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Coronary Artery disease (CAD)


Coronary artery disease or CAD occurs when plaque deposits of cholesterol and other substances build up inside the arteries that supply blood to the heart. This causes the arteries to become stiffened and narrowed, or blocked.

What causes CAD? The lining of the arteries is normally large enough for oxygentated blood to flow through to the heart and other organs. Plaque deposits clogging your arteries can restrict or even block the flow. A complete blockage can cause a heart attack.

Arteriosclerosis is the thickening, hardening, and loss of elasticity in the walls of the arteries, which can potentially damage the heart. Atherosclerosis is a form of arteriosclerosis that causes the hardening of the vessels due to the buildup of plaque inside the vessel.

Why do some people develop CAD? The risk factors for developing CAD include:

  • Family history of heart disease
  • Excess weight
  • Over age 45 for men and post-menopausal for women
  • Lack of physical exercise
  • Smoking
  • Medical conditions, such as diabetes, high cholesterol and high blood pressure

What are the symptoms of CAD?

Symptoms may not be noticeable for years. They can include angina, or chest pain, which may feel mildly uncomfortable or like indigestion. Other common symptoms include shortness of breath and feeling tired. Symptoms may be triggered by exercise or stress.

How is CAD diagnosed? Your physician will base the diagnosis on your medical history, risk factors, and symptoms. They may order one or more tests to help reach a diagnosis. Tests may include electrocardiogram (ECG or EKG), echocardiogram (ECHO), a stress test, blood tests, and others.

How is CAD treated?

Treatment will be based on your test results and your symptoms. Your physician may suggest lifestyle changes to help lower your risk of more serious heart disease, such as eating a healthier diet, getting more exercise, and quitting smoking. You may also be advised to take medications to treat diabetes, high cholesterol, high blood pressure and other risk factors for CAD.


A percutaneous coronary intervention (PCI), also called a coronary angioplasty, is a minimally invasive procedure often used to open narrowed or blocked arteries and restore blood flow to the heart. This is also known as “revascularization.”

Who will do the procedure?

Interventional cardiologists are physicians specially trained to diagnose coronary artery disease and perform PCIs. They use techniques and medical devices specifically designed for treating CAD.

How is the procedure done?

You can expect to be awake for the procedure and given medication to help you relax. Your doctor will make a small incision in your wrist or groin and insert a catheter into the blood vessel. A catheter is a small, thin tube specially designed for these procedures. There may be a balloon at the end of the catheter that your doctor will inflate to help open the artery and restore blood flow. Other medical devices are designed to remove the plaque. In some cases, after blood flow is restored, the physician will use a small mesh tube called a stent to help support and keep the artery open.


Plaque is a buildup of fatty, waxy deposits in your arteries. It is made up of cholesterol, fat, waste products from cells, calcium and clotting material in the blood called fibrin. Atherosclerosis is plaque buildup that causes narrowing of the arteries, which can lead to coronary artery disease.

Also called “angina pectoris,” angina is chest pain or discomfort that occurs when your heart muscle (myocardium) doesn’t get enough blood and oxygen. Angina can last for different lengths of time, but it comes back. There can be other causes of angina besides atherosclerosis or a blood clot, such as poor blood flow through a narrowed heart valve or a problem with your heart’s pumping ability.

Blood cholesterol is a fat-like, waxy substance that your body makes—and needs. It’s used during the processes of digestion and hormone production. But when your body makes too much cholesterol, due to diet and other causes, the extra cholesterol can stick to the inner wall of the artery. The body sends white blood cells to trap it, which coats the cholesterol in more fat. The cells form a thin cap over the soft plaque. If your blood pressure goes up, the pressure can break the cap open, form a dangerous clot, and cause a heart attack.

Chronic Total Occlusion (CTO)
When an artery becomes completely blocked by plaque buildup for three months or longer, it is called a chronic total occlusion (CTO). CTOs are seen in one in five patients who undergo coronary angiography, an imaging technique used to evaluate blood flow through the arteries.