Living with Coronary Artery Disease

The most common type of heart disease in the United States is coronary artery disease (CAD), according to the Centers for Disease Control and Prevention (CDC). It affects 1 in 20 Americans aged 20 and older.

“Coronary artery disease is when plaque builds up on the walls of the arteries that supply blood to your heart, due to high cholesterol and high inflammation,” Farouc Jaffer, MD, PhD, explains. Dr. Jaffer is a Mass General Brigham interventional cardiologist who cares for patients at Massachusetts General Hospital.

Plaque is made up of cholesterol, fat, cells, and other substances. As the buildup of plaque narrows the arteries, blood flow to the heart can be reduced. This can lead to chest pain, known as angina, and even heart failure. If the arteries become fully blocked, you could be at risk for heart attack or sudden death.

Coronary artery disease can have serious effects on your health, and if you’ve been diagnosed with CAD, it’s easy to feel overwhelmed. Fortunately, if you follow the treatment plan from your care team and make healthy lifestyle changes, you can manage the condition and improve your health. Learn more about living with coronary artery disease.

Follow your coronary artery disease treatment plan.

Take prescription medications to manage coronary artery disease.

Your care team may prescribe you a variety of medications to treat your coronary artery disease. These may include statins to lower cholesterol, and drugs to control high blood pressure (hypertension), diabetes, high triglycerides (a type of fat that circulates in the blood), and inflammation.

Talk to your health care care team about interventional or surgical procedure options.

Minimally-invasive or surgical procedures to treat coronary artery disease may include:

• Angioplasty: A small balloon is used to widen narrowed arteries.

• Stent placement: A small mesh tube is inserted into an artery to hold it open.

• Coronary artery bypass graft: A surgeon uses a blood vessel from elsewhere in the body to reroute blood through the heart.

Manage other chronic health conditions.

Certain chronic conditions may contribute to coronary artery disease, like cancer, diabetes, or lung or kidney disease. Making sure these other conditions are managed can help improve your overall health. Mass General Brigham specializes in multidisciplinary, coordinated care of multiple conditions. PCPs collaborate closely with other specialists on your team to efficiently manage the chronic conditions affecting your health.

Cardiac rehabilitation for coronary artery disease

Depending on your symptoms, your care team may recommend a cardiac rehabilitation program. These programs are designed to help you recover from a heart attack, heart failure, or other heart problems that require medical care or surgery. A cardiac rehabilitation program provides you with a dedicated team that includes your existing care team, nutrition and exercise specialists, counsellors, and physical therapists. These specialists will help guide you through physical activity, provide education on living a healthy lifestyle, and offer tips on how to manage stress and improve your mental health.

Living with complex coronary artery disease

“Complex coronary artery disease occurs when people have a more complicated form of the condition or have other conditions that make it more difficult to treat,” Dr. Jaffer says.

He explains, “In certain situations, treatment of complex coronary artery disease requires more specialized stenting or surgical procedures.” One example is a procedure called percutaneous coronary intervention, or PCI. In a PCI procedure, a thin tube called a catheter is inserted into the wrist or groin to place a stent in the heart. 

Dr. Jaffer specializes in treating a type of complex coronary artery disease called chronic total occlusion (CTO), where the arteries become completely blocked. Coronary artery bypass surgery used to be the only way to treat these blockages, but improvements in CTO stenting have made those procedures an effective option for treatment as well. 

Because complex coronary artery disease requires more advanced, specialized care, Dr. Jaffer and the experts at Mass General Brigham take a multidisciplinary approach. Interventional cardiologists and cardiac surgeons work closely together, in collaboration with your existing care team, to develop individualized treatment plans.

“We will review your medical history, symptoms, and test results together in great detail. We will ask you about your activity and life goals to design a personalized treatment plan for you,” confirms Dr. Jaffer.

Get support for dealing with coronary artery disease.

Mental health is another important element of living with coronary artery disease. Dealing with a medical condition like CAD can result in feelings of sadness, worry, stress, and anger. Uncontrolled stress or an emotional event can even cause broken heart syndrome, or Takotsubo cardiomyopathy, where people feel heart attack symptoms.

If you need help managing stress, or are experiencing anxiety or depression, talk to your PCP or other members of your care team. They may refer you to speak with a counselor or other mental health care provider. Medications for anxiety or depression may also help.

You don’t have to face your CAD diagnosis alone. Share your diagnosis with friends and family, keep them updated, and ask for help if you need it. Your local area may also have patient support groups for patients with heart disease. It may be helpful to connect with other people going through a similar experience.

Know when to seek further help or emergency care for coronary artery disease.

The most common symptom of coronary artery disease is chest pain or discomfort (angina). Many other people don’t experience symptoms, and aren’t diagnosed with coronary artery disease until they have a heart attack, according to the CDC.

Trust your instincts and call 9-1-1 if you think you may be having a heart attack or medical emergency. Signs and symptoms may include:

• Angina, tightness, or pressure

• Pain or pressure in the neck, shoulder, arm, or back

• Worsening shortness of breath

• Weakness or dizziness

• Nausea or abdominal pain and cramping (for women)

• Sweating

What questions should I ask my doctor about coronary artery disease?

You may have lot of questions after you’ve been diagnosed with CAD. Bring a list of questions with you when you see your doctor, so that you don’t forget to ask anything that’s important to you.

Some questions you might consider asking about CAD:

• What’s causing my CAD? How blocked are my arteries? How will the blockages be monitored over time?

• What is my risk of having a heart attack, and what can I do to prevent one? When should I seek emergency medical attention?

• What symptoms should I be keeping an eye on? When should I notify your office if I see change?

• What medications might be right for me? When would a procedure or surgery be recommended?

• Are there any over-the-counter medications that might interact with my prescription medications?

• Do I have any activity restrictions I should be aware of, whether it’s a type of exercise, daily activities, or sex?

• Are there any patients support groups or other resources I should be aware of?

Coronary artery disease requires careful management and adjusting your lifestyle. But by following your treatment plan and working closely with your providers, you can prevent it from getting worse and improve your health.