What Is Coronary Artery Disease?

Coronary artery disease (CAD), also called coronary heart disease, is a condition in which plaque (plak) builds up inside the coronary
arteries. These arteries supply your heart muscle with oxygen-rich blood.

Plaque is made up of fat, cholesterol (ko-LES-ter-ol), calcium, and other substances found in the blood. When plaque builds up in the
arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Atherosclerosis

Figure A shows a normal artery with normal blood flow. Figure B shows an artery with plaque buildup.

Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your
arteries. Blood clots can partially or completely block blood flow.

Overview

When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina
(an-JI-nuh or AN-juh-nuh) or a heart attack. What Causes Coronary Artery Disease?
Research suggests that coronary artery disease (CAD) starts when certain factors damage the inner layers of the coronary arteries. These
factors include:

 Smoking

 High amounts of certain fats and cholesterol in the blood

 High blood pressure

 High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing
causes plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your
coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks.
This narrows the arteries more and worsens angina or causes a heart attack

What Is Coronary Artery Disease?

Coronary artery disease is atherosclerosis of the coronary arteries, producing blockages in the vessels
which nourish the heart itself. Atherosclerosis occurs when the arteries become clogged and narrowed,
restricting blood flow. Without adequate blood flow from the coronary arteries, the heart becomes starved
of oxygen and vital nutrients it needs to work properly.
How Does Coronary Artery Disease Develop?
Your coronary arteries are blood vessels on the heart. They are smooth and elastic, allowing blood to flow
freely.
Before your teen years, fat can start to deposit in the blood vessel walls. As you get older, the fat builds
up. This causes injury to your blood vessel walls. In an attempt to heal itself, the fatty tissues release
chemicals that promote the process of healing but make the inner walls of the blood vessel sticky.
Then, other substances, such as inflammatory cells, proteins, and calcium that travel in your bloodstream
start sticking to the inside of the vessel walls. The fat and other substances combine to form a material
called plaque, which can narrow the flow of blood in the artery (atherosclerosis).
Some plaque deposits are hard on the outside and soft and mushy on the inside. Some plaque is fragile,
cracking or tearing, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in
the blood that aid clotting) come to the area, and blood clots accumulate on the injured vessel wall. This
causes the artery to narrow even more. Sometimes, the blood clot breaks apart by itself, and blood
supply is restored.
Over time, the inside of the arteries develop plaques of different sizes.
Eventually, a narrowed coronary artery may develop new blood vessels that go around the blockage to
get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be
able to supply enough oxygen-rich blood to the heart muscle.
 In other cases, the blood clot may totally block the blood supply to the heart muscle, causing what is
called an acute coronary syndrome. This is actually a name given to three serious conditions:

 Unstable angina: chest pain that can often be relieved with oral medications, is unstable, and may
progress to a heart attack. Usually more intense medical treatment or a procedure is required to treat this
acute coronary syndrome.
 Non-ST segment elevation myocardial infarction (NSTEMI) or "non-Q-wave MI": This heart attack, or
MI, does not cause typical changes on an electrocardiogram (ECG). However, chemical markers in the
blood indicate that damage has occurred to the heart muscle.
 ST segment elevation myocardial infarction (STEMI) or "Q-wave MI": This heart attack, or MI, is
caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and
causes changes on the ECG as well as chemical markers in the blood.

Some people have symptoms that tell them that they may soon develop an acute coronary syndrome,
others may have no symptoms until something happens, and still others have no symptoms of the acute
coronary syndrome at

Other Names for Coronary Artery Disease

 Atherosclerosis

 Coronary heart disease

 Hardening of the arteries

 Heart disease

 Ischemic (is-KE-mik) heart disease

 Narrowing of the arteries

Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing to an area of your heart muscle. Angina may
feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back.

A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This prevents oxygen-rich blood from reaching
that area of heart muscle and causes it to die. Without quick treatment, a heart attack can lead to serious problems and even death.

Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias (ah-RITH-me-ahs). Heart failure is a condition in
which your heart can't pump enough blood throughout your body. Arrhythmias are problems with the speed or rhythm of your heartbeat.

Outlook

CAD is the most common type of heart disease. It's the leading cause of death in the United States for both men and women. Lifestyle
changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people

What Are the Symptoms of Coronary Artery Disease?

 The most common symptom is of coronary artery disease is angina, called or angina pectoris, or simply
chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, numbness,
fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt
in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.
Other symptoms that can occur with coronary artery disease include:

 Shortness of breath
 Palpitations (irregular heart beats, skipped beats, or a "flip-flop" feeling in your chest)
 A faster heartbeat
 Weakness or dizziness
 Nausea
 Sweating

Learn to recognize your heart disease symptoms and the situations that cause them. Call your doctor if you
begin to have new symptoms or if they become more frequent or severe. If you or someone you are with
experience chest discomfort, especially with one or more of the symptoms listed above, don't wait longer
than a few minutes (no more than 5) before calling 9-1-1 to get help.
If you have angina and have been prescribed nitroglycerin, call your doctor or have someone take you to
the nearest emergency room if pain persists after taking two doses (taken at five-minute intervals) or after
15 minutes.
Emergency personnel may tell you to chew an aspirin to help break up a possible blood clot, if there is not
a medical reason for you to avoid aspirin.
Ischemia, and even a heart attack, can occur without any warning symptoms. This is called silent
ischemia. It can occur among all people with heart disease, though it is more common among people with
diabetes

Who Is At Risk for Coronary Artery Disease?

Coronary artery disease (CAD) is the leading cause of death in the United States for both men and women. Each year, more than half a
million Americans die from CAD.

Certain traits, conditions, or habits may raise your chance of developing CAD. These conditions are known as risk factors.

You can control most risk factors and help prevent or delay CAD. Other risk factors can't be controlled.

Major Risk Factors

Many factors raise the risk of developing CAD. The more risk factors you have, the greater chance you have of developing CAD.

 Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL
cholesterol (sometimes called good cholesterol).

 High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over a period of time.

 Smoking. This can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't
allow enough oxygen to reach the body's tissues.
  Insulin resistance. This condition occurs when the body can't use its own insulin properly. Insulin is a hormone that helps move
blood sugar into cells where it's used.

 Diabetes. This is a disease in which the body's blood sugar level is high because the body doesn't make enough insulin or doesn't
use its insulin properly.

 Overweight or obesity. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high
amount of extra body fat.

 Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors linked to overweight and obesity that raise your
chance for heart disease and other health problems, such as diabetes and stroke.

 Lack of physical activity. Lack of activity can worsen other risk factors for CAD.

 Age. As you get older, your risk for CAD increases. Genetic or lifestyle factors cause plaque to build in your arteries as you age.
By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms.

o In men, the risk for CAD increases after age 45.

o In women, the risk for CAD risk increases after age 55.

 Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with CAD before 55 years of
age, or if your mother or a sister was diagnosed with CAD before 65 years of age.

Although age and a family history of early heart disease are risk factors, it doesn't mean that you will develop CAD if you have one or both.

Making lifestyle changes and/or taking medicines to treat other risk factors can often lessen genetic influences and prevent CAD from
developing, even in older adults.

Emerging Risk Factors

Scientists continue to study other possible risk factors for CAD.

High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for CAD and heart attack. High levels of CRP are proof
of inflammation in the body. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger
inflammation and help plaque grow.

Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of developing CAD and
having a heart attack.

High levels of fats called triglycerides in the blood also may raise the risk of CAD, particularly in women.

Other Factors That Affect Coronary Artery Disease

Other factors also may contribute to CAD. These include:

 Sleep apnea. Sleep apnea is a disorder in which your breathing stops or gets very shallow while you're sleeping. Untreated sleep
apnea can raise your chances of having high blood pressure, diabetes, and even a heart attack or stroke.
  Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—
particularly one involving anger.

 Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors for heart disease. Men should have no more
than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.

What Are the Signs and Symptoms of Coronary Artery Disease?

A common symptom of coronary artery disease (CAD) is angina. Angina is chest pain or discomfort that occurs when your heart muscle
doesn't get enough oxygen-rich blood.

Angina may feel like pressure or a squeezing pain in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. This pain
tends to get worse with activity and go away when you rest. Emotional stress also can trigger the pain.

Another common symptom of CAD is shortness of breath. This symptom happens if CAD causes heart failure. When you have heart failure,
your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe.

The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary
arteries.

Signs and Symptoms of Heart Problems Linked to Coronary Artery Disease

Some people who have CAD have no signs or symptoms. This is called silent CAD. It may not be diagnosed until a person show signs and
symptoms of a heart attack, heart failure, or an arrhythmia (an irregular heartbeat).

Heart Attack

A heart attack happens when an area of plaque in a coronary artery breaks apart, causing a blood clot to form.

The blood clot cuts off most or all blood to the part of the heart muscle that's fed by that artery. Cells in the heart muscle die because they
don't receive enough oxygen-rich blood. This can cause lasting damage to your heart. For more information, see the animation in "What
Causes a Heart Attack?"

Heart With Muscle Damage and a Blocked Artery

 Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-
section of the coronary artery with plaque buildup and a blood clot.

The most common symptom of heart attack is chest pain or discomfort. Most heart attacks involve discomfort in the center of the chest that
lasts for more than a few minutes or goes away and comes back. The discomfort can feel like pressure, squeezing, fullness, or pain. It can
be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn.

Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or stomach. Shortness of breath or fatigue
(tiredness) often may occur with or before chest discomfort. Other symptoms of heart attack are nausea (feeling sick to your stomach),
vomiting, lightheadedness or fainting, and breaking out in a cold sweat.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to your body. Heart failure doesn't mean that your heart has stopped
or is about to stop working. It means that your heart can't fill with enough blood or pump with enough force, or both.

This causes you to have shortness of breath and fatigue that tends to increase with activity. Heart failure also can cause swelling in your feet,
ankles, legs, and abdomen.

Arrhythmia

An arrhythmia is a problem with the speed or rhythm of the heartbeat. When you have an arrhythmia, you may notice that your heart is
skipping beats or beating too fast. Some people describe arrhythmias as a fluttering feeling in their chests. These feelings are called
palpitations.

Types of Arrhythmia
The four main types of arrhythmia are premature (extra) beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias
(bray-de-ah-RITH-me-ahs).

Premature (Extra) Beats

Premature beats are the most common type of arrhythmia. They're harmless most of the time and often don't cause any symptoms.

When symptoms do occur, they usually feel like fluttering in the chest or a feeling of a skipped beat. Most of the time, premature beats need
no treatment, especially in healthy people.

Premature beats that occur in the atria are called premature atrial contractions, or PACs. Premature beats that occur in the ventricles are
called premature ventricular contractions, or PVCs.

In most cases, premature beats occur naturally, not due to any heart disease. But certain heart diseases can cause premature beats. They
also can happen because of stress, too much exercise, or too much caffeine or nicotine.

Supraventricular Arrhythmias

Supraventricular arrhythmias are tachycardias (fast heart rates) that start in the atria or the atrioventricular (AV) node. The AV node is a
group of cells located between the atria and the ventricles.

Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-
Parkinson-White (WPW) syndrome.

Atrial Fibrillation

AF is the most common type of serious arrhythmia. It's a very fast and irregular contraction of the atria.

In AF, the heart's electrical signal doesn't begin in the SA node. Instead, the signal begins in another part of the atria or in the nearby
pulmonary veins and is conducted abnormally.

When this happens, the electrical signal doesn't travel through the normal pathways in the atria. Instead, it spreads throughout the atria in a
fast and disorganized manner.

