Coronary artery disease

What is coronary artery disease?

Coronary artery disease (CAD) is the most common type of heart disease. It occurs when the coronary arteries, the blood vessels that supply oxygen and nutrients to the heart muscle, become narrowed or blocked by a build-up of fatty deposits called plaques.

If a plaque ruptures, a blood clot can form and suddenly block the artery, causing a heart attack.

Common symptoms

• Angina, chest tightness or discomfort, usually with exertion
• Shortness of breath on exercise
• Fatigue with reduced exercise tolerance
• In some cases, no symptoms at all until a heart attack occurs

How is it diagnosed?

• Exercise stress test: monitoring your heart during exercise on a treadmill
• CT coronary angiogram: a non-invasive scan to visualise the coronary arteries
• Coronary angiography: a catheter-based test that gives the most detailed view of the arteries
• Intravascular imaging (IVUS or OCT): imaging from inside the artery during angiography for the most precise assessment

How is it treated?

• Medications: aspirin, statins, blood pressure tablets, and anti-anginal drugs to manage symptoms and reduce risk
• Coronary angioplasty and stenting (PCI): a minimally invasive procedure to open a narrowed artery and place a stent
• Chronic total occlusion (CTO) PCI: a specialised procedure to open a completely blocked artery
• Coronary artery bypass surgery: for patients with extensive disease affecting multiple arteries
• Cardiac rehabilitation: a structured programme of exercise, education, and support after treatment

How should you prepare?

For any appointment it helps to bring: a list of your current medications and doses; copies or details of any previous heart tests (ECGs, scans, or angiogram reports); a note of your symptoms, when they happen, and what brings them on; and your questions. If you have results from another hospital, ask that clinic to send them ahead of your visit.

When to seek urgent help

If you experience sudden, severe chest pain lasting more than 15 minutes, call 999 or 112 immediately. This could be a heart attack requiring emergency treatment.