are a type of unsaturated fatty acid that's thought to reduce inflammation throughout the body, a contributing factor to coronary artery disease. However, recent studies have not shown them to be beneficial. More research is needed.

  • 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 also contain beneficial omega-3 fatty acids, though studies have not found these sources to be as effective as fish. The shell on raw flaxseeds also contains soluble fiber, which can help lower blood cholesterol.
  • Other dietary sources of omega-3 fatty acids. Other dietary sources of omega-3 fatty acids include canola oil, soybeans and soybean oil. These foods contain smaller amounts of omega-3 fatty acids than do fish and fish oil, and evidence for their benefit to heart health isn't as strong.

Other supplements may help reduce your blood pressure or cholesterol level, two contributing factors to coronary artery disease. These include:

  • Alpha-linolenic acid (ALA)
  • Artichoke
  • Barley
  • Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
  • Blond psyllium
  • Cocoa
  • Coenzyme Q10
  • Garlic
  • Oat bran (found in oatmeal and whole oats)
  • Sitostanol (found in oral supplements and some margarines, such as Benecol)

Preparing for your appointment

Early-stage coronary artery disease often produces no symptoms, so you may not discover you're at risk of the condition until a routine checkup reveals you have high cholesterol or high blood pressure. So it's important to have regular checkups.

If you know you have symptoms of or risk factors for coronary artery disease, you're likely to see your primary care doctor or a general practitioner. Eventually, however, 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. For some tests, for example, you may need to fast for a time beforehand.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to coronary artery disease.
  • Write down your key medical information, including other conditions with which you've been diagnosed, all medications and supplements you're taking, and family history of heart disease.
  • Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
  • Write down questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

  • What are the possible causes for my signs and symptoms?
  • What tests do I need?
  • Should I see a specialist?
  • Should I follow any restrictions while I wait for my next appointment?
  • What emergency signs and symptoms should prompt a call to 911 or emergency medical help?

Questions to ask if you are referred to a cardiologist include:

  • What is my diagnosis?
  • What is my risk of long-term complications from this condition?
  • What treatment do you recommend?
  • If you're recommending medications, what are the possible side effects?
  • Am I a candidate for 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 these 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 doctor or cardiologist who sees you for heart-related signs and symptoms may ask:

  • What are your symptoms?
  • When did you begin experiencing symptoms?
  • Have your symptoms gotten worse over time?
  • Do you have chest pain or difficulty breathing?
  • Does exercise or physical exertion make your symptoms worse?
  • Are you aware of heart problems in your family?
  • Have you been diagnosed with other health conditions?
  • What medications are you taking?
  • Have you ever been treated with 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 becoming more physically active. These are primary lines of defense against coronary artery disease and its complications, including heart attack and stroke.