Coronary artery disease (narrowing of the arteries)

To diagnose coronary artery disease, a health care provider will examine you. You'll likely be asked questions about your medical history and any symptoms. Blood tests are usually done to check your overall health.

Tests

Test to help diagnose or monitor coronary artery disease include:

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. It can show how fast or slow the heart is beating. Your provider can look at signal patterns to determine if you're having or had a heart attack.

Echocardiogram. This test uses sound waves to create pictures of the beating heart. An echocardiogram can show how blood moves through the heart and heart valves.

Parts of the heart that move weakly may be caused by a lack of oxygen or a heart attack. This may be a sign of coronary artery disease or other conditions.

Exercise stress test. If signs and symptoms occur most often during exercise, your provider may ask you to walk on a treadmill or ride a stationary bike during an ECG. If an echocardiogram is done while you do these exercises, the test is called a stress echo. If you can't exercise, you might be given medications that stimulate the heart like exercise does.

Nuclear stress test. This test is similar to an exercise stress test but adds images to the ECG recordings. A nuclear stress test shows how blood moves to the heart muscle at rest and during stress. A radioactive tracer is given by IV. The tracer helps the heart arteries show up more clearly on images.

Heart (cardiac) CT scan. A CT scan of the heart can show calcium deposits and blockages in the heart arteries. Calcium deposits can narrow the arteries.

Sometimes dye is given by IV during this test. The dye helps create detailed pictures of the heart arteries. If dye is used, the test is called a CT coronary angiogram.

Cardiac catheterization and angiogram. During cardiac catheterization, a heart doctor (cardiologist) gently inserts a flexible tube (catheter) into a blood vessel, usually in the wrist or groin. The catheter is gently guided to the heart. X-rays help guide it. Dye flows through the catheter. The dye helps blood vessels show up better on the images and outlines any blockages.

If you have an artery blockage that needs treatment, a balloon on the tip of the catheter can be inflated to open the artery. A mesh tube (stent) is typically used to keep the artery open.

Treatment for coronary artery disease usually involves lifestyle changes such as not smoking, eating healthy and exercising more. Sometimes, medications and procedures are needed.

Medications

There are many drugs available to treat coronary artery disease, including:

Cholesterol drugs. Medications can help lower bad cholesterol and reduce plaque buildup in the arteries. Such drugs include statins, niacin, fibrates and bile acid sequestrants.

Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in some people.

Daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Don't start taking a daily aspirin without talking to your health care provider.

Beta blockers. These drugs slow the heart rate. They also lower blood pressure. If you've had a heart attack, beta blockers may reduce the risk of future attacks.

Calcium channel blockers. One of these drugs may be recommended if you can't take beta blockers or beta blockers don't work. Calcium channel blockers can help improve symptoms of chest pain.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These medicines lower blood pressure. They may help keep coronary artery disease from getting worse.

Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain. Nitroglycerin is available as a pill, spray or patch.

Ranolazine. This medication may help people with chest pain (angina). It may be prescribed with or instead of a beta blocker.

Surgeries or other procedures

Coronary artery stent

Coronary artery stentOpen pop-up dialog boxCoronary bypass surgery

Coronary bypass surgeryOpen pop-up dialog box

Sometimes, surgery is needed to fix a blocked artery. Some options are:

Coronary angioplasty and stent placement. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). The heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow.

A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents slowly release medication to help keep the arteries open.

Coronary artery bypass graft surgery (CABG). A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. CABG is an open-heart surgery. It's usually done only in those with many narrowed heart arteries