This causes the walls of the atria to quiver very fast (fibrillate) instead of beating normally. As a result, the atria aren't able to pump blood into
the ventricles the way they should.

The animation below shows atrial fibrillation. Click the "start" button to play the animation. Written and spoken explanations are provided with
each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to
move through the frames.

How Is Coronary Artery Disease Diagnosed?

Your doctor will diagnose coronary artery disease (CAD) based on:
  Your medical and family histories

 Your risk factors

 The results of a physical exam and diagnostic tests and procedures

Diagnostic Tests and Procedures

No single test can diagnose CAD. If your doctor thinks you have CAD, he or she will probably do one or more of the following tests.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records the electrical activity of your heart. An EKG shows how fast your heart is beating and
whether it has a regular rhythm. It also shows the strength and timing of electrical signals as they pass through each part of your heart.

Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An EKG also can show signs of a previous or current
heart attack.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are performed. If you can't exercise, you're
given medicine to speed up your heart rate.

When your heart is beating fast and working hard, it needs more blood and oxygen. Arteries narrowed by plaque can't supply enough
oxygen-rich blood to meet your heart's needs. A stress test can show possible signs of CAD, such as:

 Abnormal changes in your heart rate or blood pressure

 Symptoms such as shortness of breath or chest pain

 Abnormal changes in your heart rhythm or your heart's electrical activity

During the stress test, if you can't exercise for as long as what's considered normal for someone your age, it may be a sign that not enough
blood is flowing to your heart. But other factors besides CAD can prevent you from exercising long enough (for example, lung diseases,
anemia, or poor general fitness).

Some stress tests use a radioactive dye, sound waves, positron emission tomography (PET), or cardiac magnetic resonance imaging (MRI)
to take pictures of your heart when it's working hard and when it's at rest.

These imaging stress tests can show how well blood is flowing in the different parts of your heart. They also can show how well your heart
pumps blood when it beats.

Echocardiography

This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of
your heart and how well your heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to
the heart muscle caused by poor blood flow.

Chest X Ray

A chest x ray takes a picture of the organs and structures inside the chest, including your heart, lungs, and blood vessels.

A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms that aren't due to CAD.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk
factors for CAD.

Electron-Beam Computed Tomography

Your doctor may recommend electron-beam computed tomography (EBCT). This test finds and measures calcium deposits (called
calcifications) in and around the coronary arteries. The more calcium detected, the more likely you are to have CAD.

EBCT isn't used routinely to diagnose CAD, because its accuracy isn't yet known.

Coronary Angiography and Cardiac Catheterization

Your doctor may ask you to have coronary angiography (an-jee-OG-ra-fee) if other tests or factors show that you're likely to have CAD. This
test uses dye and special x rays to show the insides of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). A long,
thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your
coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary
arteries.

Cardiac catheterization is usually done in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may
feel some soreness in the blood vessel where your doctor put the catheter.

What Is an Electrocardiogram?

An electrocardiogram (e-lek-tro-KAR-de-o-gram), or EKG, is a simple, painless test that records the heart's electrical activity. To understand
this test, it helps to understand how the heart works.

With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the signal causes the heart to contract
and pump blood. The process repeats with each new heartbeat. The heart's electrical signals set the rhythm of the heartbeat.

An EKG shows:
  How fast your heart is beating

 Whether the rhythm of your heartbeat is steady or irregular

 The strength and timing of electrical signals as they pass through each part of your heart

This test is used to detect and evaluate many heart problems, such as heart attack, arrhythmia (ah-RITH-me-ah), and heart failure. EKG
results also can suggest other disorders that affect heart function.

EKGs also are used to monitor how the heart is working. This article focuses on how EKGs are used for testing purposes.

What Is Echocardiography?

Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart.

The test gives your doctor information about the size and shape of your heart and how well your heart's chambers and valves are working.
Echo also can be done to detect heart problems in infants and children.

