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CAD is a progressive condition, and symptoms may not appear for some time. It is possible to not know you have CAD until the condition has significantly progressed and complications appear. Over time, CAD may lead to:

Angina

Angina is the most common symptom of CAD. It is described as chest pain or discomfort with a squeezing or pressure-like quality, usually felt behind the breastbone, but sometimes felt in the shoulders, arms, neck, jaws, or back. Angina is an indicator that your heart is not getting all the oxygen it needs to keep working at its optimal level. People who have angina are at an increased risk of having a heart attack .

Types of angina include:

  • Stable angina or angina pectoris —The attacks are predictable, and the triggers that cause them can be identified. They do not occur when you are resting or relaxed, and symptoms will usually disappear after a few minutes of rest.
  • Unstable angina —The symptoms are less predictable. Chest pain may occur while resting or even sleeping (nocturnal angina), and the discomfort may last longer and be more intense. Stable angina becomes unstable when symptoms occur more frequently, last longer, or occur more easily. You should call your doctor immediately if you experience symptoms at rest, or a worsening pattern of symptoms.
  • Variant or Prinzmetal angina —This is usually caused by the spasm of a coronary vessel. It occurs when you are at rest and often in the middle of the night. It can be quite severe and in some cases associated with arrhythmias .
  • Microvascular angina —Caused by spasms in the smallest arterial vessels of the heart. Spasms cause a decrease in the heart's blood supply leading to chest pain.

Angina: Most Common Areas of Pain


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Complications

CAD can eventually lead to severe complications such as:

  • Heart attack —Blood flow to the heart is completely blocked in one or more of the coronary arteries that supply the heart muscle.
  • Stroke —Blood flow to the brain is completely blocked in one or more arteries that supply the brain with oxygen.
  • Heart arrhythmias —Irregular heartbeats feel like palpitations or flutters, and indicate problems with the heart's electrical circuit. They can also lead to sudden cardiac arrest .
  • Heart failure —A progressive condition in which the heart cannot pump enough blood to meet the needs of the body. Symptoms of heart failure include shortness of breath and swelling of ankles, feet, or abdomen.

Heart Attack Symptoms


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Differences Between Angina and a Heart Attack

Having angina, especially for the first time, may be frightening. People may mistake it for having a heart attack or mistakenly think it is heartburn . A stable pattern of angina does not necessarily mean a heart attack is about to occur. Some differences include:

  • Duration of pain —In general, anginal pain lasts for only a few minutes and is relieved by rest or nitroglycerin, a medication that increases blood flow to the heart. Heart attack pain may last longer, or may subside and return. There may also be a change in the general pattern of the stable angina you are used to.
  • External factors —Anginal pain is often brought on by exercise or activity, emotional tension, dreams, cold or windy weather, low blood sugar, or even eating. Your symptoms can subside when you alter the behavior or environmental trigger. Heart attack pain will usually not subside with rest and may be accompanied by other symptoms such as shortness of breath, nausea, or sweating. Women, the elderly, or people with diabetes may have less typical or more subtle symptoms signaling angina or heart attack. Some people may have silent ischemia and experience no symptoms at all.

Note of Caution

If you experience chest pain that is new, worsening, or persistent, call for emergency medical services right away . Do not try to determine for yourself if the pain is due to angina, a heart attack, or some less serious condition. Do not drive yourself to the hospital. Heart attacks can cause severe, permanent damage to the heart, or death. Seeking help quickly is important because some of the most effective treatments to increase survival and recovery are ideally given within the first hour after symptoms begin. Emergency medical service personnel give these treatments while on the way to the hospital. About half of all deaths due to heart attack happen within one hour of the start of symptoms, often before a person gets to the hospital.

Associated Conditions

Build up of plaque and damage to blood vessels rarely occurs in the heart's blood vessels alone. Blood vessel damage in other areas of the body may lead to other conditions such as:

  • Erectile dysfunction (ED) —ED is often caused by a blood flow problem in blood vessels of the penis. It may be an early sign of blood vessel problems that can exist throughout the body. ED has been found to precede CAD by an average of 2-3 years.
  • Peripheral artery disease (PAD) —Narrowing and obstruction of arteries outside of the heart and brain.
  • Chronic kidney disease —may often be caused by blood vessel damage.

These conditions are sometimes warning signs of blood vessel problems that contribute to CAD.

References:

Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed January 27, 2014.

Nascimento ER1, Maia AC, et al. Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence. Clinics (Sao Paulo). 2013;68(11):1462-1468.

Warning signs of a heart attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp. Updated January 15, 2014. Accessed January 27, 2014.

What are the signs and symptoms of coronary heart disease? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs.html. Updated August 23, 2013. Accessed January 27, 2014.



Last reviewed September 2013 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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