The heart is a living muscle and it requires a constant supply of oxygen (supplied by blood vessels called arteries). Coronary artery disease is present when the blood flow to the heart muscle is impaired due to narrowing in the blood vessels that bring blood to the heart (coronary arteries). These narrowings are most often due to the process of hardening of the arteries, which is termed "atherosclerosis".  

Atherosclerosis is often evident on a microscopic level in early adulthood and is attributed to many different factors including age, family history/genetics, high blood pressure, abnormal blood cholesterol, cigarette smoking, diabetes mellitus, diet, psychosocial stress and lack of regular physical exercise. These narrowings (also called coronary stenoses) often develop slowly over time, with a build up of cholesterol beneath the inner most layers of the artery. Chronic inflammation and the effects of various local factors can lead to disruption of the inner most lining, exposing the cholesterol underneath. This often triggers a blood clot (thrombosis) in an attempt to heal the inner blood vessel surface. If the clot is severe and impairs flow down the vessel, an acute coronary syndrome may result. If the vessel lining heals and the clot dissolves and stabilizes, the coronary plaques often end up a bit thicker, but may not yet restrict blood flow down the vessel. When slowly building coronary plaques begin to restrict blood flow to the heart (usually at first with strenous exertion, when the heart itself requires more blood), angina pectoris may develop. Angina is classically a chest pressure sensation in the mid-chest (which may radiate to the jaw or left arm) which occurs with exertion and is relieved with rest or nitro. Angina should generally last less than 15-20 minutes, because a lack of blood flow to the heart lasting more than 20 minutes will usually cause heart tissue death (infarction) which can be detected with sensitive blood tests (troponin, high-sensitivity troponin).


Disclaimer: The brief patient information supplied here and the outside links provided are not intended to replace the advice of your physician and are only meant to help guide patients to formulate questions during their physician appointments. Each patient's situation is unique and a large number of factors are considered when arriving at a management plan for your specific condition. 

Coronary Artery Disease and Stable Angina