The test also can identify areas of heart muscle that aren't contracting normally due to poor blood flow or injury from a previous heart attack.
In addition, a type of echo called Doppler ultrasound shows how well blood flows through the chambers and valves of your heart.

Echo can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta.
The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Revised August

What Is Coronary Angiography?

Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the inside of your coronary arteries. The
coronary arteries supply oxygen-rich blood to your heart.

A material called plaque (plak) can build up on the inside walls of the coronary arteries, causing them to narrow. When this happens, it's
called coronary heart disease (CHD) or coronary artery disease.

CHD can prevent enough blood from flowing to your heart and can lead to angina (an-JI-nuh or AN-juh-nuh) and heart attack. (Angina is
chest pain or discomfort.) Coronary angiography shows whether you have CHD.

Most of the time, the coronary arteries can't be seen on an x ray. During coronary angiography, special dye is injected into the bloodstream
to make the coronary arteries show up on an x ray.

A procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun) is used to get the dye to your coronary arteries. A long, thin, flexible tube
called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck.

What Is Cardiac MRI?

Magnetic resonance imaging (MRI) is a safe, noninvasive test that creates detailed pictures of your organs and tissues. "Noninvasive" means
that no surgery is done and no instruments are inserted into your body.

MRI uses radio waves, magnets, and a computer to create pictures of your organs and tissues. Unlike computed tomography (to-MOG-ra-
fee) scans (also called CT scans) and standard x rays, MRI doesn't use ionizing radiation or carry any risk of causing cancer.

Cardiac MRI creates pictures of your heart as it's beating, producing both still and moving pictures of your heart and major blood vessels.
Doctors use cardiac MRI to get pictures of the beating heart and to look at its structure and function. These pictures can help them decide
how to treat people who have heart problems.

Cardiac MRI is a common test. It's used to diagnose and evaluate a number of diseases and conditions, including:

 Coronary heart disease, also called coronary artery disease

 Damage caused by a heart attack

 Heart failure

 Heart valve problems

 Congenital heart defects

 Pericarditis (a condition in which the membrane, or sac, around your heart is inflamed)

 Cardiac tumors

Cardiac MRI can help explain results from other tests, such as x rays and CT scans. Sometimes, cardiac MRI is used to avoid the need for
invasive procedures or tests that use radiation (such as x rays) or dyes containing iodine (these dyes may be harmful to people who have
kidney problems).

Often during cardiac MRI, a contrast agent is injected into a vein to highlight portions of the heart or blood vessels. This contrast agent often
is used for people who are allergic to the dyes used in CT scanning.

People who have severe kidney or liver problems may not be able to have the contrast agent. As a result, they may have an MRI that doesn't
use the substance (a noncontrast MRI).

How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines, and medical procedures. The goals of treatments are
to:

 Relieve symptoms

 Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque

 Lower the risk of blood clots forming, which can cause a heart attack

 Widen or bypass clogged arteries

  Prevent complications of CAD

Lifestyle Changes

Making lifestyle changes can often help prevent or treat CAD. For some people, these changes may be the only treatment needed:

 Follow a heart healthy eating plan to prevent or reduce high blood pressure and high blood cholesterol and to maintain a healthy
weight

 Increase your physical activity. Check with your doctor first to find out how much and what kinds of activity are safe for you.

 Lose weight, if you're overweight or obese.

 Quit smoking, if you smoke. Avoid exposure to secondhand smoke.

 Learn to cope with and reduce stress.

Follow a Heart Healthy Eating Plan

For a heart healthy eating plan, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site
provides practical tips on healthy eating, physical activity, and controlling your weight.

Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high cholesterol. TLC is a three-part program that
includes a healthy diet, physical activity, and weight management.

With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is mainly found in meat and
poultry, including dairy products. No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans,
monounsaturated, and polyunsaturated fats.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can
be found on the Nutrition Facts label.

Foods high in soluble fiber also are part of a healthy eating plan. They help block the digestive track from absorbing cholesterol. These foods
include:

 Whole grain cereals such as oatmeal and oat bran

 Fruits such as apples, bananas, oranges, pears, and prunes

 Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

A diet high in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant
stanols or sterols, work like soluble fiber.

Fish are an important part of a heart healthy diet. They're a good source of omega-3 fatty acids, which may help protect the heart from blood
clots and inflammation and reduce the risk for heart attack. Try to have about two fish meals every week. Fish high in omega-3 fats are
salmon, tuna (canned or fresh), and mackerel.
You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-sodium and low-salt foods and "no added salt"
foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit alcoholic drinks. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the
blood.) Alcohol also adds extra calories, which will cause weight gain. Men should have no more than two alcoholic drinks a day. Women
should have no more than one alcoholic drink a day.

See the NHLBI's "Your Guide to Lowering Your Cholesterol With TLC" for more information.

Dietary Approaches to Stop Hypertension (DASH) eating plan. Your doctor may recommend the DASH eating plan if you have high

blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in
salt/sodium.

This eating plan is low in fat and cholesterol. It also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH
eating plan is reduced in red meat (including lean red meat), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients,
protein, and fiber.

The DASH eating plan is a good heart healthy eating plan, even for those who don't have high blood pressure. See the NHLBI's "Your Guide
to Lowering Your Blood Pressure With DASH" for more information.

Increase Physical Activity

Regular physical activity can lower many CAD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight.
Physical activity also can lower your risk for diabetes and raise your levels of HDL cholesterol (the "good" cholesterol that helps prevent
CAD).

Check with your doctor about how much and what kinds of physical activity are safe for you. Unless your doctor tells you otherwise, try to get
at least 30 minutes of moderate-intensity activity on most or all days of the week. You can do the activity all at once or break it up into shorter
periods of at least 10 minutes each.

Moderate-intensity activities include brisk walking, dancing, bowling, bicycling, gardening, and housecleaning.

More intense activities, such as jogging, swimming, and various sports, also may be appropriate for shorter periods. See the NHLBI's "Your
Guide to Physical Activity and Your Heart" for more information.

Maintain a Healthy Weight

Maintaining a healthy weight can decrease risk factors for CAD. If you're overweight, aim to reduce your weight by 7 to 10 percent during
your first year of treatment. This amount of weight loss can lower your risk for CAD and other health problems.

After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25.

BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29 is considered
overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CAD.
You can calculate your BMI using the NHLBI's online calculator, or your health care provider can calculate your BMI.

For more information on losing weight and maintaining your weight, see the Diseases and Conditions Index Overweight and Obesity article.

Quit Smoking

If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for CAD. Talk to your doctor about
programs and products that can help you quit. The U.S. Department of Health and Human Services also has information on how to quit
smoking.

You also should avoid exposure to secondhand smoke.

Reduce Stress

Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving
anger. Also, some of the ways people cope with stress, such as drinking, smoking, or overeating, aren't heart healthy.

Physical activity can help relieve stress and reduce other CAD risk factors. Many people also find that meditation or relaxation therapy helps
them reduce stress.

Medicines

You may need medicines to treat CAD if lifestyle changes aren't enough. Medicines can:

 Decrease the workload on your heart and relieve CAD symptoms

 Decrease your chance of having a heart attack or dying suddenly

 Lower your cholesterol and blood pressure

 Prevent blood clots

 Prevent or delay the need for a special procedure (for example, angioplasty or coronary artery bypass grafting (CABG))

Medicines used to treat CAD include anticoagulants (AN-te-ko-AG-u-lants), aspirin and other antiplatelet (an-ty-PLAYT-lit) medicines, ACE
inhibitors, beta blockers, calcium channel blockers, nitroglycerin, glycoprotein IIb-IIIa, statins, and fish oil and other supplements high in
omega-3 fatty acids.

Medical Procedures

You may need a medical procedure to treat CAD. Both angioplasty and CABG are used as treatments.

Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is
threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward
against the wall of the artery. This widens the artery and restores the flow of blood.
Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube
called a stent is placed in the artery to keep it open after the procedure.

In CABG, arteries or veins from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can
improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

You and your doctor can discuss which treatment is right for you.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after CABG, angioplasty, or a heart attack. Cardiac rehab, when
combined with medicine and surgical treatments, can help you recover faster, feel better, and develop a healthier lifestyle. Almost everyone
with CAD can benefit from cardiac rehab.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians, and psychologists
or other behavioral therapists.

Rehab has two parts:

 Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your
exercise plan will be based on your individual abilities, needs, and interests.

 Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your
risk for future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle
and with your fears about the future.

How Can Coronary Artery Disease Be Prevented or Delayed?

Taking action to control your risk factors can help prevent or delay coronary artery disease (CAD). Your chance of developing CAD goes up
with the number of risk factors you have.

Making lifestyle changes and taking prescribed medicines are important steps. See "How Is Coronary Artery Disease Treated?" for
information on heart healthy eating plans, physical activity, maintaining a healthy weight, and medicines.

Know your family history of health problems related to CAD. If you or someone in your family has CAD, be sure to tell your doctor. Also, let
your doctor know if you smoke.
 The animation shows how the heart's electrical signal starts in a place in the right atrium other than the sinoatrial node, causing the atria to
beat very fast and irregularly.

In AF, electrical signals can travel through the atria at a rate of more than 300 per minute. Some of these abnormal electrical signals can
travel to the ventricles, causing them to beat too fast and with an irregular rhythm. AF usually isn't life threatening, but it can be dangerous
when it causes the ventricles to beat very fast.

The two most serious complications of chronic (long-term) AF are stroke and heart failure. Stroke can happen if a blood clot travels to an
artery in the brain, blocking off blood flow.

In AF, blood clots can form because some of the blood "pools" in the fibrillating atria instead of flowing into the ventricles. If a piece of a blood
clot in the left atrium breaks off, it can travel to the brain, causing a stroke. People who have AF often are treated with blood-thinning
medicines to lower their risk for blood clots.

Heart failure is when the heart can't pump enough blood to meet the body's needs. AF can cause heart failure if the ventricles beat too fast
and don't have enough time to fill with blood to pump out to the body. Heart failure causes fatigue (tiredness), leg swelling, and shortness of
breath.

AF and other supraventricular arrhythmias can occur for no apparent reason. But most of the time, an underlying condition that damages the
heart muscle and its ability to conduct electrical impulses causes AF. These conditions include high blood pressure, coronary heart disease
(also called coronary artery disease), heart failure, and rheumatic heart disease.
Other conditions also can lead to AF, including an overactive thyroid gland (too much thyroid hormone produced) and heavy alcohol use. AF
also becomes more common as people get older.

Atrial Flutter

Atrial flutter is similar to AF, but instead of the electrical signals spreading through the atria in a fast and irregular rhythm, they travel in a fast
and regular rhythm.

Atrial flutter is much less common than AF, but it has similar symptoms and complications.

Paroxysmal Supraventricular Tachycardia

PSVT is a very fast heart rate that begins and ends suddenly. PSVT occurs due to problems with the electrical connection between the atria
and the ventricles.

In PSVT, electrical signals that begin in the atria and travel to the ventricles can reenter the atria, causing extra heartbeats. This type of
arrhythmia usually isn't dangerous and tends to occur in young people. It can happen during vigorous exercise.

A special type of PSVT is called Wolff-Parkinson-White syndrome. WPW syndrome is a condition in which the heart's electrical signals travel
along an extra pathway from the atria to the ventricles.

This extra pathway disrupts the timing of the heart's electrical signals and can cause the ventricles to beat very fast. This type of arrhythmia
can be life threatening.

The animation below shows Wolff-Parkinson-White syndrome. Click the "start" button to play the animation. Written and spoken explanations
are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below
the buttons to move through the frames.
 The animation shows how an extra, abnormal electrical pathway in the heart disrupts the normal timing of the heart's electrical signal,
causing the atria and ventricles to beat too fast.

Ventricular Arrhythmias

These arrhythmias start in the ventricles. They can be very dangerous and usually need medical attention right away.

Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary heart disease, heart attack, weakened
heart muscle, and other problems can cause ventricular arrhythmias.

Ventricular Tachycardia

Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer.

A few beats of ventricular tachycardia often don't cause problems. However, episodes that last for more than a few seconds can be
dangerous. Ventricular tachycardia can turn into other, more dangerous arrhythmias, such as v-fib.

Ventricular Fibrillation

V-fib occurs when disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood
out to the body, you'll lose consciousness within seconds and die within minutes if not treated.

To prevent death, the condition must be treated right away with an electric shock to the heart called defibrillation (de-fib-ri-LA-shun).
V-fib may happen during or after a heart attack or in someone whose heart is already weak because of another condition. Health experts
think that most of the sudden cardiac deaths that occur every year (about 335,000) are due to v-fib.

The animation below shows ventricular fibrillation. Click the "start" button to play the animation. Written and spoken explanations are
provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the
buttons to move through the frames.

The animation shows how disorganized electrical signals in the heart's ventricles can cause them to pump abnormally and quiver.

Torsades de pointes (torsades) is a type of v-fib that causes a unique pattern on an EKG (electrocardiogram). Certain medicines or
imbalanced amounts of potassium, calcium, or magnesium in the bloodstream can cause this condition.

People who have long QT syndrome are at higher risk for torsades. People who have this condition need to be careful about taking certain
antibiotics, heart medicines, and over-the-counter medicines.

Bradyarrhythmias

Bradyarrhythmias are arrhythmias in which the heart rate is slower than normal. If the heart rate is too slow, not enough blood reaches the
brain. This can cause you to lose consciousness.

In adults, a heart rate slower than 60 beats per minute is considered a bradyarrhythmia. Some people normally have slow heart rates,
especially people who are very physically fit. For them, a heartbeat slower than 60 beats per minute isn't dangerous and doesn't cause
symptoms. But in other people, bradyarrhythmia can be due to a serious disease or other condition.

Bradyarrhythmias can be caused by:

  Heart attack

 Conditions that harm or change the heart's electrical activity, such as an underactive thyroid gland or aging

 An imbalance of chemicals or other substances, such as potassium, in the blood

 Some medicines, such as beta blockers

Bradyarrhythmias also can happen as a result of severe bundle branch block. Bundle branch block is a condition in which an electrical signal
traveling down either or both of the bundle branches is delayed or blocked.

When this happens, the ventricles don't contract at exactly the same time, as they should. As a result, the heart has to work harder to pump
blood to the body. The cause of bundle branch block often is an existing heart condition.

Arrhythmias in Children

A child's heart rate normally decreases as he or she gets older. A newborn's heart beats between 95 to 160 times a minute. A 1-year-old's
heart beats between 90 to 150 times a minute, and a 6- to 8-year-old's heart beats between 60 to 110 times a minute.

A baby or child's heart can beat faster or slower than normal for many reasons. Like adults, when children are active, their hearts will beat
faster. When they're sleeping, their hearts will beat slower. Their heart rates can speed up and slow down as they breathe in and out. All of
these changes are normal.

Some children are born with heart defects that cause arrhythmias. In other children, arrhythmias can develop later in childhood. Doctors use
the same tests to diagnose arrhythmias in children and adults.

Treatments for children who have arrhythmias include medicines, defibrillation (electric shock), surgically implanted devices that control the
heartbeat, and other procedures that fix abnormal electrical signals in the heart

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA can make you
faint and it can cause death if it’s not treated right away.

For more information, see the animations in "Types of Arrhythmia."